Finance and Public Finance and Public Pensions Forms

State Data Collection Website Instructions
I.

Logging In
a. In Browser, navigate to website
https://statecollection.census.gov/SDCHome.aspx

b. Select state from the drop down menu, then click ‘Go.’

1

c. The State homepage will then appear.

d. Enter userID (lowercase letters only) and password. See section c if this is the
first time logging into the system.
Note: UserID provided in the initial notification letter.

2

e. If it is your first time logging into the system, click ‘Forgot Password’ to create a
password for the account.

f. Enter UserID and Email address associated with the account and click ‘Reset
Password’.

g. Two emails will be sent to the email address associated with the account (from
Kristen.i.ricks@census.gov), one verifying the UserID and one containing a link
back to the website to create a new password.
3

Note: If emails are not received or an error message is received, please
contact the Census support staff at ewd.local.finance@census.gov.
h. After clicking on the link, create a password containing at least 12 characters
with one uppercase character, one lowercase character, a number, and a special
character (!, @, #, $, & are known acceptable special characters).
i. Confirm the password by re-entering it into the next space provided.
j. Click ‘Continue,’ which returns user to the home screen.
k. Enter UserID and newly created password.
l. Click ‘Login.’

4

II.

Download Survey
a. Select ‘2018 City Template’ to download the Annual Financial Report.

b. From the pop-up window, select ‘Open.’
Note: Depending on the browser, the result after clicking the template link will be
different. The below screenshot will appear if using Internet Explorer and a similar
pop-up window in Firefox.
Microsoft Edge will open the template as a read only browser window. You must
download the file and open in Excel for all functions to work properly.
Google Chrome will automatically download the template, showing up as a tab on a
bottom left tool bar. You must select that tab and open the template in Excel.

5

6

c. Once the template opens in Excel, enter your User Name and Password into the
highlighted fields.

d. Then, select the Verification tab.

7

e. Using the drop down arrow, select the appropriate community name from the
menu.

f. Save the template to your local hard drive. (Ex.: homer2018.xlxs)
g. Complete each tab of the template, Parts I – XI, and re-save to your local hard
drive.

8

III.

Upload Survey
a. Log in to the State Data Collection website using steps from Part I.
b. From the File Upload screen – Step 2, select Browse to find the completed
Annual Financial Report on your local hard drive.

c. Once the completed file has been selected from the hard drive and the Filename
field is populated, select Upload File.

9

d. You will receive a notification once file has successfully uploaded.

e. Click ‘Log Out.’

10

State Data Collection Website Instructions
I.

Logging In

a. In Browser, navigate to website
https://statecollection.census.gov/SDCHome.aspx

b. Select state from the drop down menu, then click ‘Go.’

1

c. The State homepage will then appear.

d. Enter userID (lowercase letters only) and password. See section c if this is the
first time logging into the system.
Note: UserID provided in the initial notification letter.

2

e. If it is your first time logging into the system, click ‘Forgot Password’ to create a
password for the account.

f. Enter UserID and Email address associated with the account and click ‘Reset
Password’.

3

g. Two emails will be sent to the email address associated with the account (from
Kristen.i.ricks@census.gov), one verifying the UserID and one containing a link
back to the website to create a new password.
Note: If emails are not received or an error message is received, please
contact the Census support staff at ewd.local.finance@census.gov.
h. After clicking on the link, create a password containing at least 12 characters
with one uppercase character, one lowercase character, a number, and a special
character (!, @, #, $, & are known acceptable special characters).
i. Confirm the password by re-entering it into the next space provided.
j. Click ‘Continue,’ which returns user to the home screen.
k. Enter UserID and newly created password.
l. Click ‘Login.’

4

II.

Download Survey
a. Select ‘2018 City Template’ to download the Annual Financial Report.

b. From the pop-up window, select ‘Open.’
Note: Depending on the browser, the result after clicking the template link will be
different. The below screenshot will appear if using Internet Explorer and a similar
pop-up window in Firefox.
Microsoft Edge will open the template as a read only browser window. You must
download the file and open in Excel for all functions to work properly.
Google Chrome will automatically download the template, showing up as a tab on a
bottom left tool bar. You must select that tab and open the template in Excel.

5

6

c. Once the template opens in Excel, enter your User Name and Password into the
highlighted fields.

d. Then, select the Verification tab.

7

e. Using the drop down arrow, select the appropriate community name from the
menu.

f. Save the template to your local hard drive. (Ex.: homer2018.xlxs)
g. Complete each tab of the template, Parts I – XI, and re-save to your local hard
drive.

8

III.

Upload Survey
a. Log in to the State Data Collection website using steps from Part I.
b. From the File Upload screen – Step 2, select Browse to find the completed
Annual Financial Report on your local hard drive.

c. Once the completed file has been selected from the hard drive and the Filename
field is populated, select Upload File.

