790A Multiple Pay 790A Multiple Pay Groups Enrollment Fax

Page 3 of 4

B ureau of Labor Statistics

U.S Department of Labor

Data Collection Center

dccaddress

dcccity, dccst dcczip

Phone: dccphone

Fax: faxphone

January 30, 2021

Attn: Payroll Manager

Con_Firm

Con_Address

Con_City, Con_State Con_Zipcode

Dear Payroll Manager:

A data collection specialist from the Bureau of Labor Statistics (BLS) will soon telephone to ask your company’s help with determining the nation’s monthly counts of employment. The person whose name appears below will be the one who will be calling you. The focus of this call will be to gather information about your payroll that includes the 12^th day of the month.

The Data Collection Specialist assigned to your business:	username
Telephone number:	userphone

The call is to explain the reasons for including your company in the production of the nation’s employment numbers and answer any questions you might have. We also want to:

• Confirm your business address and locations.

• Confirm whether we have the correct state Unemployment Insurance account number (UI#) for your company.

• Ask how frequently employees of your company are paid and whether you have more than one payroll.

Your company was selected as a part of a scientific sample of businesses throughout the United States. The BLS 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 (Title 5 of Public Law 107-347), the information you provide to the BLS will not be disclosed in identifiable form without your informed consent.

Thank you in advance for your cooperation. Your assistance in producing this important information about our nation’s economy is greatly appreciated.

Sincerely,

signature

dcccntct2

Data Collection Center Manager

This report is authorized by law 29 U.S.C.2.  We request your cooperation to make the results of this survey comprehensive accurate, and timely.  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 of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent.

Please note this report is mandatory in North Carolina, under Section 96-4(g) (l) of the North Carolina Employment Security Law; in Oregon, under the Oregon Revised Statute 657.660; in Washington, under the Revised Code of Washington sections 50.12.010, 50.12.070, and 50.12.180; and in South Carolina, under Section 41-29-120 of the Code of Laws of South Carolina (for firms employing more than twenty individuals). 

We estimate that it will take an average of 10 minutes to complete this form each month including time to review instructions, search existing data sources, gather and maintain the necessary data, and complete and review this information.  If you have any comments regarding these estimates or any other aspects of this survey, send them to the Bureau of Labor Statistics, Division of Current Employment Statistics (1220-0011), 2 Massachusetts Avenue, NE, Washington, DC 20212.  You are not required to respond to the collection of information unless it displays a currently valid OMB control number. Form Approved OMB No. 1220-0111.

MP MF INT

►Our records show the following information for your firm:

Contact: Attn: Payroll Manager2
Con_Firm2	Tel: con_tel Ext: con_ext
Con_Address2	Fax: con_fax
Con_City2, Con_State2 Con_Zipcode2

► Definitions for the Questions on the Next Page

C

olumn 1 EMPLOYEE COUNT– ALL WORKERS

Total number of persons in this pay group who worked or received pay for any part of the pay period that includes the 12^th of the month.

Include:	Exclude:
 Executives and their staff  Full-time and part-time workers  Salaried officials of corporations  Trainees  Workers on active duty, if receiving pay from employer  Workers on paid sick leave  Workers on paid vacation  Workers on other paid leave	 Outside contractors and their employees  Pensioners  Proprietors, owners, or partners of unincorporated firms  Workers on active duty, if not receiving pay from employer  Workers on leave without pay for entire pay period  Workers on strike for entire pay period  Unpaid family members

EMPLOYEE COUNT– Production workers

Number of "All Workers" defined above who are Production Workers. Production Workers include working supervisors or group leaders who may be “in charge” of some employees, but whose supervisory functions are only incidental to their regular work.

Include individuals working in:
Mining, quarrying, crude petroleum production, and natural gas production
Blasting Cleaning Crushing Development Drainage	Drilling Excavating Flow Control Guard Service Handling		Hauling Hoisting Inspection Janitorial Loading	Maintenance Processing Pumping Repair Rig Building		Shipping Storage Trucking Ventilation Warehousing
Logging industries
Cutting Timber	Transporting Timber		Producing wood chips in the field
Exclude individuals working in:
Accounting or finance Advertising C afeterias Collection and credit Executive, professional, and technical positions		Legal or medical positions Personnel Purchasing or sales

Column 2 WOMEN EMPLOYEE COUNT

Number of “All Workers” defined above who are women.

C olumn 3 Payroll, EXCLUDING COMMISSIONS Total gross pay earned during the entire pay period. Report separately for All Workers and for Production Workers. Report pay before employee deductions for:
Taxes FICA (Social Security) Health insurance Pay deferral plans such as 401K	Bonds Pensions Unemployment insurance Union dues
Include:	Exclude:
Wages and salaries Paid holidays, vacation, sick leave, and other paid leave Incentive pay Bonuses paid each pay period Overtime pay Severance, if paid over multiple pay periods	Commissions Annual pay for unused leave Awards or bonuses not paid each pay period Employer contributions to pay such as 401K Pay advances, such as vacation pay advances Payments "in kind" Retroactive or back pay Severance, if provided as one payment Travel or work-related reimbursements

C

olumn 4 Commissions

Report separately for “All Workers” and for “Production Workers”.

• Report for the most recent complete period for which commissions are available, which might be different from the pay period that includes the 12th. Enter 0 if none paid for the period or pay group.

• Exclude base pay, drawing accounts, or basic guarantees.

C

olumn 5 Hours, INCLUDING OVERTIME

Total number of hours for which employees received pay during the entire pay period. Report separately for All Workers and Production Workers.

• Include overtime; stand-by or reporting time; and hours not worked, but for which workers received pay (holidays, vacations, sick leave, etc.).

• Report hours for salaried and commission-only employees based on their standard work week.

• Do not convert overtime or other premium hours to straight-time equivalent hours.

MP MF INT

Each month report your payroll information for the pay period that includes the 12^th of the month. For questions refer to page 2 for the Column definitions or call the Data Collection Specialist listed on page 1 of this form.

Reference Month/Year: mon1 year1		1 Employee Count	2 Women Employee Count	3 Payroll, Excluding Commissions	4 Commissions	5 Total Hours, including overtime
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers
Report #: reptnum State: STC Location: REGlocation UI: ReptUI
Pay Type pay-type1	All Workers
	Production Workers

We will send you another form for reporting next month.

Please keep this form to use when the Data Collection Specialist calls you to complete the survey. Thank You!

790A Aug 2011 790MultiAEnr_FAX.dot