2 Current Surveys

Attachment D – Current Surveys

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Location Information

DEFINITION OF ESTABLISHMENT
The reporting unit for this questionnaire is an establishment. An establishment is generally a single physical location where business is conducted
or where services or industrial operations are performed.

PHYSICAL ADDRESS
Please update the location's physical address if needed.

Name 1

Store/Plant

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Name 2

Number and Street

City, town, village, etc.

State

ZIP Code

Select State or Territory

99999-9999

For Census Bureau Use Only
CFN

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Legal Boundary and Municipality

EIN:
Store / Plant:
CFN:
LEGAL BOUNDARY AND MUNICIPALITY

Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
Yes
No
No legal boundaries
Do not know

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In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 1: Employer Identification Number

EIN:
Store / Plant:
CFN:
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax
Return?
Yes
No

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 1: Employer Identification Number - Enter/Update EIN

EIN:
Store / Plant:
CFN:
ITEM 1: EMPLOYER IDENTIFICATION NUMBER - ENTER / UPDATE EIN
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest Internal Revenue Service Form 941, Employer’s Federal
Quarterly Tax Return?
EIN
99-9999999

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 3: Operational Status

EIN:
Store / Plant:
CFN:
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2019?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator

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CEASED OPERATION OR SOLD OR LEASED INFORMATION

If this establishment ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY

If this establishment was sold or leased to another operator, what is the name, address, and 9-digit Employer Identification Number (EIN) of this
establishment's new owner or operator?
Name of new owner/operator

Mailing Address (Number and Street,
P.O. Box, etc.)

City, town, village, etc.

State

ZIP Code

Select State or Territory

99999-9999

EIN

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99-9999999

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 4: Months in Operation

EIN:
Store / Plant:
CFN:
ITEM 4: MONTHS IN OPERATION

Check
if
None
What was the number of months in operation during 2019?

2019

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
General Reporting Guidelines

,
EIN:
Store / Plant:
CFN:

GENERAL REPORTING GUIDELINES

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Reporting Period:
Responses should cover calendar year 2019.
If your fiscal year covers at least 10 months of calendar year 2019, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941 (Employer’s Quarterly Federal Tax Return)
IRS Form 944 (Employer’s Annual Federal Tax Return)
If you report by fiscal year, indicate the exact dates of the fiscal year on the submission certification screen.
Prior Year Data:
Where available, your establishment's Prior Year data is prelisted in the 2018 column.
Check these figures and make any necessary corrections as needed.
If 2018 Inventories figures are not prelisted, report these figures in the appropriate sections as instructed.

Providing Estimates:
If book figures are not available, estimates are acceptable.
How to Report Dollar Figures:
Dollar figures should be rounded to thousands of dollars. EXAMPLE - DO NOT ENTER DATA
Check
if
None
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:

2019
$

2036

,000.00

EXAMPLE - DO NOT ENTER DATA

EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:

X

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Check
if
None

2019
$

,000.00

How to Report Percents:
Percents should be rounded to whole percents. EXAMPLE - DO NOT ENTER DATA
2019
EXAMPLE - if figure is 38.76% of total sales, report 39:

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

39

%

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information

,
EIN:
Store / Plant:
CFN:

ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What was the total value of products shipped and other
receipts for this establishment?
(Report detail in Item 22.)

Check
if
None

Exclude:
Freight charges
Excise taxes

2019

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Include:
All products physically shipped from this
establishment during 2019

2018

$

,000.00

$

,000.00

$

,000.00

$

,000.00

B. What was the market value of products shipped to other
domestic plants of your company for further assembly,
fabrication, or manufacture?
(This is a breakout of the $,000.00 reported in Item 5, line
A.)
Include:
A reasonable portion of other costs (company
overhead)
A reasonable portion of profits
Exclude:
Products that are shipped to or on order from your
company’s sales or wholesale offices and sold to
customers outside your company

