various Variable Content for Item 26 -- Special Inquiries

Attachment D-11
2007 Economic Census

Information; Professional, Scientific, and Technical Services; Management of
Companies and Enterprises; Administrative and Support and Waste Management
and Remediation Services; Educational Services; Health Care and Social
Assistance; Arts, Entertainment, and Recreation; and Other Services (Except
Public Administration) Sectors

Variable Content for Item 26 – Special Inquiries

VARIABLE CONTENT OF ITEM 26. - SPECIAL INQUIRIES

The “Special Inquiries” item contains 24 separate inquiries. Those inquiries appear in
this attachment in the following order:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

Media
Franchise
New Construction, Including Renovation
Maintenance and Repair
Personnel by Occupation
Source of Research and Development Funds
Research and Development Acquisition
Proprietors and Partners of Unincorporated Businesses
Expenses of Legal Aid Societies
Single and Multiple Services
Computer System Integration
Gross Billings
Employment by Function
Merchandise Sales
Professional Employer Organizations
Placement Services
Patient Services
Government Ownership and Control
Grants, Similar Payments, and Transferred Contributions of TaxExempt Establishments
Social Assistance
Repair Receipts
Laundry Work
Drycleaning
Repayments of Cash Advances

Some inquiries have more than one variation. Each variation will show in this attachment
with the form numbers that the variation appears on noted.

IN-51101
#L MEDIA
Estimate the percent of dollar value receipts from subscriptions, sales, and advertising reported in
? , sum of lines 1 and 2, by type of dissemination media.

$$00
Percent

1. Print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

2. Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

3. Other media, including CD-ROM/DVD-ROM, diskette or cassette, and microform. . . . . . . . .

%

4. Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

Also on IN-51102, IN-51103, IN-51105

IN-51103,
PS-54101, PS-54102, PS-54110, PS-54111,
AS-56101, AS-56102, AS-56103, AS-56104, AS-56105, AS-56202, AS-56203,
ED-61101,
HC-62106, HC-62107, HC-62108, HC-62401, HC-62402,
AE-71302, AE-71303, AE-71304,
OS-81101, OS-81102, OS-81201, OS-81203, OS-81204, OS-81205
#L FRANCHISE
Was this establishment operating under a trademark authorized by a franchisor in $$00?
(Mark "X" only ONE box.)
0237

Yes - franchisee owned establishment

0238

Yes - franchisor owned establishment

0239

No

IN-51501, IN-51701, IN-51702, IN-51750, IN-51751
#L NEW CONSTRUCTION, INCLUDING RENOVATION
1. Was this establishment involved in new construction or renovation of buildings, structures, or communication
lines during $$00?
0991

Yes

0992

No - Go to line B

2. Capital expenditures for new construction, including renovation
(Include labor and materials. Exclude land and the value of production machinery
and equipment not an integral part of a structure.) . . . . . . . . . . . . . . . .

$ Mil.

$$00
Thou.

Dol.

0900

Mark "X"
if None

3. Percentage of the capital expenditures reported in line 2 that represented work done by
your own employees as opposed to work done by contractors or other hired labor . . .

$$00
Percent

%
0901

IN-51501, IN-51701, IN-51702, IN-51750, IN-51751
#L MAINTENANCE AND REPAIR
1. Was this establishment involved in maintenance and repair of buildings, structures, or communication lines
owned by your enterprise during $$00?
(Report "No" if expenses were limited to activities such as janitorial services, cleaning, lawn maintenance, etc.)
0916

Yes

0917

No - Go to

?

2. Expenses for maintenance and repairs
(Exclude expenses for such activities as janitorial services, cleaning, lawn
maintenance, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$ Mil.

$$00
Thou.

Dol.

0918

3. Percentage of the expenses for maintenance and repairs reported in line 2 that
represented work done by your own employees as opposed to work done by
contractors or other hired labor . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None

$$00
Percent

%
0919

PS-54101
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation. The total
should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions (secretaries, etc.) on the one line which best describes the
primary nature of their work.
Line 1 - Lawyers who are members of a professional service corporation should be included here. The proprietor or
partners not considered employees of the firm for federal tax purposes should be included in part B, PROPRIETORS
AND PARTNERS OF UNINCORPORATED BUSINESSES.
$$00
Cen- Number of employees
for pay period
sus including March 12,
use
$$00

Occupation

1.