9

d. You will receive a notification once file has successfully uploaded.

e. Click ‘Log Out.’

10

State Name

State # Code

Total taxes (reported)
Property taxes

T01

Sales and gross receipts
General sales and gross receipts

T09

Selective sales taxes
Alcoholic beverages

T10

Amusements

T11

Insurance premiums

T12

Motor fuels

T13

Public Utilities

T15

Tobacco products

T16

Total marijuana sales
(include recreational and medical, if
collected)

T17

Sports betting (including pari-mutuels)

T18

Other selective sales

T19

Licenses
Alcoholic beverages

T20

Amusements

T21

Corporation

T22

Hunting and fishing

T23

Motor vehicle

T24

Motor vehicle operators

T25

Amt 23

Amt 22

Amt 21

Marijuana Licenses

T26

Public utilties

T27

Occupation and business, NEC

T28

Other licenses

T29

Individual income

T40

Corporation net income

T41

Death and gift

T50

Documentary and stock transfer

T51

Severance

T53

Other

T99

Total taxes (calculated)

Report
State Government Tax Collections: 2023

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
WORKSHEET

2023 ANNUAL
SURVEY OF PUBLIC PENSION PLANS
Locally-Administered Defined Benefit Plans

F-11(04/13/2023)

OMB No. 0607-0585: Approval Expires 07/31/2024

November 7, 2023

WORKSHEET
DO NOT use this worksheet to respond to the survey. It is intended to assist you
with gathering and preparing your data prior to reporting online.

Need help or have
questions?
● Visit
https://www.census.gov/
programs-surveys/aspp/
information.html
● Call
1-800-832-2839 weekdays,
8AM to 5PM ET

Return to https://portal.cenus.gov when you are ready to report online.

Report Online - Do Not Return

DUE DATE:

-

GENERAL INSTRUCTIONS
Before filling out this survey, please read carefully each part and all related definitions and instructions.
Note especially:

1.

To complete this worksheet, you will need the Annual Comprehensive Financial Report (ACFR) for the retirement
system listed in the mailing address (Use the annual report if the retirement system does not have a ACFR).
Report figures for Defined Benefit plans only. Do not include Defined Contribution or other Postemployment
Benefit plans in the data.

3.

If you are including data for any retirement system(s) administered in addition to the system identified in
the address box above, list retirement system(s) in 23 , REMARKS section, at the end of the worksheet.

4.

Report corporate stocks and bonds at market value, and adhere to Governmental Accounting Standards Board
(GASB) guidelines when reporting gains and losses on investments.

5.

Report figures relating to all accounts and reserves of the system, including amounts for retirement, disability,
survivors’, and other benefits, as well as any amounts for administration of the system. Exclude transfers between
reserves of the system.

6.

Do not delay reporting to await finally audited figures, if substantially accurate figures can be supplied on a
preliminary basis.

Please continue on the next page

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2.

Page 2
Enter correct information for any errors in the mailing address below:

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1

Addressee Title or Department
ATTN:
Street 1

Street 2

City

PART 1

State

Zip Code

ENDING DATE OF FISCAL YEAR

(MM)

2

What is the retirement system’s fiscal year end date? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

What was the retirement system’s latest fiscal year end date
that occurred before July 1, 2023? Use this fiscal year data to
complete the remainder of this worksheet even though more recent
data may be available. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART 2
4

(MM)

(DD)

(DD)

(YYYY)

MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS

What was the total number of members of the retirement system during the fiscal year indicated in 3 ?
Number of
Members

Exclude
● Beneficiaries
A. Active members – Current contributors in contributory systems or employees
in non-contributory systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of
Members

1. Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Non-vested (on military or other extended leave only) . . . . . . . . . . . . . . . . . . . . . .

3. TOTAL – (Sum of items B1. through B2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet F-11

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B. Inactive members – Former employees and employees on military or other
extended leave without pay having retained retirement credits, but not currently
receiving retirement benefit payments.

Page 3
What was the total number of retirees and beneficiaries during the fiscal year indicated in 3 ?
Provide estimates if detailed data are not available.
Number of
Retirees/
Beneficiaries
A. Retirees and beneficiaries of system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART 3
6

RECEIPTS FOR DEFINED BENEFIT PLANS

What was the amount of receipts during the fiscal year indicated in 3 ?
Exclude
● Amounts received from sales of investments (should be reported in 7 )
● Amounts received from repayment of loans made to members

A. Employee contributions Amounts contributed by all
member employees or withheld from their salaries for
financing benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$Bil.

Employee Contributions
Mil.
Thou.
Dol.

