Service Annual Survey

Attachment 3 - Detailed Electronic Worksheet Collection

Form No.

Description

Tax Status

Separate Tax Status Form* (see Footnotes)

Tax Status (question 5)

Total Revenue (question 6)

Product Data (question 6)

Revenues from Electronic Sources (question 8)

Source of Revenue (question 9)

Analysis of Motor Carrier Operations (question 10)

Patient Visits (question 10)

Class of Customer (question 11)

Inpatient/ Outpatient Activity (question 11)

Year-end Inventories (question 12)

Electronic Health Records (question 12)

Exported Services Revenue (question 13)

Benefits Paid (Losses) OR Direct Losses Incurred (see Footnotes) (question 13)

Operating Expenses (question 14)

Hotel Management (question 15)

SA-22010

Electric Power Generation, Transmission and Distribution; Natural Gas Distribution

T

x

x

x

x

x

SA-22130

Water, Sewage and Other Systems

T

x

x

x

x

x

SA-48000

Scenic and Sightseeing Transportation; Support Activities for Transportation

T

x

x

x

SA-48100

Air Transportation

T

x

x

x

x

SA-48121

Nonscheduled Chartered Passenger Air Transportation

T

x

x

x

x

SA-48300

Water Transportation

T

x

x

x

x

SA-48400

Truck Transportation

T

x

x

x

x

x

x

SA-48500

Transit and Ground Passenger Transportation

T

x

x

x

x

SA-48610

Pipeline Transportation

T

x

x

x

x

SA-49000

Postal Service; Couriers and Messengers; Warehousing and Storage

T

x

x

x

SA-51000

Record Production; Other Sound Recording Industries

T

x

x

x

x

SA-51111

Newspaper Publishers

T

x

x

x

x

x

x

x

SA-51112

Periodical Publishers

T

x

x

x

x

x

x

x

SA-51113

Book Publishers

T

x

x

x

x

x

x

x

SA-51114

Directory and Mailing List Publishers

T

x

x

x

x

x

x

x

SA-51118

Greeting Card Publishers

T

x

x

x

x

x

x

SA-51119

All Other Publishers

T

x

x

x

x

x

x

SA-51120

Software Publishers

T

x

x

x

x

x

x

x

SA-51210

Motion Picture and Video Production; Motion Picture and Video Distribution

T

x

x

x

x

x

x

SA-51213

Motion Picture and Video Exhibition

T

x

x

x

x

x

SA-51219

Postproduction Services and Other Motion Picture and Video Industries

T

x

x

x

x

x

x

SA-51222

Integrated Record Production/Distribution

T

x

x

x

x

x

SA-51223

Music Publishers

T

x

x

x

x

x

SA-51224

Sound Recording Studios

T

x

x

x

x

x

SA-51510

Radio and Television Broadcasting

T

x

x

x

x

SA-51520

Cable and Other Subscription Programming

T

x

x

x

x

SA-51710

Wired Telecommunications Carriers

T

x

x

x

x

x

SA-51721

Wireless Telecommunications Carriers (except Satellite)

T

x

x

x

x

x

SA-51730

Telecommunications Resellers

T

x

x

x

x

x

SA-51740

Satellite Telecommunications

T

x

x

x

x

SA-51790

All Other Telecommunications

T

x

x

x

SA-51820

Data Processing, Hosting, and Related Services

T

x

x

x

x

SA-51911

News Syndicates

T

x

x

x

x

SA-51912

Libraries and Archives

T/E

x

x

x

x

x

SA-51913

Internet Publishing and Broadcasting and Web Search Portals

T

x

x

x

x

x

SA-51919

All Other Information Services

T

x

x

x

x

SA-52000

Monetary Authorities-Central Bank; Securities and Commodity Exchanges ; Miscellaneous Intermediation ; All Other Financial Investment Activities; Direct Life Insurance Carriers; Direct Insurance (except Life, Health, and Medical) Carriers ; Agencies, Brokerages, and Other Insurance Related Activities

T

x

x

x

SA-52200

Credit Intermediation and Related Activities

T

x

x

x

x

SA-52311

Investment Banking and Securities Dealing; Securities Brokerage

T

x

x

x

x

x

SA-52312

Commodity Contracts Dealing; Commodity Contracts Brokerage

T

x

x

x

x

x

SA-52390

Portfolio Management; Investment Advice

T

x

x

x

x

x

SA-52400

Direct Health and Medical Insurance Carriers

T

x

x

x

x

x

SA-52410

Direct Life Insurance Carriers

T

x

x

x

x

x

SA-52412

Direct Property and Casualty Insurance Carriers; Direct Title Insurance Carriers; Other Direct Insurance (except Life, Health, and Medical) Carriers

T

x

x

x

x

SA-52413

Reinsurance Carriers

T

x

x

x

x

SA-53000

Passenger Car Rental; Passenger Car Leasing; Truck, Utility Trailer, and RV (Recreational Vehicle) Rental and Leasing; Consumer Goods Rental; General Rental Centers; Commercial and Industrial Machinery and Equipment Rental and Leasing; Real Estate; Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)