Associate lawyers (employees of firm) . . . . . . . . . . . . . . . . . . . . . . . .

3231

2.

Paraprofessionals (law clerks, legal assistants, investigators, etc.) . . . . . . . . . . .

3232

3.

Managers and other nonlegal professional staff . . . . . . . . . . . . . . . . . . . .

3233

4.

All other (stenographers, bookkeepers, etc.) . . . . . . . . . . . . . . . . . . . . .

3234

5.

TOTAL (Sum of lines 1 through 4 should equal

3200

?

, line A. . . . . . . . . . . . . . . .

PS-54059
#L PERSONNEL BY OCCUPATION
Enter employment and payroll reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation.
The total should equal the number reported in ? , line A.
Enter personnel who perform a variety of functions (e.g., those with multiple job duties, licenses, or registrations)
on the one line which best describes the primary nature of their work. Scientific research and development
establishments should report scientists, engineers, and technicians/technologists on lines 4a and 4b.
$$00
Occupation

1.

Accounting personnel
a.

2.

Certified public accountants (employees of the firm) . . . . . . . . . . . . . . .

3251

b. Public accountants not certified (employees of the firm) . . . . . . . . . . . . . .
Legal personnel

3252

a.

3.

4.

Associate lawyers (employees of the firm) . . . . . . . . . . . . . . . . . . . .

3231

b. Legal paraprofessionals (Include law clerks, legal assistants, investigators, etc.) . .
Computer personnel

3232

a.

Computer programmers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3201

b.

Systems engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3202

c. Other computer-related personnel . . . . . . . . . . . . . . . . . . . . . . . .
Research and development personnel

3203

a.

5.

Number of employees
Cenfor pay period
sus
use including March 12,
$$00

Scientists and engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Technicians/technologists . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other personnel and technology
a.

Licensed or registered architects . . . . . . . . . . . . . . . . . . . . . . . .

3241

b.

Licensed or registered engineers . . . . . . . . . . . . . . . . . . . . . . . .

3242

c.

Licensed or registered surveyors . . . . . . . . . . . . . . . . . . . . . . . .

3243

d.

Certified engineering technicians . . . . . . . . . . . . . . . . . . . . . . . .

3244

e.

Other technically-trained personnel . . . . . . . . . . . . . . . . . . . . . . .

3362

6.

Sales personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3206

7.

Managers, management consultants, and all other professionals . . . . . . . . . . . .

3269

Manufacturing/production workers . . . . . . . . . . . . . . . . . . . . . . . . . .
All other personnel (Include personnel such as secretarial, maintenance, security, and
9. other support staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. TOTAL (Sum of lines 1 through 16 should equal ? , line A for column 1 and ? , line B1
for column 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0325

8.

3270

3200

PS-54107
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the number reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Number of employees
CenCenfor pay period
sus
sus
including
March
12,
use
use
$$00

1.

Computer programmers . . . . . . . . . . . . . . . . . . .

3201

3261

2.

Systems engineers . . . . . . . . . . . . . . . . . . . . .

3202

3262

3.

Other computer-related personnel . . . . . . . . . . . . . .

3203

3263

4.

Engineers, except systems . . . . . . . . . . . . . . . . . .

3204

3264

5.

Other technical personnel, except computer . . . . . . . . . .

3205

3265

6.

Sales personnel . . . . . . . . . . . . . . . . . . . . . . .

3206

3266

7.

Manufacturing/production workers . . . . . . . . . . . . . .

0325

3267

8.
9.

All other personnel . . . . . . . . . . . . . . . . . . . . .
TOTAL (Sum of lines 1 through 8 should equal ? , line A for
column 1) . . . . . . . . . . . . . . . . . . . . . . . . . .

