Form OS-81901 Prototype Classification Form

Attachment F-1
2007 Economic Census

Professional, Scientific, and Technical Services; 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

Prototype Classification Form

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U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2007 ECONOMIC CENSUS
Classification Form

FORM

OS-81190

OMB No. : Approval Expires

(DRAFT)

DUE DATE
FEBRUARY 12, 2008
OS-81190
Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001

CLASSIFICATION PROTOTYPE
Need help or have questions
about filling out this form?
Visit our Web site at
www.census.gov/econhelp
- OR Write to the address above.
Include your 11-digit Census File
Number (CFN) printed in the
mailing address.
(Please correct any errors in this mailing address.)

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations
that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau. By the same
law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality
of Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents'
files are immune from legal process.
• Use blue or black ink.
• Do not use pencil.
• Place an "X" inside the box.

• Please center numbers in their respective boxes.
• Do not put slashes through 0 or 7.

Examples:

0 1 2 3 4 5 6 7 8 9

The reporting unit for this form is an establishment. An establishment is generally a single physical location where
business is conducted or where services or industrial operations are performed.
1

Not Applicable.

2

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. box and rural route addresses are not physical locations.)

0032

Yes - Go to line B

No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0044

Do not know

C. In what type of municipality is this establishment physically located? (Mark "X" only ONE box.)
0229

City, village, or borough

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

0230

Town or township

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0231

Other

0232

Do not know

CONTINUE ON PAGE 2

81190019

0031

Form OS-81190
3

Page 2

(DRAFT)

OPERATIONAL STATUS
Which ONE of the following best describes this establishment's operational status at the end of 2007?
(Mark "X" only ONE box.)
0011

In operation

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

Month

Day

Year

0018
0015

Sold or leased to another operator - Give date at right AND enter
name and address of new owner or operator and Employer
Identification Number (EIN) below
0060

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

4 – 18 Not Applicable.
19 KIND OF BUSINESS OR ACTIVITY
Principal kind of business or activity in 2007
(Mark "X" only ONE box.)
General motor vehicle mechanical and electrical repair and maintenance
0700

811 111 00 1

General motor vehicle repair shop

811 111 00 3

Diesel engine repair shop

811 111 00 2

Truck tractor or trailer repair shop, general

811 112 00 1

Exhaust system repair shop

811 113 00 1

Transmission repair shop

811 118 20 1

Brake, front end, and wheel alignment shop

811 118 40 1

Radiator repair shop

811 118 10 1

Carburetor and fuel systems repair shop

811 118 30 1

Electrical repair shop (primarily for motor vehicles)

811 118 90 1

Suspension repair shop, automotive

811 198 00 2

Air-conditioning repair shop

777 811 01 1

Other motor vehicle mechanical and electrical repair and maintenance services - Specify

0701

Motor vehicle body, paint, and interior repair and maintenance
811 121 10 1

Paint or body repair shop

811 121 10 2

Collision repair shop
CONTINUE WITH

19

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81190027

Specialized motor vehicle mechanical and electrical repair and maintenance

Form OS-81190

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
19 KIND OF BUSINESS OR ACTIVITY - Continued
Motor vehicle body, paint, and interior repair and maintenance - Continued
0700

811 121 20 1

Van conversion services

811 121 10 3

Restoration shop, antique and classic automotive

811 121 30 1

Upholstery and interior repair shop

811 122 00 1

Glass replacement and repair shop (primarily for motor vehicles)

811 122 00 2

Window tinting service

Other motor vehicle care and maintenance services
811 191 00 1

Oil change and lubrication shop

811 192 00 1

Carwash

811 192 00 2

Automotive detailing service

488 410 00 1

Towing, wrecker service

811 198 00 3

Emissions testing service

811 198 00 5

Automotive safety inspection service

811 198 00 4

Rustproofing, undercoating service

326 212 00 1

Tire retreading and recapping

777 811 01 2

All other motor vehicle care and maintenance services - Specify

0701

Gasoline service stations and retailers of motor vehicles and parts (retailers may also provide motor
vehicle repair services)
Gasoline station with convenience store

447 190 10 5

Other gasoline service station, excluding truck stops

441 320 00 1

New tire dealer

441 310 40 3

Auto parts/supply store

441 120 00 2

Motor vehicle dealer, used only

441 110 00 1

Motor vehicle dealer, new and used

777 811 01 3

All other automotive activity - Specify

81190035

447 110 00 1

0701

CONTINUE WITH

19

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Form OS-81190

Page 4

(DRAFT)

19 KIND OF BUSINESS OR ACTIVITY - Continued
Other repair and maintenance activity
0700

811 211 00 2

Stereo, television, VCR, and other consumer electronic equipment repair, excluding computer

811 310 90 3

Armature rewinding or electric motor repair shop

811 310 90 K

Gasoline engine and/or compressor repair, excluding motor vehicle

777 811 01 4

All other repair and maintenance services - Specify

0701

Other kind of business or activity
777 811 02 7

Rebuilding or remanufacturing equipment or parts on a factory basis - Specify

773 000 00 2

Other kind of business or activity - Specify

0701

0701

20 – 25 Not Applicable.
26 SPECIAL INQUIRIES
MERCHANDISE SALES
1. Did this establishment sell 'new' merchandise, excluding parts installed in repair work, in 2007?
0000

Yes - Go to line 2

0000

No - Go to

?

2. List below the principal lines of 'new' merchandise sold and indicate the approximate
percentage of each to the total dollar sales and receipts in 2007.
2007
CenPercent of
sus total sales and
use receipts of this
establishment

New merchandise sold

a.

0000

%

0000

b.

0000

%

0000

c.

0000

%

d. Total of 'new' merchandise sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0000

%

81190043

0000

27 – 29 Not Applicable.

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Form OS-81190

Page 5

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.

Yes

No - Enter time period covered

Month

Name of person to contact regarding this report

Area code
Telephone

Year

Month

FROM

Year

TO

81190050

Is the time period covered by this report a calendar year?

Title

Number

Extension

Area code

Number

Fax

-

Internet e-mail address

Date
completed

Month

Day

Thank you for completing your 2007 ECONOMIC CENSUS form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.
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Year