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5

B. Employer (government) contributions
1. From parent local government(s)
Include
● Employer contributions from the government for
financing of benefits
$Bil.
● Parent government contributions or appropriations
for administration or other support of the system
● Local taxes credited directly to the system . . . . . . . . . . .

Employer (Government)
Contributions
Mil.
Thou.
Dol.

2. From state government
Include
● State aid
● Shared taxes received by the system from the state
government either directly or through the parent
local government
● Amounts received from other local governments on
behalf of their employees . . . . . . . . . . . . . . . . . . . . . . . .
C. Earnings on investments

Exclude
● Gains and losses on investment transactions
(should be reported in 7 )

$Bil.

Investment Earnings
Thou.
Mil.

Dol.

1. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Other investment earnings – Specify:

C

.....

4. TOTAL – (Sum of items C1. through C3.) . . . . . . . . . . . . . . .

Worksheet F-11

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Include
● Interest
● Dividends
● Rents
● Other earnings on investments

Page 4
What was the amount of net gains and losses on investments during the fiscal year indicated in 3 ?
Report losses as a negative value.
Gains and Losses
$Bil.

Mil.

Thou.

Dol.

Payments
Thou.

Dol.

A. Realized and unrealized gains or losses on
investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PART 4
8

PAYMENTS FOR DEFINED BENEFIT PLANS

What was the amount of payments during the fiscal year indicated in 3 ?
Exclude
● Amounts paid out for purchase of investments
and loans made to members

$Bil.

Mil.

A. Benefit payments – Report annual amounts . . . . . . . . . . . . . . .

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7

B. Withdrawals – Amounts paid to employees, former
employees, or their survivors, representing return of
contributions made by employees during the period of
their employment, and any interest on such amounts . . . . . . . .
C. Administrative expenses – Include costs related to the
administration and general operation of the pension
system, including but not limited to:
● Interest expense
● Actuary fees
● Directors/trustees fees and expenses
● Personnel costs (excluding investment managers)
● Rental costs
● Legal fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
D. Investment expenses – Include costs arising from
investment management, including, but not limited to:
● Internal investment management personnel costs
● Investment management fees (paid to external
asset managers)
● Trading expenses
● Legal fees (investment management related)
● Asset consultant fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PART 5

What was the total amount of cash and investments (at market value) held at the end of the fiscal
year indicated in 3 ?
A. Cash and short-term investments
Include
● Cash on hand
● Demand deposits
● Time or savings deposits
● Repurchase agreements
● Commercial company paper
● Bankers acceptances
● Money market mutual funds . . . . . . . . . . . . . . . . .
B. Long-term investments
Include
● Equities
● Fixed income
● Real property
● Other securities and investments . . . . . . . . . . . . .

$Bil.

Cash and Short-term
Investments
Mil.
Thou.

Dol.

$Bil.

Long-term Investments
Mil.
Thou.

Dol.

$Bil.

Cash and Investments
Mil.
Thou.

Dol.

C. TOTAL – (Sum of totals for items A. and B.) . . . . . . . . .
Worksheet F-11

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9

CASH AND INVESTMENTS FOR DEFINED BENEFIT PLANS

Page 5
PART 6

ACTUARIAL INFORMATION FOR DEFINED BENEFIT PLANS

10

Are actuarial data available for this plan?
Yes – Continue
No – Go to Part 7, Remarks
$Bil.

Total Pension Liability
Mil.
Thou.

11

What was the total pension liability (TPL) at the
. . . .year?
...........................
beginning of the fiscal

12

Below is a list of potential changes in the employer’s total pension liability.
Provide values for only those that apply for the fiscal year.

Dol.

$Bil.

Total Pension Liability
Mil.
Thou.

Dol.

$Bil.

Total Pension Liability
Mil.
Thou.

Dol.

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To complete this part, continue using the ACFR or annual report used to complete the previous parts
of the form. Use this report even though more recent data may be available.

A. Total service cost . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. Changes of benefit terms . . . . . . . . . . . . . . . . . . . . . .
C. Difference between expected and actual
experience and other adjustments . . . . . . . . . . . . . .

D. Changes of assumptions . . . . . . . . . . . . . . . . . . . . . .
E.

Benefit payments
Include
● Refunds of member contributions . . . . . . . . . . . . .

F.

Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

Total pension liability – ending . . . . . . . . . . . . . . . . . . . .

Worksheet F-11

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G. Other changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 6
PART 6

ACTUARIAL INFORMATION FOR DEFINED BENEFIT PLANS
Fiduciary Net Position
Mil.
Thou.

14

What is the fiduciary net position (FNP) for this
plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

Calculation of net pension liability (NPL) (Difference
of FNP reported in 14 and TPL reported in 13 ) . . . . . . . . . . .