3208

3268

3200

3260

Number of active
proprietors or
partners for pay
period including
March 12, $$00

PS-54103
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the amount reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated businesses operating
at more than one location should report the proprietor or partners at the one location at which they spend most of
their working time.
Enter each employee, proprietor, or partner on one line only. Include personnel with multiple licenses or registrations
on the line which best describes the primary nature of their work.
Number of employees
CenCenfor pay period
sus
sus
including
March
12,
use
use
$$00

1.

Licensed or registered architects . . . . . . . . . . . . . . .

3241

3291

2.

Licensed or registered engineers . . . . . . . . . . . . . . .

3242

3292

3.

Licensed or registered surveyors . . . . . . . . . . . . . . .

3243

3293

4.

Certified engineering technicians . . . . . . . . . . . . . . .

3244

3294

5.

Computer programmers . . . . . . . . . . . . . . . . . . .

3201

3261

6.

Systems engineers . . . . . . . . . . . . . . . . . . . . .

3202

3262

7.

Other computer-related personnel . . . . . . . . . . . . . .

3203

3263

8.

Other technically-trained personnel . . . . . . . . . . . . . .

3245

3295

9. All other personnel . . . . . . . . . . . . . . . . . . . . .
10. TOTAL (Sum of lines 1 through 9 should equal ? , line A for
column 1) . . . . . . . . . . . . . . . . . . . . . . . . . .

3246

3296

3200

3260

also PS-54105, PS-54112

Number of active
proprietors or
partners for pay
period including
March 12, $$00

PS-54102
#L PERSONNEL BY OCCUPATION
Enter employment and payroll reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational
category. The total should equal the number reported in ? , line A.
Line 1b - Licensed, registered, and public accountants, and accounting practitioners who are not certified by the state
should be included here.
Lines 1a and 1b - Accountants who are members of a professional service corporation should be included here. The
proprietor or partners not considered employees of the firm for federal tax purposes should be included on line 1c,
PROPRIETORS AND PARTNERS OF UNINCORPORATED BUSINESSES.
Enter personnel who perform a variety of functions on the one line which best describes the primary nature of their
work.
Number of employees
Cenfor pay period
sus
use including March 12,
$$00

1.

2.
3.

Type of employee working for this establishment
a. Certified public accountants (employees of firm) . . . . . . . . . . . . . . . . . .

3251

b. Public accountants not certified (employees of firm) . . . . . . . . . . . . . . . .

3252

c. Management consultants and other nonaccounting professional staff . . . . . . . .

3253

d. All others, including clerical and other support staff . . . . . . . . . . . . . . . .
Employees whose payroll is processed by this establishment, but who are not
management and administrative employees of this establishment (i.e., employees or
individuals serviced by payroll or talent payment services) . . . . . . . . . . . . . . .
TOTAL (Sum of lines 1a through 2 should equal ? , line A for column 1 and ? , line B1
for column 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3254

3255

3200

PS-54119
#L PERSONNEL BY OCCUPATION
Enter employment and payroll reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupation.
The total should equal the number reported in ? , line A. Enter personnel who perform a variety of functions (e.g.,
those with mutiple job duties, licenses, or registrations) on the one line which best describes the primary nature of
their work.
Census
use

1.

2.
3.

4.

Research and development personnel
a. Scientists and engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

b. Technicians/technologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Administrative and professional mangement staff (e.g., executives, accounting,
personnel/human relations, legal) . . . . . . . . . . . . . . . . . . . . . . . . . . .
All other personnel (Include personnel such as secretarial, maintenance, security, and
other support staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

TOTAL (Sum of lines 1a through 3 should equal

0000

?

, line A . . . . . . . . . . . . . . .

0000

0000

Number of
employees for pay
period including
March 12, $$00

HC-62102, HC-62104
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the amount reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated practices operating at
more than one location should report the proprietor or partners at the one location at which they spend most of their
working time.
Cen- Number of employees Cenfor pay period
sus including March 12, sus
use
use
$$00

1.