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C. What percent of the $,000.00 reported in Item 5, line A
was for goods that were ordered or whose movement was
controlled or coordinated over electronic networks?
(Report whole percent.)
E-shipments are online orders accepted for manufactured
products from customers. These include shipments to
other domestic plants of your own company for further
manufacture, assembly, or fabrication. The price and terms
of sale for these shipments are negotiated over an online
system. Payment may or may not be made online.
Include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems

%

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

%

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 7: Employment, Payroll, and Fringe Benefits Additional Information

,
EIN:
Store / Plant:
CFN:

ITEM 7: EMPLOYMENT, PAYROLL, AND FRINGE BENEFITS

Exclude:
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report values in Item 16, line C1.)
Temporary staffing obtained from a staffing service (Report values in Item 16, line C1.)
Purchased professional and technical services (Report values in Item 16, line C9.)
Subcontractors and their employees (Report cost of contract work in Item 16, line A3.)
Fishermen, agricultural employees, members of the Armed Forces, and pensioners carried on your active rolls
A. What was the number of production workers at this establishment (direct labor including first-line supervisors) for the pay period including:
Include:
Workers engaged in fabricating, processing, assembling, inspecting, receiving, packing, warehousing, shipping (but not delivering),
maintenance, repair, janitorial, guard services, product development, auxiliary production for plant’s own use (e.g., power plant),
recordkeeping, and other closely associated services (including truck drivers delivering ready-mixed concrete)
Check
if
None

2. June 12 (Q2)?

3. September 12 (Q3)?

4. December 12 (Q4)?

Sum of four quarters of production workers at this
establishment (direct labor including first-line
supervisors) (Add lines A1 through A4.)

B. What was the Average number of annual production
workers at this establishment (direct labor including
first-line supervisors)?
(Divide sum of four quarters of production workers by
4 and round to the nearest whole number.)

2018 Number

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1. March 12 (Q1)?

2019 Number

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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)
All persons on paid sick leave, paid holidays, and paid vacation during the year at this establishment

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
C. What was the number of all other (non production)
employees at this establishment for the first quarter
(January - March 2019)?
Include:
Officers at this establishment, if a corporation
Supervision above line-supervisor level
Sales employees, including delivery (truck driver and
helpers)
Advertising, clerical, credit, collection, purchasing,
finance, legal, executive, and technical employees
Employees installing and servicing this
establishment's products
Exclude:
Proprietors and partners, if an unincorporated
concern
Temporary staff and leased employees (Report values
in Item 16, line C1.)

D. HOURS WORKED:
What was the annual number of hours worked by the
production workers at this establishment (direct
labor including first-line supervisors) reported in
line B?
Exclude:
Hours paid for vacations, holidays, or sick leave
unless an employee elects to work during their
vacation period. Report only actual hours worked
by such employee. Overtime hours should be
reported as actual hours worked and not as
straight-time equivalent hours.

2019 Hours

2018 Hours
,000

,000

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TOTAL (Add lines B and C.)

E. PAYROLL
What was the annual payroll at this establishment before deductions for:
Exclude:
Employer-paid annual cost for fringe benefits reported in lines F1 through F3
2019

2018

$

,000.00

$

,000.00

2. All other employees reported in line C?

$

,000.00

$

,000.00

TOTAL (Add lines E1 and E2.)

$

,000.00

$

,000.00

What was the first quarter payroll at this
establishment before deductions (January - March
2019)?

$

,000.00

$

,000.00

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1. Production workers reported in line B?

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MA-10000 - Annual Survey of Manufactures
F. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS
(This is the employer’s annual cost at this establishment for legally required programs and programs not required by law. If any of the items here are
maintained in your records only at the company level, allocate their costs to the manufacturing establishment. You may distribute the total on the
basis of the ratio of the payroll of each manufacturing establishment to the total company payroll unless you have developed your own method of
making such allocations. Specify the method used and the approximate portion that has been allocated in the Item 31: REMARKS section at the end
of the instrument.)

