Various Government Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

QUARTERLY SURVEY OF
SELECTED NON-PROPERTY TAXES

FORM

F-73

(05-02-2013) Draft 8

OMB No. 0607-0112: Approval Expires 09/30/2016

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
• Visit
census.gov/govs/qtax
• Call
1-866-880-9010 weekdays,
7AM to 5PM ET
• Email
govs.qtax@census.gov
In correspondence
pertaining to this report,
please refer to the User
ID below the address box.
REPORT ONLINE: It’s fast and secure. Respond
to this survey via the Internet at the following Web
address using the supplied User ID and Password:
respond.census.gov/f73

User ID:
➤
Password:

GENERAL INSTRUCTIONS
1.

Report figures for the calendar quarter named in the form title.

2.

You may report on either a cash or accrual basis.

3.

Do not delay reporting to await final figures, if reasonable estimates can be supplied on a preliminary basis.

4.

PLEASE COMPLETE ALL ITEMS ON THE FORM. If some items do not apply to this government, enter zero ("0")
and specify those items as "not applicable" in (3) REMARKS.

5.

To report revisions to any of the prior seven quarters, call 1-866-880-9010.

6.

Use a black or blue ballpoint pen. Do not use pencil or felt-tip pen.

1

Is the addressee title/department and mailing address the same as shown in the address label?
Mark "X" only one box.
Yes – Go to 2

No – Enter correct information below

Addressee Title or Department

17733015

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Before filling out this form, please read carefully each part and all related definitions and instructions.
Note especially:

ATTN:
Street 1

Street 2

City

State

Zip Code

Please continue on the next page

Page 2

HOW TO
REPORT
DOLLAR
FIGURES

2

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

What was the amount of tax collections for the following selected taxes imposed by this government
for the quarter ending
Report zero for any item that has no collection for this quarter.
Include
• Collections during the quarter from all levies for all funds of this government and its agencies
• Taxes collected for this government by another government or authorized agency
• Current and delinquent amounts, penalties, and interest
Exclude
• Any taxes collected on behalf of other governments
• Shares of taxes imposed by another government
A. General sales and gross receipts taxes
Include
• Sales and use taxes
• Taxes on goods and services, measured as a
percent of sales or receipts, or as an amount
per unit sold (e.g., gallon, package, etc.)
• Only taxes imposed by this government
Exclude
• Taxes imposed on the sale of particular
commodities, businesses, or services (e.g.,
hotel/motel, car rental, amusements, etc.)
• Sales tax distributions for revenue sharing
from State or from other governments . . . . . . . . . . .

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

$Bil.

Mil.

Thou.

Dol.

T09

B. Local individual income taxes
Include
• Taxes on individuals measured by net income
and taxes on special types of income (e.g.,
interest, dividends, income from intangible
property, etc.)
Exclude
• Income tax distribution for revenue
sharing from the State or from other
governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T40

Form F-73

Include
• Taxes on corporations and unincorporated
businesses (when taxed separately from
individual income), measured by net
income, whether on corporations in general
or on specific kinds of corporations, such
as financial institutions . . . . . . . . . . . . . . . . . . . . . . .

17733023

§2j?8¤

C. Local corporation net income taxes

T41

Please continue on the next page

Page 3

3

Use this space for any explanations that may be essential in understanding the reported data.
Include
• Any significant changes occurring within the last quarter
• Any difficulties encountered in completing this form
• Identify and list all items that are "not applicable" for this government

Who should be contacted to answer questions about data reported on this form?
Name of contact person - Please print

§2j?@¤

Area code and phone number

Email Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed
(MM)
(DD)
(YYYY)

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This form has been approved by the Office of
Management and Budget (OMB) and given the number 0607-0112. Please note the number displayed in the upper right-hand corner of this form. Display of this number confirms
that we have approval from OMB to conduct this survey. If this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this
voluntary survey. Information provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Please note that this is a national form that applies to governments with wide differences in the size of their service areas, the amount of population served, and the extent and
complexity of their activities. Public reporting burden for this collection of information is estimated to vary from 10 minutes to 1 hour per response, with an average of 20 minutes
per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork
Project 0607-0112, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to Paperwork@census.gov; use Paperwork Project
0607-0112 as the subject.

Form F-73

17733031

4