16

Calculated ratio of financial net position (FNP)
to employer’s total pension liability (TPL) (FNP
reported in 14 divided by TPL reported in 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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$Bil.

Dol.

Actuarially Determined Contribution
$Bil.
Mil.
Thou.
Dol.
17

18

What is the actuarially determined contribution
amount for this plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$Bil.

Contribution Received
Mil.
Thou.

Dol.

$Bil.

Covered-Employee Payroll
Mil.
Thou.

Dol.

What were the contributions actually received in
relation to the actuarial determined contribution
for this plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19

What is the amount of covered-employee payroll
for this plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20

What is the current discount rate for this plan
(also called the investment rate of return)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

The table below asks about the sensitivity of net pension liability/(asset) to changes in the discount
rate for this plan. What is the amount of the net pension liability with a 1% decrease in the discount
rate? What is the amount of the net pension liability with a 1% increase in the discount rate?
One Percent Decrease

Current Rate

%

One Percent Increase

Net pension
liability

22

What was the actual money-weighted
rate of return (loss)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet F-11

%

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Rate

Page 7
PART 7

Use this space for any explanations that may be essential in understanding the reported data.
Include
● Any significant changes occurring within the last year
● Any difficulties encountered in completing this worksheet

PART 8
24

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23

REMARKS

CONTACT INFORMATION

Who should be contacted to answer questions about data reported on this survey?

Area code and phone number

Email Address

Title of contact person

Extension

Area code and fax number

Date completed
(MM)
(DD)

(YYYY)

Thank you for completing this survey.
Retain a copy of the completed report for your records.
NOTE: Title 13 United States Code (U.S.C.), Sections 161 and 182 authorizes the Census Bureau to conduct this collection. These data are subject to
provisions of Title 13, U.S.C., Section 9(b) exempting data that are customarily provided in public records from rules of confidentiality. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number is 0607-0585 and appears at
the upper right of this screen. Without this approval, we could not conduct this survey.
We estimate this survey will take an average of 2.5 hours to complete, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information.

Worksheet F-11

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Name of contact person

2022 ANNUAL
SURVEY OF STATE GOVERNMENT FINANCES
Finances of Insurance Trust Systems

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
(8-4-2010)

FORM

F-13

OMB No. 0607-0585: Approval Expires 07/31/2024

(12-01-2022)

DUE DATE:
February 17, 2023
RETURN TO:
ewd.state.finance@census.gov

Need help or have
questions?

Agency or Fund Name:

• Visit

census.gov/programs-surveys/
state.html

• Call

1-866-820-7210
weekdays, 7AM to 5PM ET

• Email
ewd.state.finance@census.gov

NOTE: Title 13 United States Code (U.S.C.), Sections 161 and 182 authorizes the Census Bureau to conduct this collection and to request your voluntary
assistance. These data are subject to provisions of Title 13, U.S.C., Section 9(b) exempting data that are customarily provided in public records from rules of
confidentiality. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems
that transmit your data.
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number is 0607-0585 and appears at the
upper right of this form. Without this approval, we could not conduct this survey.
Please note that this collection of information applies to governments with wide differences in the size of their service areas, the amount of population
served, and the extent and complexity of their activities. We estimate the time to complete this survey varies from 30 minutes to 2 hours, with an average of 1
hour, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: EWD Survey Comments 0607-0585, U.S.Census Bureau, 4600 Silver Hill Road, Room EWD-5K071, Washington, DC
20233. You may e-mail comments to ewd.state.finance@census.gov. Be sure to use EWD Survey Comments 0607-0585 as the subject.

GENERAL INSTRUCTIONS
Before filling out this form, please read carefully each part and all related definitions and instructions. Note especially:

§2.{0¤

1. Report figures for the system’s fiscal year which ended between October 1, 2021 and September 30, 2022.
2. Report figures relating to all accounts and reserves of the system, including amounts for retirement, disability, survivors,
and other benefits, as well as any amounts for administration of the system. Exclude transfers between reserves of the system,
and also any investment transactions relating to loans to system members.
3. Report in whole dollars.
4. PLEASE COMPLETE ALL ITEMS ON THE FORM. If some items do not apply to the system, do not leave them blank.
Mark these items with “None” or a dash in the reporting space provided.
5. Do not delay reporting to await finally audited figures, if substantially accurate figures can be supplied on a preliminary basis.

PART 1 – ENDING DATE OF FISCAL YEAR

1

Which one of the following indicates the ending date of the system’s fiscal year that ended
between October 1, 2021 and September 30, 2022? Use this fiscal year even though a more
recent one may be available. Mark "X" only one box.