Include:
Premium equivalents for self-insured plans and fees paid to third-party administrators (TPAs)
Spread on stock options that are taxable to employees at this establishment as wages

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2019 Annual Survey of Manufactures (ASM)

Exclude:
Employee contributions
Disbursements from trusts or funds to satisfy health insurance claims
What were the employer's annual costs at this establishment for:

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

2. Retirement Plans?
a. Defined benefit pension plans (qualified and
nonqualified) - Plans that specify the benefit to be
paid to employees upon retirement, generally either
a specific amount or a percentage of compensation.
Employer contributions are based on actuarial
computations that include employee's compensation
and years of service and are not allocated to specific
accounts maintained for employees.
b. Defined contribution plans - Plans that define
the employer contributions to a separate account
provided for each employee. The employee
"benefit" at retirement depends on the amount
contributed and the results of the account's activity.
Examples:
Profit sharing plans
Money purchases (e.g., 401k, 403b)
Stock bonus plans (e.g., ESOPs)

Include:
Legally-required fringe benefits (e.g., Social
Security, workers compensation insurance, state
disability insurance programs, long- and short- term
disability, unemployment tax, and Medicare)
Life insurance benefits
"Quality of life” benefits (e.g., childcare assistance,
adoption assistance, subsidized commuting, longterm care insurance, flexible workplace, employerprovided home PC, etc.)
Employer contributions to pre-tax benefit accounts
(e.g., health savings account)
Education assistance
Stock options
Other benefits not specified above (e.g., job-related
travel accident insurance, education assistance,
wellness programs, fitness centers, employee
assistance programs, etc.)

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3. Payroll taxes, employer-paid insurance premiums,
and other employer-paid benefits?

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1. Health Insurance? - Insurance premiums on hospitals,
medical plans, and single-service plans such as dental,
vision, and prescription drug plans

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MA-10000 - Annual Survey of Manufactures
assistance programs, etc.)
Exclude:
Disbursements from trusts or funds to satisfy health
insurance claims

4. TOTAL (Add lines F1 through F3.)

$

,000.00

$

,000.00

$

,000.00

$

,000.00

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 9: Value of Inventories Additional Information

,
EIN:
Store / Plant:
CFN:

ITEM 9: VALUE OF INVENTORIES
Report inventories at cost or market using generally accepted accounting practices, and report all inventories owned by this establishment regardless
of where the inventories are held. If this establishment is part of a multiple-establishment company, assign to each establishment those inventories
that the establishment is responsible for as if it owned them.

A. Finished goods (final output of this
establishment, but still within ownership)?
B. Work-in-process (goods that have been
substantially transformed in the
manufacturing process, but are not yet the
final output of the establishment)?
C. Materials, supplies, fuels, etc. (goods that are
raw inputs to the manufacturing process and
will be substantially altered to produce this
establishment’s output)?

TOTAL (Add lines A through C.)

Check
if
None

Check
if
None

End of 2019

$

,000.00

$

End of 2018

$

,000.00

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

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What was the value of inventories owned by this establishment as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 10: Inventories by Valuation Method Additional Information

,
EIN:
Store / Plant:
CFN:

ITEM 10: INVENTORIES BY VALUATION METHOD

Of the $,000.00 reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2019 and the $,000.00
reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2018, how much is subject to the following
valuation methods:

Check
if
None

Check
if
None

End of 2019

End of 2018

$

,000.00

$

,000.00

2. Average Cost?

$

,000.00

$

,000.00

3. Standard Cost?

$

,000.00

$

,000.00

4. Other non-LIFO valuation method(s)?

$

,000.00

$

,000.00

$

,000.00

$

,000.00

B. LIFO Valuation Method (gross LIFO amount)?

$

,000.00

$

,000.00

TOTAL Non-LIFO and LIFO methods (Add TOTAL
of lines A1 through A4 and B.)

$

,000.00

$

,000.00

C. What is the amount of LIFO reserve (if any)?
(If the value of reserve is negative, use "-".)

$

,000.00

$

,000.00

Describe

TOTAL (Add lines A1 through A4.)

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1. First-In, First-Out (FIFO)?

