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pdfAttachment B
2012 ECONOMIC CENSUS
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
OMB No. 0607-0938: Approval Expires
(DRAFT)
(Please correct any errors in this mailing address.)
DUE DATE
FEBRUARY 12, 2013
Need help or have questions?
• Read the accompanying information sheet(s) before
answering the questions.
MC-32000
• Visit econhelp.census.gov
• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.
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Go to:
econhelp.census.gov
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001
Mail your
completed
form to:
- OR -
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 ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.
• Please center numbers in
their respective boxes.
• Place an "X" inside the box.
Examples:
The reporting unit for this form is an establishment. An establishment 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
Is the Employer Identification Number (EIN) shown to the left of the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?
32000010
0021
2
Yes - Go to
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
0032
Yes - Go to line B
0035
Number and street
0036
City, town, village, etc.
No - Enter
physical
location
0037
State
0038
ZIP Code
CONTINUE WITH
PENALTY FOR FAILURE TO REPORT
2
ON PAGE 2
CONTINUE ON PAGE 2
Page 2
2
PHYSICAL LOCATION - Continued
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
0040
Do not know
0024
Do not know
C. In what type of municipality is this establishment physically located?
(Mark "X" only ONE box.)
0046
3
City, village, or
borough
0047
Town or township
0048
Other
OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2012?
(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
0015
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
0060
Month
Day
Year
0018
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"
if None
MONTHS IN OPERATION
30 .)
. . . . . . . . . .
0002
32000028
Number of months in operation during 2012 (If none, mark "X" and go to
2012
Number
CONTINUE ON PAGE 3
Page 3
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
HOW TO
REPORT
DOLLAR
FIGURES
5
Mark "X"
if None
Dollar figures should be rounded to
thousands of dollars.
If a figure is $2,035,628.79:
Report
If a value is "0" (or less than $500.00):
Report
$ Bil.
2012
Mil.
2
Thou.
0 3 6
EXAMPLE
SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None
A. Total value of products shipped and other receipts (Report detail
in 22 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ Bil.
2012
Mil.
Thou.
0100
B. Value of products exported (This is a breakout of the value
reported on line A.)
Report the value of products shipped for export. Include
shipments to customers in the Panama Canal Zone, the
Commonwealth of Puerto Rico, and U.S. possessions, as well as
the value of products shipped to exporters or other wholesalers
for export. Also, include the value of products sold to the U.S.
Government to be shipped to foreign governments. Exclude
products shipped for further manufacture, assembly, or fabrication
in the United States. . . . . . . . . . . . . . . . . . . . . . .
6
0130
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 , line A? Or, were the orders for any of the shipments reported in 5 , line A received over an
electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet
0181
Yes - Go to line B
0182
No - Go to
• Extranet
• Other online systems
2012
Percent
7
0109
%
32000036
B. Percent of total reported in 5 , line A that were ordered, or whose movement was controlled or
coordinated over electronic networks (Report whole percents. Estimates are acceptable.) . . . .
CONTINUE ON PAGE 4
Page 4
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 to the left of 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 12th . . . .
0325
2. All other employees for pay period including March 12 . . . . . . . . . .
0336
3. TOTAL (Add lines A1 and A2) . . . . . . . . . . . . . . . . . . . . . .
0337
Mark "X"
B. Payroll before deductions (Exclude employer's cost for fringe benefits.) if None
1. Annual payroll
. . . . . . . . . . . . . . . . . . . . . . .
0300
2. First quarter payroll (January-March 2012) . . . . . . . . . .
0310
8
Not Applicable.
9
VALUE OF INVENTORIES
2012
Number
Mark "X"
if None
A. Number of employees
Report inventories using
generally accepted
Mark "X"
accounting practices.
if None
(Include finished products,
work in process, material
supplies, fuels, etc.) . . . .
$ Bil.
End of 2012
Mil.
Mark "X"
if None
Thou.
0460
$ Bil.
$ Bil.
2012
Mil.
End of 2011
Mil.
Thou.
Thou.
0470
10 – 12 Not Applicable.
13 ASSETS AND CAPITAL EXPENDITURES
(Refer to the instructions on how to report leasing arrangements.)
32000044
Report the dollar value of assets, capital expenditures, and depreciation.
A. Total capital expenditures (new and used) during the year
(Exclude land.) . . . . . . . . . . . . . . . . . . . . . . . . .
0520
B. Gross value of depreciable assets (original cost) at the end of the
year (Exclude land.) . . . . . . . . . . . . . . . . . . . . . . .
0505
Mark "X"
if None
$ Bil.
2012
Mil.
Thou.
Mark "X"
if None
$ Bil.
2012
Mil.
Thou.
14 RENTAL PAYMENTS
Buildings, machinery, and equipment (Include land.) . . . . . . . . .
0550
15 Not Applicable.
CONTINUE ON PAGE 5
Page 5
If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 COST OF MATERIALS, RESALES, FUELS, ELECTRICITY, AND WORK DONE
FOR YOU BY OTHERS ON YOUR MATERIALS
Mark "X"
if None
$ Bil.
2012
Mil.
Thou.
0420
32000051
Cost of materials, parts, containers, packaging, etc., used; cost of
products bought and sold as such 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. . . . . . . . . . . . . . . . . . . . .
CONTINUE ON PAGE 6
File Type | application/pdf |
File Title | MC-32000 $$00 ECONOMIC CENSUS - |
Author | brown538 |
File Modified | 2011-10-04 |
File Created | 2011-09-27 |