2017 - 2019 Report of Organization

Attachment C
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2017-2019 Report of Organization
OMB Control Number 0607-0444
Form NC-99001 Information Sheet

Definitions and Instructions for the
Report of Organization, NC-99001
Estimates are acceptable if book figures are not readily available.
This survey contains questions about the organization, questions about each of the pre-identified
locations of this organization (if any), and questions for any locations being added to this organization (if
any).
Respondents will either have a short survey (S) or a long survey (L) to fill out. The (L) survey contains
questions for the organization (survey NC-99001(L)), the pre-listed locations, and any additional locations
to add. The (S) survey contains questions for the organization (survey NC-99001(S)), and any additional
locations to add.
Respondents can fill out this survey via downloading a spreadsheet template or online.
o

The spreadsheet template option requires downloading the spreadsheet from this instrument,
filling out the spreadsheet, uploading the completed spreadsheet back to the instrument,
reviewing and correcting the responses (as needed), and submitting the responses within this
instrument.

o

The online option is a question by question response driven approach. Respondents will navigate
through this survey, based on responses to questions and clicking the ‘Save and Continue’
button, then review and correct the responses (as needed) and then submit these responses
within this instrument.

Burden Statement
We estimate this survey will vary from a half-hour for the smallest companies to 25 hours for
the largest companies to complete, with an average of 3 hours and 31 minutes to complete,
including the 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: ESMD Survey Comments 06070444, U.S. Census Bureau, 4600 Silver Hill Road, Room ESMD-5H160, Washington, DC 20233.
You may e-mail comments to ESMD.surveys@census.gov. Be sure to use "ESMD Survey
Comments 0607-0444" as the subject.
Response to this collection of information is not required unless it displays a valid approval
number from the Office of Management and Budget (OMB). The OMB eight-digit number appears
in the upper right corner of the instrument.

Discontinued Operations - If your organization discontinued operations before 2018, complete the
Operational Status section of the questionnaire for each location (e.g., Closed or Sold) along with the
effective date for of the status change. If your organization was in operation for any part of 2018, a
completed questionnaire is required for the portion of the year 2018 in which your organization was in
operation.
Census File Number (CFN) - A CFN has been assigned to your company. Always refer to the complete
number in any correspondence with the U.S. Census Bureau.

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Employer Identification Number (EIN) - The EIN is the nine-digit taxpayer identification number
assigned by the Internal Revenue Service (IRS) and used by all business firms and other legal entities to
file federal employment tax returns such as Forms 941 and 943; and federal income tax returns such as
Forms 1065, 1120, and 990 series.
Company - An economic unit comprising one or more establishments under common ownership or
control.
Subsidiary - A company that is owned or controlled by another firm or company. Subsidiaries include
firms in which your company owns more than 50 percent of the outstanding voting stock, as well as firms
in which your company has the power to direct or cause the direction of the management and policies.
Establishment - An establishment is a single physical location where business is conducted or where
services or industrial operations are performed. (For example: a factory, mill, store, hotel, movie theater,
mine, farm, and administrative office.) If distinctly separate activities are performed at the same location,
and if there is significant employment in each activity, then each activity should be treated as a separate
establishment, except agricultural production as explained below. (For example: construction activities
operated out of the same physical location as a lumber yard.)
For firms engaged in construction, real estate management or operation, transportation, communication,
electric, gas, and sanitary services, and similar types of physically dispersed activities, it is not necessary
to list separately each individual "site," "project," "field," "network," "line," or "system." It is only necessary
to report for main or branch offices, terminals, stations, etc., which are either (a) directly responsible for
supervising such activities, or (b) the base from which personnel operate to carry out these activities.
Foreign Locations - Report a foreign location only if any of the employees at the location are reported on
an IRS Form 941 for an EIN that is also used to report employees at domestic locations. You only need to
report one foreign location for each such EIN. If more than one such establishment exists for an EIN,
consolidate the employment and payroll data at the headquarters location, using "foreign employees" as
the secondary name.

Mailing Address
This information is what the U.S. Census Bureau has on file for this establishment and lists the location
this survey was mailed to. Respondents may update ATTN, Name 1, Name 2, Street, City, State, and ZIP
Code fields if the information displayed is incorrect.

Ownership or Control: Voting stock validation
Select the suitable answer to indicate if another domestic company owns more than 50 percent of the
voting stock of your company.

Ownership or Control: Management and policy
Select the suitable answer to indicate if another domestic company has the power to control the
management and policies of your company.

Ownership or Control: Percent of Voting Stock Held
Select the suitable answer to indicate the percentage of voting stock held by the owning or controlling
company. Franchisees should not list their franchisor as a controlling company unless they own more
than 50 percent of the voting stock.
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Ownership or Control: Company Information
Enter the name, home office address, and Employer Identification Number (EIN) of the owning or
controlling company. Franchisees should not list their franchisor as a controlling company unless they
own more than 50 percent of the voting stock.

Foreign Ownership or Control
Select the suitable answer to indicate if a foreign entity (company, individual, government, etc.) owns
directly or indirectly 10 percent or more of the voting stock or an equivalent interest in your company.