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A. Non-LIFO (Last-In, First-Out) valuation methods

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MA-10000 - Annual Survey of Manufactures
Item 13: Capital Expenditures Additional Information

EIN:
Store / Plant:
CFN:
ITEM 13: CAPITAL EXPENDITURES
Include:
Dollar value of capital expenditures
Buildings, structures, and equipment used directly or indirectly by this establishment to produce the goods and services reported in Item 5, line
A and Item 22

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2019 Annual Survey of Manufactures (ASM)

What were the capital expenditures for new and used depreciable assets in 2019 for:
A. New and used buildings and other structures?

2019

2018

$

,000.00

$

,000.00

1. Automobiles, trucks, etc. for highway use?

$

,000.00

$

,000.00

2. Computers and peripheral data processing
equipment?

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

B. New and used machinery and equipment?

3. All other expenditures for machinery and
equipment?
TOTAL (Add lines A and B1 through B3.)

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Exclude:
The value of land on which structures stand

Check
if
None

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 14: Rental Payments Additional Information

EIN:
Store / Plant:
CFN:
ITEM 14: RENTAL PAYMENTS
Include:
Operating leases
Exclude:
Capital leases (leases with a contract to own at the end of the lease)
At this establishment, what were the payments for:
A. Rental or lease of buildings and other structures?
Check
if
None

2019

2018

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

B. Rental or lease of machinery and equipment?
Include:
Production, loading, and transportation machinery
and equipment
Construction equipment
Tools
Office equipment
Furniture
Vehicles
Exclude:
Computer time-sharing charges for machinery and
equipment rentals from computer service companies
where the computer is not on site at the
establishment

TOTAL (Add lines A and B.)

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Include:
Job-site trailers
Land on which the buildings and other structures
stand

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 16: Selected Expenses Additional Information

,
EIN:
Store / Plant:
CFN:

ITEM 16: SELECTED EXPENSES

A. For this establishment, what were the production-related costs in 2019 for:

Include:
Cost of production-related materials purchased
by this establishment for other companies
(contractors).
Exclude:
Non-production-related expenses that were paid
to other companies (contractors) by this
establishment. (Report these expenses on the
next screen in Item 16, line C.)

Check
if
None

2019

2018

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

5. Purchased electricity? (Report comparable quantity
on line B1.)

$

,000.00

$

,000.00

TOTAL (Add lines A1 through A5.)

$

,000.00

$

,000.00

2. Products bought and sold without further processing?
(Report sales in Item 5, line A and in Wholesaling
Services product codes in Item 22.)
3. Work done for you by others on your materials (work
contracted to others)? (Report on line A1 the cost of
production-related materials purchased by this
establishment for other companies (contractors).)
4. Purchased fuels consumed for heat, power, or the
generation of electricity? (Report on line B2 the
quantity of electricity generated (Gross less
generating station use).)

B. For this establishment, what was the quantity of:
1. Purchased electricity? (Quantity comparable to cost
reported in line A5)
2. Generated electricity (gross less generating station
use)? (Quantity comparable to cost reported in line
A4)
3. Electricity sold or transferred to other
establishments? (Also include quantity on lines B1
and/or B2.)

2019 Kilowatt Hours

2018 Kilowatt Hours

,000

,000

,000

,000

,000

,000

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1. Materials, parts, containers, packaging, supplies, etc.
used for manufacturing processes, repairs, services
for others, or other operating supplies?

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures

Item 16: Selected Expenses - Continued

,
EIN:
Store / Plant:
CFN:

ITEM 16: SELECTED EXPENSES

C. What were the other operating expenses paid by this establishment in 2019 for:

1. Temporary staff and leased employees? (Professional
Employer Organizations and staffing agencies for
personnel)
Include:
All charges for payroll, benefits, and services

Check
if
None

2019

2018

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

2. Expensed equipment? (Expensed computer
hardware and other equipment)
Include:
Copiers
Fax machines
Telephones
Shop and lab equipment
CPUs
Monitors
Laptops
Tablets
Exclude:
Packaged software (Report on line C3.)
Leased and rented equipment (Report in Item
14, line B.)
3. Expensed purchases of software? (Purchases of
prepackaged, custom-coded or vendor-customized
software)
Include:
Software developed or customized by others
Web-design services and purchases
Licensing agreements
Upgrades of software
Maintenance fees related to software upgrades
and alterations
Exclude:
Costs associated with computer software
developed within your own company
Capitalized computer software costs