2021

2022

October

January

April

July

November

February

May

August

December

March

June

September

Please continue on the next page

Page 2
PART 2 – RECEIPTS

2

What was the amount of receipts during the fiscal year indicated in 1 ?
A. Contributions other than from State government – Premiums,
assessments, or contributions collected from employers (other than
the State government) and from employees for financing benefits.
Include
• Amounts received from local governments and their
employees
• Amounts received from State government employees
• Dividends or return of excess premiums (report as a
deduction from total contributions)

Exclude
• Amounts received from State government
(should be reported in item B.)

$Bil.

Contributions
Mil.
Thou.

Dol.

B. Contributions from State government – Premiums
or contributions paid by the State government and State
institutions or agencies for financing benefits, and any
State government contributions or appropriations for
administration or other support of the system . . . . . . . .
C. Earnings on investments – Interest earnings on investment
securities, deposits, and other interest-bearing accounts.
Exclude
• Rentals from the State government

Include
• Accrued interest on investment securities sold
• Recorded profits on investment transactions (minus
any realized losses)
• Rentals
• Other earnings on investments

$Bil.

Mil.

Earnings
Thou.

Dol.

$Bil.

Other Receipts
Mil.
Thou.

Dol.

D. Other receipts (Exclude Receipts from sale of investments)
Specify and report other receipts:
1.

...

2.

...

3.

...

PART 3 – PAYMENTS

§2.{8¤

3

What was the amount of payments made during the fiscal year indicated in
$Bil.

12 ?

Payments
Mil.
Thou.

Dol.

A. Benefits – Amounts paid to, or on behalf of, insurance
beneficiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Other payments
Include
• Administrative expenses
• Recorded costs on investment transactions
• Other costs or payments not representing benefits
Specify and report other payments:

Exclude
• Purchase of investments
$Bil.

1.

...

2.

...

3.

...

Form F-13

Mil.

Thou.

Dol.

Please continue on the next page

Page 3
PART 4 – CASH AND INVESTMENTS HELD AT THE END OF FISCAL YEAR

4

What was the total amount of cash and investments (at market value) held by the system at the end
of the fiscal year indicated in 1 ?
Amount at End of Fiscal Year
$Bil.
Mil.
Thou.
Dol.
A. Cash and deposits – Cash on hand and demand, and
time or savings deposits . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Federal government securities – Obligations of the US
Treasury and Federal Financing Bank.
Include
• Short term notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Federal agency securities – Bonds and mortgage-backed
securities issued by CCC, Export-Import Bank, FHA, GNMA,
Postal Service, and TVA . . . . . . . . . . . . . . . . . . . . . . . . . . . .
D. Securities of State and local governments and their
agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E.

Other securities
1. Corporate bonds
Include
• Debentures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F.

2.

Corporate stocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Mortgages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Other --

Exclude -Real property . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL – (Sum of items A. through E.) . . . . . . . . . . . . . . . . .

PART 5 – REMARKS

§2.{@¤

5

Use this space for any explanations that may be essential in understanding the reported data.
Include --Any significant changes occurring within the last year OR difficulties encountered in completing this form

PART 6•– CONTACT INFORMATION
•
6
Who should be contacted to answer questions about data reported on this form?
Name of contact person - Please print

Area code and phone number

Email Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed (MM) (DD) (YYYY)

Department Website

Thank you for completing this form. Retain a copy of the completed questionnaire for your records.
Form F-13

Page 3
PART 3 – REVENUES - Continued
B. Local sales taxes
Include
• Taxes on goods and services, measured as a percent of sales or
receipts, or as an amount per unit sold (e.g., gallon, package, etc.)
• Only taxes imposed by this government
Exclude
• Shares of taxes imposed by another government (should be
reported in 5 )
1.

General sales and gross receipts taxes
Include
• Sales and use taxes
• Taxes applicable with only specified exceptions (e.g.,
food and prescribed medicines) to sales of all goods and
services or to all gross receipts, whether at a single rate
or at classified rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Tax Revenues
$Mil.

Thou.

Dol.

Alcoholic beverages sales tax
Include
• Taxes on sale of alcoholic beverages, whether collected
through government-operated liquor stores or through
private outlets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Amusements sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Motor fuels sales tax
Include
• Taxes on gasoline, diesel oil, aviation fuel, gasohol,
ethanol, and any other fuels used in motor vehicles
or aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Parimutuels tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

Public utilities sales tax
Include
• Taxes imposed distinctively on public utilities, and
measured by gross receipts, gross earnings, or units
of service sold, either as a direct tax on consumers
or as a percentage of gross receipts of utility
• Telephone, cable, and other telecom taxes (e.g., 911
taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

Tobacco products tax
Include
• Taxes on sale of tobacco products and synthetic-cigars
and cigarettes, including related products like cigarette
tubes and paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

Other sales tax – Specify: C
...

