ORS 15-1G Establishment Collection Form for Government Industry

U.S. Department of Labor

Occupational Requirements
Survey

Bureau of Labor Statistics

The BLS publishes statistical tabulations from this survey that
This report is authorized by law, 31 United States
may reveal the information reported by individual State and
Code §§ 1535/FAR 17.5 of the Economy Act. Your
O.M.B. #1220-0189
local governments. Upon your request, however, the BLS will
voluntary cooperation is needed to make the results
hold the information provided on this survey form in confidence. of this survey comprehensive, accurate and timely.
We estimate that it will take an average of 34 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 (1220-0189), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond
to the collection of information unless it displays a currently valid OMB control number.

ESTABLISHMENT COLLECTION FORM FOR GOVERNMENT INDUSTRY
Start Time/End Time:

Address # 1.
Physical Address

Personal Visit Address

Mailing Address

Schedule Number(#):
Company Name:
Secondary Name (Doing Business As):
Address:
City/State/ZIP:

Address # 2.
Physical Address

Personal Visit Address

Mailing Address

Company Name:
Secondary Name (Doing Business As):
Address:
City/State/ZIP:

Establishment Officials (Contact List)
# 1:
Authorizing
Telephone #:
FAX #:

Supplying

# 2:

Supplying

Authorizing

Telephone #:
FAX #:
# 3:
Authorizing
Telephone #:
FAX #:

ORS Form 15-1G

Title:
E-mail:
Address:

1,

2, or

COC.
Title:

Mail forms to

E-mail:
Address:

1,

2, or

COC.
Title:

Mail forms to

Email:
Address:

1,

2, or

COC.

Mail forms to

Supplying

1

August 2023

Central Office Clearance (Complete if clearance and/or data obtained from this source)
Clearance obtained:
Company Name:

Schedule (data) obtained:

Address:
City/State/ZIP:

Remarks

ORS Form 15-1G

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August 2023

COMPANY DATA

Establishment Information (current data)
State:
Assigned Employment:
NAICS:
Establishment Description:

Schedule #:

Sample Number:
Total Employment:

Product Description:

Collection Information
Field Economist:
Collection Date:

Method of Collection:
Payroll Reference Date:

Data obtained electronically
Written Permission:
Date of Permission:

Yes,

No

Status (IDC Wage)

Establishment Status:
Usable
Refusal
Out of business
Out of scope
No matching jobs
Duplicate

SMG Notification

Reason:
Ownership/NAICS change
Part of assigned unit
Collected unit larger than assigned
Employment +/- 20% of assigned
Employment up – business fluctuations
Sampled employment wrong
SMG chose establishment subsample
Overlap (set by system)
Other discrepancy

ORS Form 15-1G

Document obtained (Secondary data source)
Name and Title of Official:
Permission on file at RO:

Yes,

No

Remarks:

Remarks:

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August 2023

Remarks

ORS Form 15-1G

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August 2023

OCCUPATIONAL REQUIREMENTS SURVEY Work Schedule

Quote #

Work Schedule #

Schedule Number:

Description/occupation

Hours/day

Hours/week

Weeks/year Type

For “Work Schedule #” note also if Alternate work schedule (Only needed for index schedules)

ORS Form 15-1G

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August 2023

Remarks

ORS Form 15-1G

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August 2023