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Include:
Expenses normally considered as non-production-related costs purchased from other companies

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OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

MA-10000 - Annual Survey of Manufactures

4. Purchased communication services?
Include:
Telephone, cellular, and fax services
Computer-related communications (e.g.,
Internet, connectivity, online)
Other wired and wireless communication
services
Credit card transaction fees

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

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2019 Annual Survey of Manufactures (ASM)

5. Data processing and other purchased computer
services?

Exclude:
Services provided by other establishments of
this company (such as a separate central data
processing unit)
Expensed integrated systems (Report in line
C4.)
Repair and maintenance of computer equipment
(Report on line C6.)
Payroll processing and credit card transaction
fees (Report payroll processing fees on line C9
and credit card transaction fees on line C4.)
Expenses for telecommunication services (e.g.,
Internet, connectivity, telephone) (Report on
line C4.)

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Include:
Computer facilities management services
Computer input preparation
Data storage
Computer time rental
Optical scanning services
Other computer-related advice and services,
including training

6. Purchased repairs and maintenance to buildings
and/or machinery and equipment?

Exclude:
Extensive "repairs" or reconstruction that is
capitalized. Report these as a capital
expenditure in Item 13.
Costs of materials, parts, and supplies directly
incurred by this establishment using its own
work force to perform repairs and maintenance

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

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Include:
Repairs for painting, roof repairs, replacing
parts, over-hauling of equipment, and other
repairs chargeable as current operating costs
Cost of repair and maintenance of any leased
property if this establishment assumes the cost

19

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OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures

7. Water, sewer, refuse removal, and other non-electric
utility payments?
(Report electric utility payments on line A5. If the
costs of these utilities are included in a lease or rental
payment, report in Item 14, line A.)
Include:
Cost of hazardous waste removal or treatment
Exclude:
Cost of refuse removal services if included in
rental payments
Machinery or equipment reported as a capital
expenditure in Item 13
Cost of salaries paid to employees of this
establishment whose work involves refuse
removal and/or hazardous waste removal or
treatment

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

$

,000.00

8. Purchased advertising and promotional services?
Include:
Marketing and public relations services
Exclude:
Salaries paid to employees of this establishment
for advertising work
9. Purchased professional and technical services?
Include:
Management consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll processing
Architectural
Engineering
Other professional services (i.e. janitorial,
security, or landscape services)
Exclude:
Salaries paid to your own employees for these
services (Report in Item 7.)
10. Governmental taxes and licensing fees? (Payments
to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

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$

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20

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Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

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2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures

11. All other operating expenses not reported
elsewhere?
Exclude:
Purchases of merchandise for resale
Non-operating expenses
Other expenses reported in Items 7, 13, 14,
and 16

$

,000.00

$

,000.00

$

,000.00

$

,000.00

Describe

TOTAL (Add lines 1 through 11.)

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2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

21

Do Not Submit - For Informational Purposes ONLY

OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

MA-10000 - Annual Survey of Manufactures
Item 17: Principal Business or Activity

,
EIN:
Store / Plant:
CFN:

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2019 Annual Survey of Manufactures (ASM)

ITEM 17: PRINCIPAL BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's principal kind of business or activity in 2019?
If none of the provided selections seem appropriate or selection options are not provided, provide a specific description to search for an appropriate
business activity.
Select only ONE.

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2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

22

Do Not Submit - For Informational Purposes ONLY

OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

Do Not Mail - Report Online

2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 22: Detail of Sales, Shipments, Receipts, or Revenue

,
EIN:
Store / Plant:
CFN:

ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what was the value of each product or service?