Allopathic physicians - licensed practitioners having M.D.
degree . . . . . . . . . . . . . . . . . . . . . . . . .
Osteopathic physicians - licensed practitioners having D.O.
degree . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic physicians - licensed practitioners having D.C.
degree . . . . . . . . . . . . . . . . . . . . . . . . .
Podiatric physicians - licensed practitioners having D.P.M.
degree . . . . . . . . . . . . . . . . . . . . . . . . .

. .

3211

3271

. .

3212

3272

. .

3214

3274

. .

3215

3275

5.

Optometrists - licensed practitioners having O.D. degree . . .

3216

3276

6.

Dentists - licensed practitioners having D.M.D., D.D.S., or
D.D.Sc. degree . . . . . . . . . . . . . . . . . . . . . . .

3213

3273

3223

3283

3217

3277

Physical, occupational, and speech therapists, and audiologists

3218

3278

10. Registered nurses . . . . . . . . . . . . . . . . . . . . . .

3219

3279

11. Licensed practical nurses . . . . . . . . . . . . . . . . . . .

3220

3280

12. All other health practitioners . . . . . . .
13. All other employees (Include management
staff.) . . . . . . . . . . . . . . . . . .
14. TOTAL (Sum of lines 1 through 13 should
column 1) . . . . . . . . . . . . . . . .

3221

3281

3222

3282

3200

3260

2.
3.
4.

7.
8.

9.

Other dental practitioners (Include hygienists, assistants, and
others performing or assisting with dental procedures.) . . . .
Mental health practitioners, excluding practitioners with M.D.
or D.O. degree (Include psychologists, licensed clinical social
workers, etc.) . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . .
and administrative
. . . . . . . . . .
equal ? , line A for
. . . . . . . . . .

Number of active
proprietors or
partners for pay
period including
March 12, $$00

HC-62105
#L PERSONNEL BY OCCUPATION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by occupational category in
column 1. The total of column 1 should equal the amount reported in ? , line A.
Enter each active proprietor or partner by occupational category in column 2. Only the proprietor or partners not
considered employees of the firm for federal tax purposes should be included. Unincorporated practices operating at
more than one location should report the proprietor or partners at the one location at which they spend most of their
working time.
Cen- Number of employees Cenfor pay period
sus including March 12, sus
use
use
$$00

1.
2.

Dentists - licensed practitioners having D.M.D., D.D.S., or
D.D.Sc. degree . . . . . . . . . . . . . . . . . . . . . . .
Other dental practitioners (Include hygienists, technicians,
and assistants, and others performing or assisting with dental
procedures.) . . . . . . . . . . . . . . . . . . . . . . . .

3213

3273

3223

3283

3.

Registered nurses . . . . . . . . . . . . . . . . . . . . . .

3219

3279

4.

Licensed practical nurses . . . . . . . . . . . . . . . . . . .

3220

3280

5.
6.

All other health practitioners . . . . . . . . . . . . . . . . .
All other employees (Include management and administrative
staff.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TOTAL (Sum of lines 1 through 6 should equal ? , line A for
column 1) . . . . . . . . . . . . . . . . . . . . . . . . . .

3221

3281

3222

3282

3200

3260

7.

Number of active
proprietors or
partners for pay
period including
March 12, $$00

MN-55102
#L RESEARCH AND DEVELOPMENT IN $$00
Report receipts and revenues of this establishment during $$00 to support research and development activities (i.e.,
wages and salaries, direct materials costs, services and supporting costs, and an appropriate share of depreciation
and overhead). If this establishment performed research and development for the federal government or for other
enterprises on contract during $$00, include the total amount charged for such work performed.
1. Did this establishment receive funds for research and development during $$00?
3571

Yes

3572

No - Go to

?

$$00
$ Bil.

2. Source of funds for research and development
a. Federal government contracts and subcontracts . . . . . . . . . . . . .

3581

b. Nonfederal sources outside your enterprise (Include receipts from other
enterprises, state and local governments, and other organizations.) . . .