Foreign Ownership or Control: Company Information
Enter the name, address, and country of the foreign entity (company, individual government).

Foreign Ownership or Control: Percent of Voting Stock Owned
Select the suitable answer to indicate the percentage of voting stock owned directly or indirectly by a
foreign entity (company, individual, government).
All direct and indirect ownership interests held by the foreign entity should be summed to determine the
foreign entity’s percentage of ownership.

Foreign Affiliates
Select the suitable answer to indicate if your company owns 10 percent or more of the voting stock or
other equity rights of a foreign business enterprise (including an unincorporated branch, partnership, or
ownership of real estate).

Research and Development
Select the suitable answer to indicate if your company performed or funded research and development for
the year.
Research and Development (R&D) is planned, creative work aimed at discovering new knowledge or
developing new or significantly improved goods and services.
This includes:
•
•
•

activities aimed at acquiring new knowledge or understanding without specific immediate
commercial applications or uses (basic research)
activities aimed at solving a specific problem or meeting a specific commercial objective (applied
research)
systematic use of research and practical experience to produce new or significantly improved
goods, services, or processes (development)

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The term research and development excludes:
•
•
•
•
•

routine product testing, quality control, and technical services unless they are an integral part of
an R&D project
market research
efficiency surveys or management studies
literary, artistic, or historical projects
prospecting or exploration for natural resources

Research and Development Expenses
Select the suitable answer to indicate your company’s worldwide expenses for research and development
for the year.

Professional Employer Organization
Select the suitable answer to indicate if your company leases fifty percent or more of its permanent fulland part-time workforce through a contractual agreement with a Professional Employer Organization,
Permanent workforce excludes contractors and temporary staffing from a staffing service.

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Pre-listed Locations
This section of the survey contains questions for all the pre-listed locations of the organization.

A. Location Information
For each location, please update the following information as needed: major activity, Name, Secondary
Name, Store or plant No. Physical Location (number and Street), City, State, and ZIP

Discontinued Operations
If your organization discontinued operations before the survey year, please select "Ceased
Operation" and select a date for “CEASED OPERATION OR SOLD OR LEASED INFORMATION”
for each Prelisted location. Return to the Remarks section with an annotation that your
organization did not operate in any part of the survey year. If your organization did operate in any
part of the survey year, we require a report for the portion of the survey year in which your
organization was in operation.
Special Instructions for Selected Industries
Agricultural production
Establishments having any agricultural production regardless of whether it is the major
activity should be listed separately and the employment and payroll data allocated if
appropriate. Agricultural production includes the raising of/or production of crops (including
horticultural products), poultry, or livestock for sale.
Construction establishment
A construction establishment is a relatively permanent office, or other place of business,
where the usual business activities related to construction are conducted. With some
exceptions, a relatively permanent office is one which has been established for the
management of more than one project or job and which is expected to be maintained on a
continuing basis.
Banks
When checking the pre-listing of your establishments, list only the EINs used to report either
Federal employment taxes (IRS Form 941) or income (IRS Forms 1065, 1120, and 990).
DO NOT LIST EINs assigned to trust funds or estates managed by the bank and reported
on IRS Form 1041, U.S. Fiduciary Income Tax Return. Report main and branch locations as
separate establishments. Individual ATM outlets should not be listed as separate
establishments.
Retail departments or concessions
List as a separate establishment (including specific street address) those retail or service
outlets operated by your firm as a department of a retail or service establishment, such as
shoe departments or beauty salons in department stores, meat or bakery departments in
grocery stores, or millinery departments in clothing stores.
Medical
Part-time offices should not be considered as separate establishments. List only the offices
that are staffed on a full-time basis and include the employment and payroll for the part-time
offices. Home health care services should not consider the customers’ locations as separate
establishments. Employment and payroll for these locations should be included with the
main or branch office from which the work is supervised.
Legal
Part-time, temporary, or special offices should not be considered separate establishments
for purpose of this report. Data for such locations should be included with the controlling
main or branch location where the service is primarily performed.
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B. Employment and Payroll
Enter the number of employees for the pay period including March 12th, the first quarter payroll, and the
annual payroll for the location for the survey year.

Employment:
Please use the number of employees, both full- and part-time whose payroll was reported on
your organization's Internal Revenue Service Form(s) 941, Employer's Quarterly Federal
Tax Return. Include as employees all persons on paid sick leave, paid holidays, and paid
vacations; include salaried officers and executives of incorporated firms.
Exclude full- or part-time leased employees whose payroll was filed under an employee
leasing company's EIN and temporary staffing obtained from a staffing service.

