MA-10000(S) 2008 Annual Survey of Manufactures (Short Form)

Attachment C

2008 ANNUAL SURVEY OF MANUFACTURES

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

MA-10000(S)

OMB No. 0607-0449: Approval Expires

(DRAFT)

Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
Please read the accompanying
instructions before answering the
questions.
Need help or have questions
about filling out this form?
Visit our Web site at
www.census.gov/econhelp
Call:

- OR Write to the address above.
Include your 11-digit Census File
Number (CFN) printed in the
mailing address.

(Please correct any errors in this mailing address.)

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations
that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau. By the same
law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality
of Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents'
files are immune from legal process.
• Use blue or black ink.
• Do not use pencil.
• Place an "X" inside the box.

• Please center numbers in their respective boxes. Examples:
• Do not put slashes through 0 or 7.
• Complete only the unshaded portion of each item.

0 1 2 3 4 5 6 7 8 9

The reporting unit for this form is an establishment which is generally a single physical location where business is
conducted or where services or industrial operations are performed. For further clarification, see information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Are the last 5 digits of the Employer Identification Number (EIN) shown in the mailing address the same as the last
5 digits of the EIN used for this establishment on its latest 2008 Internal Revenue Service Form 941, Employer's
Quarterly Federal Tax Return?
Yes - Go to

0021

2

No - Enter current EIN (9 digits)

0022

-

0025

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. Box and rural route addresses are not physical locations.)
0031

10001014

2

0032

Yes - Go to line B
No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0044

Do not know

C. In what type of municipality is this establishment physically located? (Mark "X" only ONE box.)
0046

City, village, or borough

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

0047

Town or township

0048

Other

0024

Do not know

CONTINUE ON PAGE 2

Form MA-10000(S)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
3

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2008?
(Mark "X" only ONE box.)
0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0018

Month

Day

Year

Sold or leased to another operator - Give date at right AND
enter name and address of new owner or operator and
Employer Identification Number (EIN) below

0015

0060

Name of new owner or operator

0061 EIN

(9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065 ZIP

Code

4

Mark "X" 2008
if None Number

MONTHS IN OPERATION
Number of months in operation during 2008 (If none, mark "X" and go to 30 .) . . . . . . . . . . . .

HOW TO
REPORT
DOLLAR
FIGURES
5

Dollar figures should be rounded to
thousands of dollars.

Mark "X"
if None $ Bil.

If a figure is $1,025,628.79:

Report

If a value is "0" (or less than $500.00):

Report

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None $ Bil.

Total value of products shipped and other receipts (Report
detail in 22 .) . . . . . . . . . . . . . . . . . . . . . . .
6

2008
Mil.

Thou.

1 0 2 6

2008
Mil.

2007
$ Thou.

Thou.

0100

E-SHIPMENTS
A. Did this plant use any electronic network to control or coordinate the flow of any of the shipments of goods reported
in 5 ? Or, were the orders for any of the shipments reported in 5 received over an electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet

10001022

0002

0181

Yes - Go to line B

• Extranet
• Other online systems

0182

No - Go to

7

B. Percent of total reported in 5 that were ordered, or whose movement was
controlled or coordinated over electronic networks (Report whole percents. Estimates
are acceptable.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2008
Percent
0109

2007
Percent

%

%

CONTINUE ON NEXT PAGE

Form MA-10000(S)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
7

EMPLOYMENT AND PAYROLL
Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal Revenue
Service Form 941, Employer's Quarterly Federal Tax Return, and filed under the Employer Identification
Number (EIN) shown in the mailing address or corrected in 1 .
Exclude:
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Temporary staffing obtained from a staffing service.
For further clarification, see information sheet(s).

1. Number of production workers for pay period including
March 12 . . . . . . . . . . . . . . . . . . . . . . . . .

0325

2. All other employees for pay period including March 12 . . .

0353

3. TOTAL(Add lines A1 and A2) . . . . . . . . . . . . . . .

0356

B. Payroll before deductions (Exclude employer's cost for
fringe benefits.)

Mark "X"
if None $ Bil.

1. Annual payroll . . . . . . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March 2008) . . . . . .

0310

8

Not Applicable.

9

INVENTORIES
Report total inventories, regardless
of where held, before Last-in, Firstout adjustments (if any) owned by
this establishment as of December 31.
Include finished goods, work-in-process,
materials, supplies, fuels, etc. . . . . . .

2008
Number

Mark "X"
if None

A. Number of employees

Mark "X"
if None $ Bil.

2008
Mil.

End of 2008
Mil.
Thou.

0460

2007
Number

Thou.

Mark "X"
if None $ Bil.

2007
$ Thou.

End of 2007
Mil.
Thou.

0470

10 – 12 Not Applicable.
13 CAPITAL EXPENDITURES AND DEPRECIATION
(Refer to the instructions on how to report leasing arrangements.)
Report the dollar value of capital expenditures. (Do not
Mark "X"
include land.)
if None $ Bil.
A. Total capital expenditures for new and used buildings,
machinery and equipment . . . . . . . . . . . . . . . 0520

10001030

B. Depreciation charges for all capital equipment . . . . .
14 RENTAL PAYMENTS
(Exclude capital leases. Include operating leases.)
Total costs for rental or lease of buildings and equipment
(Including portable structures, machinery, tools, office
equipment, vehicles, and other tangible items used at this
establishment.) . . . . . . . . . . . . . . . . . . . . . .

2008
Mil.

Thou.

2007
$ Thou.

Mark "X"
if None $ Bil.

2008
Mil.

Thou.

2007
$ Thou.

Mark "X"
if None $ Bil.

2008
Mil.

Thou.

2007
$ Thou.

0540

0550

15 Not Applicable.
16 SELECTED EXPENSES
Cost of materials, parts, containers, packaging, etc.,
used; cost of products bought and sold without further
processing; cost of purchased fuels consumed for heat,
power, or the generation of electricity; cost of purchased
electricity; and cost of work done for you by others on your
materials . . . . . . . . . . . . . . . . . . . . . . . . .

0420

17 – 21 Not Applicable.
CONTINUE ON NEXT PAGE

Form MA-10000(S)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
If you cannot locate the description of any products that you produce, please enter a description of your products
in column (a) and enter their value in column (c). If additional lines are needed please use the "REMARKS" section.
Report separately for each major kind of product. Include the value of products exported and interplant transfers in the
appropriate product line(s).
An asterisk (*) at the end of a description denotes a comparability with products collected on a Current Industrial Report
(CIR) questionnaire. See paragraph on "Comparability" in Part C of CIR instruction manual for item code references.
Enter TOTAL value of shipments under code 7700000.

Products and services

Product Class
code

(a)

(b)

Products shipped and other receipts, including
interplant transfers and exports
2008
$ Bil.

(c)
Mil.

2007
Thou.

(d)
$ Thou.

018

026

034

042

059

067

10001048

075

083

091

109

CONTINUE ON NEXT PAGE

Form MA-10000(S)

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
23 – 29 Not Applicable.
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.

10001055

Is the time period covered by this report a calendar year?
Yes

No - Enter time period covered

Month

Name of person to contact regarding this report

Area code
Telephone

Number

-

Internet e-mail address

Year

Month

FROM

Year

TO

Title

Extension

Area code

Number

Fax

Date
completed

Month

Day

Year

Thank you for completing your 2008 ANNUAL SURVEY OF MANUFACTURES form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.