3582

c. Transfers or other payments from other establishments of your
enterprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3583

d. TOTAL - (Sum of lines a through c - Note that the sum of lines a and b
should equal ? , line 6.) . . . . . . . . . . . . . . . . . . . . . . . .

3580

Mil.

Thou.

Dol.

PS-54059
#L

RESEARCH AND DEVELOPMENT IN $$00
Report receipts and revenues of this establishment during $$00 to support research and development activities
(i.e., wages and salaries, direct materials costs, services and supporting costs, and an appropriate share of
depreciation and overhead). If this establishment performed research and development for the federal government
or for other enterprises on contract during $$00, include the total amount charged for such work performed.
1. Did this establishment receive funds for research and development during $$00?
3571

Yes

3572

No - Go to

?

$$00
$ Bil.

2. Source of funds for research and development
a. Federal government contracts and subcontracts . . . . . . . . . . . . . . 3581
b. Nonfederal sources outside your enterprise (Include receipts from other
enterprises, state and local governments, and other organizations.) . . . . . 3582
c. Transfers or other payments from other establishments of your enterprise

3583

d. TOTAL - (Sum of lines a through c - Note that the sum of lines a and b
should equal ? , line 1m.) . . . . . . . . . . . . . . . . . . . . . . . . . 3580

Mil.

Thou.

Dol.

MN-55102
#L RESEARCH AND DEVELOPMENT
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
Yes

No

During $$00 did this establishment:
1. Perform research and development? . . . . . . . . . . . . . . . . . . . . . . . . 0000
2. Acquire research and development performed by another establishment of this
company in the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Acquire research and development performed by another establishment of this
company outside of the United States? . . . . . . . . . . . . . . . . . . . . . . .
Acquire research and development performed by another company in the United
4. States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Acquire research and development performed by another company outside of the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Acquire rights to use patents, inventions, licenses, trademarks, software or other
types of intellectual property for use in this establishment's products or processes?

0000

0000

Do not
know

0000

PS-54119
#L RESEARCH AND DEVELOPMENT
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
Yes

No

During $$00 did this establishment:
1. Acquire research and development performed by another establishment of this
company in the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000
2. Acquire research and development performed by another establishment of this
company outside of the United States? . . . . . . . . . . . . . . . . . . . . . . .
3. Acquire research and development performed by another company in the United
States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Acquire research and development performed by another company outside of the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Acquire rights to use patents, inventions, licenses, trademarks, software or other
types of intellectual property from others for use in this establishment's products or
processes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

Do not
know

0000

PS-54059
#L RESEARCH AND DEVELOPMENT
To be completed by establishments engaged in research and development.
The United States includes all 50 states, District of Columbia, U.S. Commonwealth
Territories, and U.S. possessions.
Yes

No

During $$00 did this establishment:
1. Acquire research and development performed by another establishment of this
company in the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000
2. Acquire research and development performed by another establishment of this
company outside of the United States? . . . . . . . . . . . . . . . . . . . . . . .
Acquire research and development performed by another company in the United
3. States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Acquire research and development performed by another company outside of the
United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Acquire rights to use patents, inventions, licenses, trademarks, software or other
types of intellectual property from others for use in this establishment's products or
processes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

Do not
know

0000

PS-54101 & PS-54102
#L PROPRIETORS AND PARTNERS OF UNINCORPORATED BUSINESSES
Unincorporated businesses should report each proprietor or partner not considered employees for federal tax
purposes at this location. For businesses operating at more than one location, report the proprietor or partners at the
location where they spend most of their working time.
$$00
Mark "X" Number for the pay
if None
period including
March 12

Active proprietor or partners at this location . . . . . . . . . . . . . . . . . . .

3260

PS-54101
#L EXPENSES OF LEGAL AID SOCIETIES
Total operating expenses, including payroll, rent, depreciation, taxes, and other
overhead:
(Exclude capital expenditures, funds invested, and losses from the sale of assets.) . . .

$ Mil.
3520

$$00
Thou.

Dol.

PS-54102
#L SINGLE AND MULTIPLE SERVICES
To be completed by Offices of Certified Public Accountants.
Of the accounting services reported in

?

