SO-1003P Benefits Update Form

Page 2 of 5

{Index benefits summary only – Private industry}

National Compensation Survey

Employment Cost Index

Month Year Update

BIN - XXXXXXXX

Thank you for your assistance with the Employment Cost Index (ECI). Please supply individual wages, including commissions and production bonus payments, for each worker currently in the listed occupations within one week. Include scheduled changes effective before the reference date of Month 12, Year. Document any significant changes in numbers of workers or wages since your last report. We appreciate your continued assistance with this important program.

There are several reporting options available:

• Secure file transfer over the internet - https://blscompdata.bls.gov/NCSLite/

• Fax the completed form to 999-999-9999

• Email to ^{BLSCompdata@bls.gov}

• Mail a printed report or the completed form

As a participant in a Bureau of Labor Statistics (BLS) statistical survey, you should be aware that use of electronic transmittal methods in reporting data to the BLS involves certain inherent risks to the confidentiality of those data. Further, you should be aware that responsible electronic transmittal practices employed by the BLS cannot completely eliminate those risks. The BLS is committed to the responsible treatment of the data you report and will take appropriate steps within its ability to protect the confidentiality of those data.

Data can be reported in any standard form, but be sure to include your BIN#, XXXXXXX, on any reports or emails.

If you have any questions, please contact: Xxxxxx Xxxxxx at 999-999-8888.

Please correct name, title, or address as needed.

Prepared by: Title: Telephone:

Date Prepared:

Respondent Name Respondent Title Company Name Company Name 2

Address 1

Address 2 City, ST Zip

BIN - XXXXXXXX

As entered by the regional office.

The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law In accordance with the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3572) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.

This report is authorized by law, 29 U.S.C. 2. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate and timely.

Form Approved O.M.B. #1220-0164 Expires XX/XX/XXXX

We estimate that it will take an average of 20 minutes to complete this form, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect of this survey; including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working Conditions at BLS_PRA_Public@bls.gov. You are not required to respond to the collection of information unless it displays a currently valid OMB control number.

WK Work Schedule Full Time: 8 hours a day, 40 hours a week, 52 weeks a year Overtime Premium Pay Non-exempt: Premium 1.5x Average Annual Hours: Clerical: 88 Vacation After 1 year - 1 week After 2 years - 2 weeks After 5 years - 3 weeks Salespeople are paid based on their last 6 month average 2022 Expenditure: $25,760 paid out for 6 salespeople 2023 Expenditure: 2023 Gross Payroll: Holidays Store is closed on Easter, Thanksgiving Day, and Christmas Day Unpaid for Salespeople Clerical & Warehouse receive 1.5x pay if they work on: Memorial Day Labor Day 4th of July How many people in those two positions work on those holidays?	Notes / Changes	b-XXXXX
		r-XXXXX
		p-XXXXX
		c-XXX
		p2 / 2023
	(NOTE: This is a computer-generated form that provides prior benefits data to, and requests updated benefits data from survey respondents)

Sick Leave Unpaid for Salespeople Clerical & Warehouse Supervisor receive 3 paid days and use all 3. Other Leave Can the employees use vacation for personal days? 07 Nonproduction Bonus 2023: $250 Christmas bonus Life Insurance Eligible after 60 days 100% employer paid $30,000 flat amount $5.40 a month, per employee; 2024 Rate = $______/Month Health Insurance Blue Cross Blue Shield, Elig after 60 days continued	Notes / Changes	b-XXXXX
		r-XXXXX
		p-XXXXX
		c-XXX
		p2 / 2023
	Expected to change 12/2023 Expected to change 3/2024

11 Health Insurance - continued Monthly Premiums ER EE EE 397.79 24.50 EE+Child 184.27 397.79 EE+Spouse 292.40 397.79 Family 305.76 397.79 Dental and Vision are 100% employee paid Which plan options are the employees in the selected positions participating? 23 Long Term Disability Elig: 1 year Pays 66% of earnings $5000 monthly maximum ($100 min) 100% employer paid $0.47 per $100 of payroll per month; 2024 Rate = _____/$100/Month 14 Defined Contribution Pension 401k eligibility is 1 year Employer matches 50% up to 5% How much does each employee in the selected positions contribute? 21 Workers' Compensation What is your worker's compensation rate? Premium Discount: Experience Modifier:	Notes / Changes	b-XXXXX
		r-XXXXXX
		p-XXXXX
		c-XXX
		p2 / 2023
	Expected to change 3/2024 Expected to change 3/2024