T

x

x

x

SA-53110

Lessors of Real Estate

T

x

x

x

x

SA-53120

Offices of Real Estate Agents and Brokers; Activities Related to Real Estate

T

x

x

x

x

SA-54000

Environmental Consulting Services; Landscape Architectural Services; Drafting Services; Building Inspection Services; Geophysical Surveying and Mapping Services; Surveying and Mapping (except Geophysical) Services; Testing Laboratories; Other Scientific and Technical Consulting Services

T

x

x

x

x

SA-54002

Media Buying Agencies; Media Representatives; Display Advertising; Specialized Design Services; Advertising Material Distribution Services; Other Services Related to Advertising; Other Professional, Scientific, and Technical Services

T

x

x

x

SA-54011

Offices of Lawyers; Other Legal Services

T/E

x

x

x

x

x

x

x

SA-54131

Architectural Services

T

x

x

x

x

x

SA-54133

Engineering Services

T

x

x

x

x

x

SA-54150

Computer Systems Design and Related Services

T

x

x

x

x

x

SA-54160

Management Consulting Services

T

x

x

x

x

x

SA-54170

Scientific Research and Development Services

T/E

x

x

x

x

x

x

x

SA-54181

Advertising Agencies

T

x

x

x

x

SA-54182

Public Relations Agencies

T

x

x

x

x

SA-54186

Direct Mail Advertising

T

x

x

x

x

SA-54210

Accounting, Tax Preparation, Bookkeeping, and Payroll Services

T

x

x

x

x

SA-56000

Office Administrative Services; Facilities Support Services; Business Support Services; Convention and Visitors Bureaus; Investigation and Security Services; Services to Buildings and Dwellings; Other Support Services; Remediation Services

T

x

x

x

SA-56130

Employment Placement Agencies; Temporary Help Services

T

x

x

x

x

SA-56132

Executive Search Services

T

x

x

x

x

SA-56134

Professional Employer Organizations

T

x

x

x

x

x

SA-56150

Travel Agencies; All Other Travel Arrangement and Reservation Services

T

x

x

x

x

x

x

SA-56152

Tour Operators

T

x

x

x

x

x

x

SA-56210

Waste Collection

T

x

x

x

x

SA-56220

Waste Treatment and Disposal

T

x

x

x

x

SA-56291

Materials Recovery Facilities; All Other Waste Management Services

T

x

x

x

x

SA-61000

Educational Services

T/E

x

x

x

x

SA-62000

Offices of Physicians; Offices of Dentists; Offices of Other Health Practitioners; Outpatient Care Centers; Home Health Care Services; Hospitals

T/E

x

x

x

x

x

x

x

SA-62150

Medical and Diagnostic Laboratories

T

x

x

x

x

x

x

SA-62190

Other Ambulatory Health Care Services

T/E

x

x

x

x

x

x

x

SA-62200

General Medical and Surgical Hospitals; Psychiatric and Substance Abuse Hospitals; Specialty Hospitals

T/E

x

x

x

x

x

x

x

SA-62300

Nursing and Residential Care Facilities

T/E

x

x

x

x

x

x

SA-62400

Social Assistance

T/E

x

x

x

x

x

x

SA-71000

Agents and Managers for Artists, Athletes, Entertainers, and Other Public Figures; Amusement Arcades; Gambling Industries

T

x

x

x

SA-71002

Promoters of Performing Arts, Sports, and Similar Events; Museums, Historical Sites, and Similar Institutions; Other Amusement and Recreation Industries

T/E

x

x

x

x

x

x

SA-71110

Performing Arts Companies

T/E

x

x

x

x

x

x

x

SA-71120

Spectator Sports

T

x

x

x

x

SA-71150

Independent Artists, Writers, and Performers

T

x

x

x

x

SA-71311

Amusement and Theme Parks

T

x

x

x

x

SA-72000

Other Traveler Accommodation; RV (Recreational Vehicle) Parks and Recreation Camps; Rooming and Boarding Houses; Food Services and Drinking Places

T

x

x

x

SA-72100

Traveler Accommodation

T

x

x

x

x

x

SA-81000

Repair and Maintenance; Personal and Laundry Services

T

x

x

x

SA-81300

Grantmaking, Civic, Professional, and Similar Organizations

E

x

x

x

x

x

Footnotes:

Tax Status:

T: Taxable, T/E: Taxable and Tax-Exempt, E: Tax-Exempt

*A separate taxable and tax-exempt form will be created for each applicable form number marked (x).

Question 1A:

Mailing Address

Question 1B:

Survey Coverage

Question 2:

EIN (E forms only)

Question 3:

Organizational Change

Question 4:

Reporting Period

Question 5:

Tax Status, Number of Establishments (SA-72100A/E)

Question 6:

Sales, Receipts, or Revenue

Question 7:

Sales Tax (Only the first year of new sample)

Question 8:

Revenues from Electronic Sources

Question 9:

Source of Revenue

Question 10:

Analysis of Motor Carrier Operations (sub-sector 484), Patient Visits (sub-sector 621)

Questioin 11:

Class of Customer, Inpatient/Outpatient Activity

Question 12:

Inventories, Electronic Health Records

Question 13:

Export Revenue, Benefits Paid (Losses) (SA-52400A/E & SA-52410A/E), Direct Losses Incurred (SA-52412A/E and SA-52413A/E)

Question 14:

Operating Expenses

Question 15:

Hotel Management (SA-72100A/E)

Question 16:

N/A

Question 17:

Remarks

Question 18:

Contact Information