BLS-Green Form 236 Green Form 236116

Green Goods and Services Survey

O.M.B. No. 1220−0181

Expires September 30, 2010

Please return this form within 14 days. If you need help completing this form, contact information is listed on the last page. Thank you!

Statename

UI (10 digits)

Please report for location(s) in using Unemployment Insurance account number

1

What is the address where your business establishment is physically located?

Report data for the location below. If this address is no longer correct, please provide us with an updated address in the space provided.

Enter Physical Location Address Corrections Here

T_name

Phy_addr2

PHY_addr1

Phy_city, Phy_state phy_zip-phy_zip_ext

H

2

ave we identified your main business activity correctly?

We have listed below a description of your main business activity at this location. If this description is incorrect, please call 202-691-5185 or email GGS@bls.gov.

NAICS code: 236116 New multifamily general contractors
We have identified your main business activity as the following:		Does NOT include:
Establishments primarily engaged in: Construction of new multifamily residential housing units Includes multifamily housing construction firms acting as general contractors		Building multifamily buildings on their own account for sale as speculative builders or merchant builders Remodeling or repairing existing multifamily housing and other residential buildings Performing specialized construction work on multifamily housing and other residential buildings, generally on a subcontract basis Constructing and leasing residential buildings on their own account

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3

hat is your business establishment’s fiscal year?

Please provide us with your fiscal year that includes April 15, 2009 for the location listed in Item 1.

Start of Fiscal Year				End of Fiscal Year
MM	DD	YYYY		MM	DD	YYYY

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4

hat is your business establishment’s employment?

Please provide us with the employment figure you reported on your State’s Quarterly Contributions Report for September 2009 for the location listed in Item 1. This figure is the count of all employees subject to State Unemployment Insurance taxes that worked or received pay for the pay period that included September 12^th, 2009.

Employment for pay period that includes September 12, 2009

5

What is your percent revenue from specific product lines?

In Columns 1 and 3, please estimate the percent of total revenue at the location listed in Item 1 that comes from EnergyStar or LEED (Leadership in Energy and Environmental Design) certified new multifamily housing. Please base your estimate on total revenue for your fiscal year from Item 3. The sum of Columns 1 and 3 may not equal 100%.

Note: This section may best be completed by someone at your firm with access to financial data.

Percent of total revenue for fiscal year listed in Item 3
1 Percent of total revenue from EnergyStar or LEED certified new multifamily housing	2 Product line		3 Percent of total revenue from EnergyStar or LEED certified new multifamily housing	4 Product line
	Apartment building construction general contractors			Housing, multifamily, construction general contractors
	Condominium, multifamily, construction general contractors			Low income housing, multifamily, construction general contractors
	Construction management, multifamily building			Low-rise apartment construction general contractors
	Cooperative apartment, construction general contractors			Multifamily building construction general contractors
	Custom builders (except operative), multifamily buildings			Panelized multifamily housing assembled on site by general contractors
	Duplex (i.e., one unit above the other), construction general contractors			Precut multifamily housing assembled on site by general contractors
	Garden apartment construction general contractors			Residential construction, multifamily, general contractors
	High-rise apartment construction general contractors			Other (please specify):
	Home builders (except operative), multifamily			Other (please specify):

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6

hat is your contact information? For the person or persons who helped complete this form.

1. Contact 1’s name: __________________________________________

Title:___________________________________

Phone number: (_____)________ - _____________________ email:__________________________________

Business website:______________________________________________

2. Contact 2’s name: ____________________________________________

Title:___________________________________

Phone number: (_____)________ - _____________________ email:________________________________

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7

o you have any questions about completing this form?

Please send an email to GGS@bls.gov, or call (202)-691-5185.

Confidentiality Statement. 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. This report is authorized by law 29 U.S.C.2. Paperwork Reduction Act Statement. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate, and timely. We estimate that completing this form will take an average of 20 minutes. This estimate takes into account time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. If you have any comments regarding this survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Office of Industry Employment Statistics, Paperwork Reduction Project, 2 Massachusetts Avenue, N.E., Room 4840, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-0181 and expires on September 30, 2010. Without a currently valid number BLS would not be able to conduct this survey.

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