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Page 4

C. Licensing and permit taxes - (e.g., license and permit fees exacted (either for revenue raising or for
regulation) as a condition to the exercise of a business or nonbusiness privilege.)
Tax Revenues
$Mil.

1.

Alcoholic beverages licensing and permit taxes . . . . . . . . . . . .

2.

Amusements licensing and permit taxes . . . . . . . . . . . . . . . . . .

3.

Motor vehicles licensing and permit taxes. . . . . . . . . . . . . . . . .

4.

Public utilities licensing and permit taxes . . . . . . . . . . . . . . . . .

5.

Occupation and business licensing and permit taxes
(not reported above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

Other licensing and permit taxes – Specify: C

Thou.

Dol.

Report Online - Do Not Return

PART 3 – REVENUES - Continued

...
D. Local income taxes
1.

Local individual income taxes
Include
• Taxes on individuals measured by net income and
taxes on special types of income (e.g., interest,
dividends, income from intangible property, etc.)
Exclude
• Income tax distribution for revenue sharing from
the State or from other governments . . . . . . . . . . . . . . . . .

2.

Local corporation net income tax

E.

Report Online - Do Not Return

Include
• Taxes on corporations and unincorporated businesses
(when taxed separately from individual income),
measured by net income, whether on corporations in
general or on specific kinds of corporations, such as
financial institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other taxes
1.

Death and gift tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Documentary and stock transfer tax . . . . . . . . . . . . . . . . . . . . .

3.

Severance tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Other taxes – Specify: C

...
Worksheet F-28

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Page 6

6

What was the amount of revenues, other than tax and intergovernmental revenues, received by this
government during the fiscal year indicated in 2 ?
Include
• Revenues of all funds
Exclude
• Refunds and transfers between funds and accounts of this government
A. Utility sales revenues - Gross receipts of any water, electric, gas, or
transit systems operated by this government, from utility sales and charges.
Include
• Amounts received from the sale of utility commodities and
services to the Federal, State, or other local governments

Utility Sales Revenues
$Mil.

1.

Water supply system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Electric power system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Gas supply system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Transit or bus system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thou.

Dol.

Report Online - Do Not Return

PART 3 – REVENUES - Continued

B. Other sales and service revenues - Gross receipts from fees,
sales, rentals, tolls, maintenance assessments, and other charges
for commodities or services.
Exclude
• Utility receipts (should be reported in item A.)
• Amounts received from other governments (should be
reported in 5 )

Sewerage charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Refuse collection, disposal, and recycling charges. . . . . . . . . . .

3.

Parks and recreation charges (e.g., swimming, golf,
auditoriums, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Airports

Thou.

Dol.

Report Online - Do Not Return

1.

Other Revenues
$Mil.

Include
• Rentals and gross sales of gas and oil . . . . . . . . . . . . . . . .
5.

Hospital charges
Include
• Amounts received on behalf of individual patients under the
Medicare program or other insurance-type arrangements
Exclude
• Medicaid and the amounts for hospital purposes received
from other governments (should be reported in 5 ) . . . . .

6.

Parking facilities (e.g., lots, garages, meters, etc.) . . . . . . . . . . .

7.

Housing project rentals (gross) . . . . . . . . . . . . . . . . . . . . . . . . . .

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Page 7
PART 3 – REVENUES - Continued
8.

Highways and other roads
Include
• Bridges
• Tunnels
• Ferries

Other Revenues
$Mil.

Thou.

Dol.

(a) Operated on a fee or toll basis . . . . . . . . . . . . . . . . . . . . . .

(b) Other street and highway charges . . . . . . . . . . . . . . . . . . . .

9.

Sea and inland port facilities . . . . . . . . . . . . . . . . . . . . . . . .

10. Miscellaneous commercial activities directly operated by
this government (e.g., cemeteries, cable television,
telephone utilities, rail lines, etc.) . . . . . . . . . . . . . . . . . . . . .
11. Natural resources charges - Sale of minerals and other
natural products from public lands and revenue from
agricultural fairs and shows . . . . . . . . . . . . . . . . . . . . . . . . .
12. Other sales and service revenues - Specify:
➤

Include
• Miscellaneous fee collections

...
C. Special assessments - Compulsory contributions and
reimbursements from owners of property benefited by
improvements (e.g., streets, sewers, sidewalks, water
extensions, etc.) as well as for servicing special
assessment debt.
Exclude
• Proceeds from sales of special assessment bonds
(should be reported in 13 )
• Maintenance assessments (should be reported in item B.). . . . .
D. Receipts from sale of property and other capital assets
Include
• Property sold to other governments
Exclude
• Tax sales (should be reported in 4 ) . . . . . . . . . . . . . . . . . . . .