, lines 1 through 9, what percent were transacted as:

$$00
Percent

1. A single service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0000

%

2. Part of a multiple service package (such as financial auditing and tax planning offered together in
a single transaction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0000

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0000

1 0 0 %

PS-54107
#L COMPUTER SYSTEM INTEGRATION
Estimate the percentage of the value of the integrated systems reported in
following categories.

?

, line 2.c.(3), for the

$$00
Percent

1. Resale of purchased computer hardware . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

2. Resale of purchased computer software . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

3. Sale of custom software produced by this establishment . . . . . . . . . . . . . . . . . . .

%

4. Other, including consulting, training, engineering, etc. . . . . . . . . . . . . . . . . . . . . .

%

5. Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

PS-54110
#L GROSS BILLINGS
(To be completed only by advertising agencies.)
Gross billings and costs associated with receipts reported in

?

Mark "X"
if None

, line 1.

1. Sales of (billings for) advertising media . . . . . . . . . . . . . . . . . .

3030

2. Billings for advertising materials and other outside production services . . .

3031

3. Cost of advertising media in line 1 above . . . . . . . . . . . . . . . . .

3032

4. Purchases of advertising materials and services in line 2 above . . . . . . .

3033

$ Mil.

$$00
Thou.

Dol.

MN-55102
#L EMPLOYMENT BY FUNCTION
Enter employment reported on IRS Form 941, Employer's Quarterly Federal Tax Return, by function. The total should
equal the number reported in ? , line A (number of employees at this location).
Enter each employee on the one line which best describes his/her position. Where records do not provide actual
employee counts in terms of the function listed, estimates of the approximate number in each are acceptable.
Census
use

1.

Administrative and management:
a. Executive and general management (e.g., corporate officers and staff) . . . . . . .

3321

b. Accounting, billing, tax preparation, and bookkeeping . . . . . . . . . . . . . . .

3322

c. Personnel/human relations . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3323

d. Advertising and marketing/market research, excluding direct sales staff . . . . . . .

0000

e. Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Computer systems design, custom computer programming and electronic data
processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3326

0000

g. Other - Specify
3329

0829

2.

Sales employees (and support staff) selling directly to customers from this location . . .

3206

3.

Procurement/purchasing staff . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3331

4.

Research and development

3332

a. Scientists and engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

b. Technicians/technologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Security, including security patrol, locksmith, monitoring, and investigation and
building services, including janitorial, carpet cleaning, pest control, and landscaping

0000

6.

Repair and maintenance (for vehicles and equipment) . . . . . . . . . . . . . . . . .

3335

7.

Trucking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3336

8.

Warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3337

9.

Manufacturing/production workers . . . . . . . . . . . . . . . . . . . . . . . . . .

0325

5.

0000

10. All other - Specify

3339

0839

11. TOTAL (Sum of lines 1a through 10 should equal

?

, line A) . . . . . . . . . . . . . .

3200

Number of employees
for pay period
including March 12,
$$00

MN-55102
#L MERCHANDISE SALES
Estimate the percent of merchandise sales reported in

?

:

1. Products manufactured or assembled at this establishment . . . . . . . . . . . . . . . . . . . 0000
2. Products manufactured or assembled by other establishments of this enterprise and sold by
employees of this establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000
3. Product resales (products purchased from others and sold by this establishment without further
manufacture, fabrication, processing or assembly) . . . . . . . . . . . . . . . . . . . . . . . 0000
4. Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

$$00
Percent

%
%
%
1 0 0 %

Form AS-56101

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
26 SPECIAL INQUIRIES - Continued
B. PROFESSIONAL EMPLOYER ORGANIZATIONS
(To be completed by Professional Employer Organizations (PEO's) only).
2007

2. Payroll and employment
a. Clients' (worksite) employees paid by this
establishment

$ Bil.