Exclude:
Wholesale products (previously Resales), which include products that are bought from other establishments or transferred from other
establishments of your company and then sold without further manufacture, processing, or assembly by this establishment. Report
Wholesale products in any relevant prelisted product code, click the "Add Product Not Listed" button and search for an existing Wholesale
product, or use the section for "Add product(s) not listed above."
Products made from materials owned by others (i.e., the customer). Report your commission or contract receipts in the appropriate
Contract Manufacturing product line(s).
Freight charged
Excise taxes

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General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are
acceptable.

The manufactured products and services listed below are generally made in your industry. If you make products or have revenue from sources not
listed, click the “Add Product Not Listed” button and search for an existing product, or use the section for “Add product(s) not listed above.”

Manufacturing of Products – Report the value of the products shipped and services performed at the net selling value, free on board (FOB) plant to
the customer, after discounts and allowances.

Include:
Products made elsewhere by others from materials supplied by this establishment. Report these products on the specific lines as if they were
made in this establishment.
Products transferred to other establishments within your company. These products should be assigned the full economic value (market value);
i.e., include all direct costs of production and a reasonable proportion of all other costs and profits.

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2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

23

Do Not Submit - For Informational Purposes ONLY

OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

Do Not Mail - Report Online

2019 Annual Survey of Manufactures (ASM)
MA-10000 - Annual Survey of Manufactures
Item 28: Special Inquiries - Industrial Robots and Robotic Equipment

,
EIN:
Store / Plant:
CFN:

ITEM 28: SPECIAL INQUIRIES - INDUSTRIAL ROBOTS AND ROBOTIC EQUIPMENT

REPORTING INDUSTRIAL ROBOTIC EQUIPMENT
Estimates are acceptable.
In (A), report capital expenditures for new and used industrial robotic equipment for this establishment. Include other one-time costs, including
software and installation.
In (B) and (C), report the number of industrial robots in operation at this establishment and purchased for this establishment.
For robots purchased as part of a work cell or other integrated robotic equipment, it may not be possible to report the expenditures on only the
robots. In this case, report the expenditures on the integrated robotic equipment.
Examples of operations industrial robotic equipment can perform may include:
Palletizing
Pick and place
Machine tending
Machine handling
Dispensing
Welding
Packing/repacking

A. What were the capital expenditures for new and used
industrial robotic equipment, including software,
installation, and other one-time costs?

B. What was the number of industrial robots IN OPERATION
at this plant? Refer to instructions above for definitions.
If you are unable to provide the number of industrial robots
IN OPERATION, please explain:

Check
if
None

2019
$

2018
,000.00

2019 Number

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

$

2018 Number

,000.00

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Exclude:
Automated guided vehicles (AGVs)
Driverless forklifts
Automated storage and retrieval systems
CNC machining equipment

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INDUSTRIAL ROBOTIC EQUIPMENT
Industrial robotic equipment (or industrial robots) are automatically controlled, reprogrammable, and multipurpose machines used in the
industrial automated operations.
Industrial robots may be mobile, incorporated into stand-alone stations, or integrated into a production line.
An industrial robot may be part of a robotic cell (or work cell) or incorporated into another piece of equipment.
Industrial robots are commonly used in operations such as welding, material handling, machine tending, dispensing, cleanroom, and pick and
place.

24

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OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

MA-10000 - Annual Survey of Manufactures

C. What was the number of industrial robots PURCHASED for
this plant? Refer to instructions above for definitions.
If you are unable to provide the number of industrial robots
PURCHASED, please explain:

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2019 Annual Survey of Manufactures (ASM)

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2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

25

Do Not Submit - For Informational Purposes ONLY

OMB No.: 0607-0449

Mailing this survey to the U.S. Census Bureau does not fulfill your reporting obligation

Approval Expires: 04/30/2022

MA-10000 - Annual Survey of Manufactures
Item 31: Remarks

,
EIN:
Store / Plant:
CFN:

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2019 Annual Survey of Manufactures (ASM)

ITEM 31: REMARKS (Optional - Enter remarks only if necessary)
Please use this space only for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)

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You have 1000 characters remaining

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2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

26

U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
FORM

MANUFACTURERS’ UNFILLED ORDERS SURVEY

MA-3000
OMB No. 0607-0561: Approval Expires 10/31/2021

(01-28-2020)

Please correct errors in name, address, and ZIP code. ENTER street and number if not shown.