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Page 8

E.

Interest earnings - Interest received on all deposits and
investment holdings of this government and its agencies.
Include
• Interest on construction funds
Exclude
• Interest earnings of any employee pension funds . . . . . . . . . . .

F.

Other Revenues
$Mil.

Thou.

Dol.

$Mil.

Thou.

Dol.

Fines and forfeits - Receipts from penalties imposed for
violations of law and civil penalties . . . . . . . . . . . . . . . . . . . . . . . . .

G. Rents - Revenues from temporary possession or use of
government-owned buildings, land, and other properties . . . . . . . .
H. Royalties - Compensation or portion of proceeds from
extraction of natural resources (e.g., oil, gas, and
mineral rights) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I.

Private donations - Gifts of cash or securities from
private individuals or corporations . . . . . . . . . . . . . . . . . . . . . . .

J.

Miscellaneous other revenues - Revenues of this government
and its agencies not reported in items A. through I. or questions
4 through 5 .

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PART 3 – REVENUES - Continued

Include
• Insurance claims
• Recoveries of prior year expenditures
• Dividends
• Recorded profits from sale of investments
• Payments in lieu of taxes from private sources
Exclude
• Proceeds from borrowing
• Receipts from sale of security holdings
• Transfers between funds or accounts of this government
• Employee contributions to employee pension funds
• Interest earnings of any employee pension funds
Specify and report miscellaneous revenue:
...

2.

...

3.

...

4.

...

5.

...

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1.

Total Revenues
$Bil.

7

Mil.

Thou.

Dol.

What was the total amount of revenues reported on this
worksheet (Sum of 4 through 6 )?. . . . . . . . . . . . . . . . . . . . . .

Worksheet F-28

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Page 11

F.

Parks and recreation - Playgrounds; golf courses; swimming pools; museums; marinas; community music, drama,
festivals; zoos, and other cultural activities.
$Mil.

Thou.

Dol.

Current operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Capital outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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PART 4 – EXPENDITURES - Continued

G. Solid waste management - Street cleaning and the collection, recycling, and disposal of refuse and garbage.
$Mil.

Thou.

Dol.

Current operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Capital outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H. Sewerage - Construction, maintenance, and operation of sanitary and storm sewer systems and sewage disposal
plants.
$Mil.

Thou.

Dol.

$Mil.

Thou.

Dol.

Current operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Capital outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I.

Water supply system

Capital outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

J.

Hospitals - Construction and operation of hospitals by this government; payments to hospitals operated privately.
$Mil.

Thou.

Dol.

Current operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Capital outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Continue with 10 on the next page
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Current operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page 3

4

B. Please select the type(s) of natural resource functions this government performed during the fiscal
year indicated in question 2 . Select all that apply:
Conservation (Soil, Water, Land)
Drainage
Flood Control
Irrigation
Reclamation
Other Natural Resource Activities – Specify: C

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PART 3 – GOVERNMENT FUNCTION Continued

None of the above
C. Please select any of the following other functions this government performed during the fiscal year
indicated in question 2 . Select all that apply:
Fire Protection
Police Protection
Hospitals
Health (excluding hospitals)
Toll Highways
Highways (excluding tolls)
Parks and Recreation
None of the above

Other – Specify: C

Other – Specify: C

Other – Specify: C

Worksheet F-29

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D. Please specify any additional functions this government performed that were not listed in
4A, 4B or 4C.

Page 4

5

What was the amount of tax collections during the fiscal year indicated in 2 from all taxes imposed
by this agency?
Include
● Levies for debt service
● Levies for contributions to pension funds
● Levies for other funds or purposes
● Special property taxes (e.g., automobiles or intangible property)
● Taxes collected for this agency by another government
● Current and delinquent amounts, penalties, and interest
Exclude
● Receipts from service charges
● Special assessments
● Interest earnings
● Fines
● Any other sources that are not taxes or licenses
A. Property taxes - All taxes on property, real or personal.
Exclude
● Taxes not measured by value
● Payments in lieu of taxes (should be reported in 6 and/or 7 )

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PART 4 – REVENUES

Property Taxes
$Mil.

Thou.

Dol.

Sales taxes

B. Sales taxes
$Mil.

Thou.

Dol.

1. General sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Public utilities sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Other sales and gross receipts sales tax . . . . . . . . . . . . . . . . . . .
Tax Revenues
C. Licensing and permit taxes - (e.g., license and permit
fees exacted (either for revenue raising or for regulation)
as a condition to the exercise of a business or
nonbusiness privilege.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet F-29

C

Thou.

Dol.

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D. All other taxes – Specify:

$Mil.

.............................