Payroll
Include the total of wages paid, tips reported, and other compensation paid to your
employees in the calendar year, whether or not subject to income or social security taxes.
Include all wages, salaries, commissions, fees, bonuses, vacation allowances, sick leave
pay, severance pay, the amount of reported tips, and the value of taxable fringe benefits.
Also, include any employee contributions to a qualified pension plan, such as the 401(k)
plan. Also, include the spread on stock options that are taxable to employees as wages.
For incorporated businesses, include the salary of all officers and executives.
Exclude pensions, annuities, supplemental unemployment compensation benefits,
nontaxable fringe benefits, and commissions and fees paid to independent contractors.
Also, exclude employer contributions for pension plans, health insurance, and qualified
benefits under a cafeteria plan. For unincorporated businesses, exclude the profit or
compensation paid to proprietors or partners.
The sum of payroll reported for individual establishments for an EIN should equal the
taxable Medicare wages and tips reported on Item 5c of IRS form 941, Employer’s Quarterly
Federal Tax Return plus the spread on stock options that are taxable to employees.

C. Operational Status
Select the box that is applicable to the operation of your location during the survey year.
•

If the establishment ceased operation,
o Enter the ceased operation date in the CEASED OPERATION OR SOLD OR LEASED
INFORMATION response section.

•

If the establishment sold or leased to another operator,
o Enter the sold operation date in the CEASED OPERATION OR SOLD OR LEASED
INFORMATION response section
o Also, enter the name and address of this establishment’s new owner or operator.

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Added Locations
This survey contains questions for locations being added to the organization.
Do not add locations from the pre-listed locations section, or plants for which you
received an MA-10000 survey.

A. Location Information
For each new establishment being added, enter the EIN, name, secondary name, Store/plant
No., Physical location, City, State, ZIP, and date establishment opened or is expected to open.
Special Instructions for Selected Industries
Agricultural production
Establishments having any agricultural production regardless of whether it is the major
activity should be listed separately and the employment and payroll data allocated if
appropriate. Agricultural production includes the raising of/or production of crops
(including horticultural products), poultry, or livestock for sale.
When adding establishments engaged in agricultural production, be sure to give the type
of crops, livestock, etc.
Construction establishment
A construction establishment is a relatively permanent office, or other place of business,
where the usual business activities related to construction are conducted. With some
exceptions, a relatively permanent office is one which has been established for the
management of more than one project or job and which is expected to be maintained on
a continuing basis.
Banks
When adding establishments, list only the EINs used to report either Federal employment
taxes (IRS Form 941) or income (IRS Forms 1065, 1120, and 990). DO NOT LIST EINs
assigned to trust funds or estates managed by the bank and reported on IRS Form 1041,
U.S. Fiduciary Income Tax Return. Report main and branch locations as separate
establishments. Individual ATM outlets should not be listed as separate establishments.
Retail departments or concessions
List as a separate establishment (including specific street address) those retail or service
outlets operated by your firm as a department of a retail or service establishment, such
as shoe departments or beauty salons in department stores, meat or bakery departments
in grocery stores, or millinery departments in clothing stores.
Medical
Part-time offices should not be considered as separate establishments. List only the
offices that are staffed on a full-time basis and include the employment and payroll for the
part-time offices. Home health care services should not consider the customers’ locations
as separate establishments. Employment and payroll for these locations should be
included with the main or branch office from which the work is supervised.
Legal
Part-time, temporary, or special offices should not be considered separate
establishments for purpose of this report. Data for such locations should be included with
the controlling main or branch location where the service is primarily performed.
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B. Employment and Payroll
Enter the number of employees for the pay period including March 12th, the first quarter payroll,
and the annual payroll for the location for the survey year.

Employment:
Please use the number of employees, both full- and part-time whose payroll was reported on
your organization's Internal Revenue Service Form(s) 941, Employer's Quarterly Federal
Tax Return. Include as employees all persons on paid sick leave, paid holidays, and paid
vacations; include salaried officers and executives of incorporated firms.
Exclude full- or part-time leased employees whose payroll was filed under an employee
leasing company's EIN and temporary staffing obtained from a staffing service.

Payroll
Include the total of wages paid, tips reported, and other compensation paid to your
employees in the calendar year, whether or not subject to income or social security taxes.
Include all wages, salaries, commissions, fees, bonuses, vacation allowances, sick leave
pay, severance pay, the amount of reported tips, and the value of taxable fringe benefits.
Also, include any employee contributions to a qualified pension plan, such as the 401(k)
plan. Also, include the spread on stock options that are taxable to employees as wages.
For incorporated businesses, include the salary of all officers and executives.
Exclude pensions, annuities, supplemental unemployment compensation benefits,
nontaxable fringe benefits, and commissions and fees paid to independent contractors.
Also, exclude employer contributions for pension plans, health insurance, and qualified
benefits under a cafeteria plan. For unincorporated businesses, exclude the profit or
compensation paid to proprietors or partners.
The sum of payroll reported for individual establishments for an EIN should equal the
taxable Medicare wages and tips reported on Item 5c of IRS form 941, Employer’s Quarterly
Federal Tax Return plus the spread on stock options that are taxable to employees.

C. Major Activity Code
Select the Activity Code that best describes the activity of this establishment and specify the
principal products or services.

D. Former Owner or Operator Information
If this added location was acquired from a former owner, enter the name of the former owner, the
mailing address (Number and Street), City, State, ZIP, and the date this location was acquired.

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