Number of employees
Cenfor pay period
Census
including March 12, sus $ Bil.
use
2007
use

0738

0739

2. Mining . . . . . . . . . . . . . . . . . . .

0740

0741

3. Utilities . . . . . . . . . . . . . . . . . . .

0742

0743

4. Construction . . . . . . . . . . . . . . . .

0744

0745

5. Manufacturing . . . . . . . . . . . . . . .

0746

0747

6. Wholesale . . . . . . . . . . . . . . . . .

0748

0749

7. Retail. . . . . . . . . . . . . . . . . . . .

0760

0761

8. Transportation and warehousing . . . . . . .

0762

0763

9. Information services (e.g. publishing,
motion picture, sound recording, and
communications) . . . . . . . . . . . . . .

0764

0765

10. Finance and insurance . . . . . . . . . . .

0766

0767

11. Real estate and rental and leasing . . . . . .

0768

0769

12. Professional, scientific, and technical services

0770

0771

13. Administrative and support and waste
management and remediation services . . . .

0772

0773

26

Thou.

Dol.

0737

1. Agriculture, forestry, hunting . . . . . . . .

CONTINUE WITH

Mil.

Annual payroll
Mil.

Thou.

Dol.

56101074

1. Net revenues (i.e. gross amounts billed to client firms LESS clients'
(worksite) payroll costs such as salaries, benefits, and taxes paid to taxing
authorities) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ON PAGE 8

Produced by GIDS AutoFormatter v4.46,
on 26-Jun-2006 at 08:56 AM

CONTINUE ON PAGE 8

Form AS-56101

Page 8

(DRAFT)

26 SPECIAL INQUIRIES - Continued
Number of employees
Cenfor pay period
Census
use including March 12, sus $ Bil.
2007
use

14. Educational services . . . . . . . . . . . .

0774

0775

15. Health care and social assistance . . . . . .

0776

0777

16. Arts, entertainment, and recreation . . . . .

0778

0779

17. Accommodation (e.g., hotels and motels) and
food services (e.g., restaurants) . . . . . . .

0780

0781

18. Repair, personal care and laundry services

0782

0783

0786

0784

0785

b. Management and administrative employees of
this establishment . . . . . . . . . . . . . . .

3562

3567

c. TOTAL (Sum of lines a and b should equal 7 ,
line A for column 1 and 7 , line B1 for column 2)

3200

3300

Annual payroll
Mil.

Thou.

Dol.

19. Other - Specify

C. PLACEMENT SERVICES
Estimate the percentage of placement fees reported in
following sources:

22 ,

2007
Percent

sum of lines 1 through 3, from the

1. Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

2. Private corporations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

3. Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

4. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

1 0 0 %

D. FRANCHISE

0237

Yes - franchisee owned establishment

0238

Yes - franchisor owned establishment

0239

No

56101082

Was this establishment operating under a trademark authorized by a franchisor in 2007?
(Mark "X" only ONE box.)

27 – 29 Not Applicable.

Produced by GIDS AutoFormatter v4.46,
on 26-Jun-2006 at 08:56 AM

CONTINUE ON PAGE 9

AS-56101
#L PLACEMENT SERVICES
Estimate the percentage of placement fees reported in
following sources:

?

, sum of lines 1 through 3, from the

$$00
Percent

1. Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

2. Private corporations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

3. Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

4. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

1 0 0 %

HC-62102 & HC-62104
#L PATIENT CARE
Estimate the percent of patient care reported in

?

, line 1, from the following:

$$00
Percent

1. Visits and consultations - evaluation and management services . . . . . . . . . . . . . . . . . 0000

%

2. Surgical interventions - treatments of disease, injury, or deformity by surgeons . . . . . . . . . 0000

%

3. Non-surgical interventions - treatment of disease, injury, or deformity except by surgery . . . . . 0000

%

4. Anesthesia services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

5. Laboratory services and tests paid by other health care providers . . . . . . . . . . . . . . . . 0000

%

6. Laboratory services and tests paid directly by individuals, insurers, or government payers such as
Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000
7. Other, including health facility services such as provisions of space and equipment, meals,
nursing care, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000
8. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%
%
1 0 0 %