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Page 5

6

What was the amount of intergovernmental revenue received by this agency from other
governments during the fiscal year indicated in question 2 ? (If none, enter a zero.)
Include
● Grants
● Shares of taxes imposed by other governments
● Payments in lieu of taxes
● Reimbursements for services performed for other governments
● Payments under the American Recovery and Reinvestment Act of 2009 (ARRA)
Exclude
● Loans
● Any taxes imposed by this agency which were collected for it by another government (report in 5 )
● Receipts from utility sales to other governments (report in 7 )
Intergovernmental Revenues

Report total intergovernmental revenue received

$Mil.

Thou.

Report Online - Do Not Return

PART 4 – REVENUES - Continued

Dol.

A. From other local governments . . . . . . . . . . . . . . . . . . . . . . . . . .
B. From the State
Include
• Any amounts financed wholly or in part from Federal
grants to the State (i.e., pass-throughs)
Exclude
• Collection fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. From the Federal government directly . . . . . . . . . . . . . . . . . . . .

7

For each of this agency’s functions listed below in Column 1, what was the amount of revenues
obtained from current charges, as defined in Column 2, for commodities and services provided by
this agency from all funds, other than taxes and intergovernmental revenues, during the fiscal year
indicated in question 2 . (If none, enter a zero.)
A. Current charges
Include
● Utility services, including sales to the Federal, State, or other local governments

Column 1

Function

Column 2
Current Charges: gross
receipts from fees, sales,
rentals, tolls, maintenance
assessments, and other
charges for commodities and
services
$Mil.

Worksheet F-29

Thou.

Dol.

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Exclude
● Grants and other amounts received from the Federal, State and other local governments (report in 6 )

Page 6

B. Special assessments - Compulsory contributions and
reimbursements from owners of property benefited by
improvements (e.g., streets, sewers, sidewalks, water
extensions, etc.) as well as for servicing special
assessment debt.
Exclude
● Proceeds from sales of special assessment bonds
(report in 15 )
● Maintenance assessments (should be reported in item A.) . . . .

Other Revenues
$Mil.

Thou.

Dol.

C. Receipts from sale of property and other capital assets
Include
● Property sold to other governments
Exclude
● Tax sales (should be reported in 5 ) . . . . . . . . . . . . . . . . . . . .

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PART 4 – REVENUES - Continued

D. Interest earnings - Interest received on all deposits
and investment holdings of this agency.
Include
● Interest on construction funds
Exclude
● Interest earnings of any employee pension funds . . . . . . . . . . .
E.

Fines and forfeits - Receipts from penalties imposed for
violations of law and civil penalties . . . . . . . . . . . . . . . . . . . . . . . . .

F.

Royalties - Compensation or portion of proceeds from
extraction of natural resources (e.g., oil, gas, and
mineral rights) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. Private donations - Gifts of cash or securities from private
individuals or corporations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H. Miscellaneous other revenues - Revenues of this agency not
reported in items A. through G. or questions 5 through 6 .

Exclude
● Proceeds from borrowing
● Receipts from sale of security holdings
● Transfers between funds or accounts of this agency
● Employee contributions to employee pension funds
● Interest earnings of any employee pension funds . . . . . . . . . . .

Other Revenues
$Mil.

Thou.

Dol.

Total Revenues
$Bil.

8

Mil.

Thou.

Dol.

What was the total amount of revenues reported on this
worksheet (Sum of 5 through 7 )? . . . . . . . . . . . . . . . . . . . . . . .

Worksheet F-29

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Include
● Insurance claims
● Recoveries of prior year expenditures
● Dividends
● Recorded profits from sale of investments
● Payments in lieu of taxes from private sources

Page 8

12

What was the total amount of interest paid on long-term and short-term debt held by this agency
during the fiscal year ending indicated in question 2 ? (If none, enter a zero).
Include
● Capitalized interest paid on construction loans
Exclude
● Debt retirement (should be reported in 15 )

Interest Expenditures
$Mil.

Thou.

Dol.

A. Interest on water supply system debt . . . . . . . . . . . . . . . . . . . .

B. Interest on electric power system debt . . . . . . . . . . . . . . . . . . .

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PART 5 – EXPENDITURES - Continued

C. Interest on gas supply system debt . . . . . . . . . . . . . . . . . . . . . . .

D. Interest on transit or bus system debt . . . . . . . . . . . . . . . . . . .

E. Interest on all other debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Expenditures
$Bil.

13

What was the total amount of expenditures reported
on this form (Sum of 10 through 12 )? . . . . . . . . . . . . . . . . . . . .

14

What was the total amount of expenditures for salaries and
wages reported in 11

Mil.

Thou.

Dol.

Personnel Expenditures
$Bil.

Mil.

Thou.

Dol.

Exclude
● Fringe benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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