DUE DATE:

Report by mail:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
OR
Report electronically:

https://portal.census.gov
Authentication Code:

Need help or have questions
about completing this form?
Call: (301) 763-1779

YOUR RESPONSE IS REQUIRED BY LAW. Title 13 United States Code (U.S.C.), Sections 131 and 182, authorizes this collection. Sections 224 and 225 require your response. The U.S. Census Bureau is required by Section 9 of the
same law to keep your information CONFIDENTIAL and can use your responses only to produce statistics. The Census Bureau is not permitted to publicly release your responses in a way that could identify your business, organization,
or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number is 0607-0561 and appears at the upper right of this page. Without this approval, we could not conduct this survey.
We estimate the time to complete this survey varies from 15 minutes for single divisional companies to 60 minutes for multi-divisional companies, with an average of 30 minutes. More information about this estimate and an address where
you may write with comments is on the back of this form.

Name of person to be contacted regarding this report (Please print or type)

Area Code

Number

Title

Email

Extension

Area Code

Telephone

Number

Fax

IMPORTANT - Please read the instructions included with this form, then complete the survey below.
Provide company name (sold or acquired), address, and EIN (if applicable) below.
For additional entries, go to "Remarks".

CHANGE IN OPERATIONAL STATUS

➤

Ceased operations
Sold to another company

Period covered by data (if other than calendar year)
2019
2018
Year
Month Day
Month Day

– Provide company name (sold or acquired), address, and
EIN (if applicable) at right

Acquired another company

FROM

Month

Day

Year

Month

DATE OF OPERATIONAL
STATUS CHANGE:
Selected In-Scope Manufacturing Activities
(See Instructions and Activities List)
U.S. MANUFACTURING ONLY
(a)

Line
No.
Code

Day

Year

Month

TO

Description

Day

Year

TO

Annual Sales
2019

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2019

Annual Sales
2018

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2018

(b)

(c)

(d)

(e)

1

,000

,000

,000

,000

2

,000

,000

,000

,000

3

,000

,000

,000

,000

4

,000

,000

,000

,000

Please continue on the reverse side for additional manufacturing activities and/or remarks.

30009013

§?!{.¤

– Provide company name and address at right

Year

FROM

2
Selected In-Scope Manufacturing Activities
(See Instructions and Activities List)
U.S. MANUFACTURING ONLY
(a)

Line
No.
Code

Description

Annual Sales
2019

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2019

Annual Sales
2018

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2018

(b)

(c)

(d)

(e)

5

,000

,000

,000

,000

6

,000

,000

,000

,000

7

,000

,000

,000

,000

8

,000

,000

,000

,000

9

,000

,000

,000

,000

10

,000

,000

,000

,000

11

,000

,000

,000

,000

12

,000

,000

,000

,000

13

,000

,000

,000

,000

14

,000

,000

,000

,000

15

,000

,000

,000

,000

16

,000

,000

,000

,000

17

,000

,000

,000

,000

18

,000

,000

,000

,000

19

,000

,000

,000

,000

20

,000

,000

,000

,000

21

,000

,000

,000

,000

22

,000

,000

,000

,000

23

,000

,000

,000

,000

24

,000

,000

,000

,000

25

,000

,000

,000

,000

30009021

§?!{6¤

Remarks

CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Signature of authorized person

Date

We estimate the time to complete this survey varies from 15 minutes for single divisional companies to 60 minutes for multi-divisional companies, with
an average of 30 minutes, 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: EID Survey Comments 0607-0561, U.S. Census Bureau, 4600 Silver Hill Road, Room
EID-7K071, Washington, DC 20233. You may email comments to eid.m3.qs@census.gov. Be sure to use “EID Survey Comments 0607-0561” as the
subject.

Form MA-3000

(01-28-2020)