HC-62201
#L PATIENT CARE

Estimate the percent of patient care reported in ? , line 1, from the following:
1. Inpatient hospital facility services - evaluation and management services, treatment of disease,
injury, or deformity by surgical procedures and non-surgical procedures, etc.. . . . . . . . . . . 0000

$$00
Percent

%

2. Outpatient visits and consultations - evaluation and management services . . . . . . . . . . . . 0000

%

3. Outpatient surgical interventions - treatment of disease, injury, or deformity by surgeons . . . . . 0000

%

4. Outpatient non-surgical interventions - treatment of disease, injury, or deformity except by
surgeons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0000

%

5. Outpatient anesthesia services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

6. Outpatient medical and diagnostic testing services . . . . . . . . . . . . . . . . . . . . . . . 0000

%

7. Other, including outpatient health facility services . . . . . . . . . . . . . . . . . . . . . . . 0000

%

8. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

HC-62201
#L GOVERNMENT OWNERSHIP AND CONTROL
1. Was this establishment operated by or under the control of a government entity or a board of directors either
appointed by such an entity or publicly elected?
3501

Yes

3502

No - Go to

?

2. Level of government operating or controlling this establishment (Mark "X" only ONE box.)
3506

Federal (Include all armed services, Veterans Administration, Indian Health Service, etc.)

3507

State

3508

Local (Include county, city, hospital district or authority, etc.)

HC-62404
#L GRANTS, SIMILAR PAYMENTS, AND TRANSFERRED CONTRIBUTIONS OF TAX-EXEMPT ESTABLISHMENTS
(To be completed only by those indicating "Yes" in ? , line A2)
1. During $$00, did this establishment do any of the following:
• award grants
• make gifts or contributions
• make payments to, or on behalf of, specific individuals
• provide benefits for its members or dependents (except employment-related benefits)
• pay assessments (dues) to the parent or other chapters of the same organization
• transfer funds raised by this establishment to charities or other organizations for charitable purposes?
3511

Yes - Go to line 2

3512

No - Go to

$$00

?

2. Amount of grants, similar payments, and transferred funds . . . . . . . . .

$ Bil.

Mil.

Thou.

Dol.

3515

Also on HC-62401, 62402, 62403, OS-81301, OS-81302

HC-62401
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
the following payers:

?

, lines 1 through 8, from

$$00
Percent

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

2. Private payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

1 0 0 %

Also on HC-62402, HC-62403, HC-62404

OS-81301
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
following payers:

?

, line 7, from the

$$00
Percent

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

2. Private payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

OS-81302
#L SOCIAL ASSISTANCE
Estimate the percent of receipts for social assistance services reported in
following payers:

?

, line 12, from the

$$00
Percent

1. Government payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

2. Private payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000

1 0 0 %

#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 37 by category:

$$00
Percent

%

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3401

2. Parts installed in repair work

3402

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OS-81059

1 0 0 %

OS-81102
#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 21 by category:

$$00
Percent

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3401

2. Parts installed in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3402

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
1 0 0 %

OS-81101
#L REPAIR RECEIPTS
Estimate the percentage of repair receipts reported in

?

, lines 1 through 17 by category:

$$00
Percent

%

1. Labor charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3401

2. Parts installed in repair work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3402

%

3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

OS-81203
#L LAUNDRY WORK
Was laundry work (other than finish work) done at this location?
3001

Yes

3002

No

OS-81203
#L DRYCLEANING
Was drycleaning work (other than finish work) done at this location?
3011

Yes

3012

No

OS-81204
#L REPAYMENTS OF CASH ADVANCES
1. Did the receipts or revenue (reported in ? ) include repayments of cash advances made by this
establishment for the convenience of those served to cover such items as cemetery expenses,
transportation, flowers, newspaper notices, clergy and musician honoraria, transcripts, and other
items not in the services normally included in the price of a funeral selected at this establishment?
0000

Yes - Go to line 2

0000

No - Go to

?

2. Percent of receipts or revenue from repayments of cash advances . . . . . . . . . . . . . . . . 0000

$$00
Percent

%