Various Economic Area Pretesting Activities

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Northern Mariana Islands

FORM

IA-98183

OMB No. : Approval Expires

(DRAFT)

IA-98183

Need help or have questions about filling out this
form?
Visit www.census.gov/econhelp
Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.
- OR Write to the address below. Include your 11-digit Census
File Number (CFN) printed in the mailing address.
Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001

(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 ballpoint pen. • Please center numbers in their respective boxes. Examples:
• Do not use pencil or felt-tip pen. • Do not put slashes through 0 or 7.
0 1 2 3 4 5 6 7 8 9
• Place an "X" inside the box.
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 or a permanent office, payroll office, or other
place where business activities related to construction are conducted. For further clarification, see information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown in the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return, or
Form 944-SS, Employer's Annual Federal Tax Return?
Yes - Go to

2

0022

No - Enter current EIN (9 digits)

0025

-

98183015

0021

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

CONTINUE ON PAGE 2

Form IA-98183
2

Page 2

(DRAFT)

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.)
0031

Yes

0032

No - Enter physical
location

0035

Number and street or location description

0036

City, town, village, etc.

0037

State, other

0038

ZIP Code

-

B. Village where this establishment is physically located
0853

C. Island where this establishment is physically located
0049

3

OPERATIONAL STATUS
Which ONE of the following best describes this establishment's operational status at the end of 2012?
(Mark "X" only ONE box.)
0011

In operation

0014

Ceased operation - Give date at right

0015

0013

Temporarily or seasonally inactive
Month

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

Day

Year

0018

Name of new owner or operator

0061

EIN (9 digits)

0062

0063

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

City, town, village, etc.

0064

State, other

0065

ZIP Code

0016

4

Other status - Specify

0815

Mark "X" 2012
if None Number

MONTHS IN OPERATION
Number of months in operation during 2012 (If none, mark "X" and go to

98183023

HOW TO
REPORT
DOLLAR
FIGURES
5

30 .)

. . . . . . . . . . . .
Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.

0002

$ Mil.

2012
Thou.

If a figure is $2,035,628.79:

Report

2 0 3 6

If a value is "0" (or less than $500.00):

Report

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None

Sales of merchandise, shipments, operating receipts, and/or revenue (Exclude
grants, sales taxes, or other taxes collected.) . . . . . . . . . . . . . . . . . . .

$ Mil.

2012
Thou.

Dol.

Dol.

0100

CONTINUE ON PAGE 3

Form IA-98183

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
6

E-COMMERCE SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. Were any of the sales, shipments, receipts, and/or revenue reported in 5 a result of e-commerce transactions?
(Transactions are agreements between buyers and sellers to transfer ownership of, or rights to use, goods or
services. Payment for these goods or services may or may not be made online. Please see the information sheet(s)
for further clarification.)
E-commerce transactions include:
• Internet
• E-mail
• Extranet
0181

Yes - Go to line B

0182

No - Go to

• Electronic Data Interchange (EDI)
• Other online systems

2012
Whole percent
of sales and
receipts

7

B. Percent of total sales, shipments, receipts, and/or revenue reported in 5 that are a result of ecommerce transactions. (Exclude sales taxes. Report whole percents. Estimates are acceptable.) . .
7

%

0109

EMPLOYMENT AND PAYROLL
Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal
Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's
Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) shown in the
mailing address or corrected in 1 .
• Non-residential employees working at this establishment, whether or not FICA taxes were withheld.
For further clarification, see information sheet(s).
Mark "X"
if None

A. Number of paid employees for pay period including March 12, 2012
1. For whom FICA taxes were withheld . . . . . . . . . . . . . . . . . . . . . .

0254

2. For whom FICA taxes were NOT withheld . . . . . . . . . . . . . . . . . . .

0274

3. TOTAL (Add lines A1 and A2) . . . . . . . . . . . . . . . . . . . . . . . . .

0320

Mark "X"
if None

B. Payroll before deductions (Exclude employer's cost for fringe benefits.)
1. Annual payroll for 2012

. . . . . . . . . . . . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March, 2012) . . . . . . . . . . . . . . . .

0310

$ Mil.

2012
Number

2012
Thou.

Dol.

C. Employer's cost for fringe benefits
1. Legally required fringe benefits (Include employer payments for
Social Security, Medicare, unemployment compensation, workmen's
compensation, and local disability programs, if required.) . . . . . . . . .

98183031

2. Voluntarily provided fringe benefits (Include such items as payments for
life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.) . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. TOTAL (Add lines C1 and C2) . . . . . . . . . . . . . . . . . . . . . . .
8

0221

0222

0220

Not Applicable.

CONTINUE ON PAGE 4

Form IA-98183
9

Page 4

(DRAFT)

INVENTORIES
Report inventories using current cost (if using LIFO method of valuation, adjust to obtain FIFO or current cost).
A. Did this establishment own inventory, regardless of where held, at the end of 2012 and/or 2011?
0486

Yes - Go to line B

0487

No - Go to

12

B. Total Inventories
(Report the total value of inventories the
establishment owned.) . . . . . . . . .

Mark "X"
if None

End of 2012
$ Mil.
Thou.

Mark "X"
if None

Dol.

0460

End of 2011
$ Mil.
Thou.

Dol.

0470

C. Did this establishment have inventories by stage of fabrication (finished goods; work-in-process; and/or
materials, supplies, fuels, etc.) at the end of 2012 and/or 2011?
0388

Yes - Complete lines 1 through 3. Total should equal the amounts reported in line B.

0389

No - Go to

12

Mark "X"
if None

End of 2012
$ Mil.
Thou.

Mark "X"
if None

Dol.

1. Finished goods . . . . . . . . . . .

0461

0471

2. Work-in-process

. . . . . . . . . .

0463

0473

3. Materials, supplies, fuels, etc. . . . .

0462

0472

End of 2011
$ Mil.
Thou.

Dol.

10 and 11 Not Applicable.
12 LEGAL FORM OF ORGANIZATION
Legal form of organization that best describes this establishment at the end of 2012 (Mark "X" only ONE box.)
0691

Individual proprietorship

0692

Partnership

0694

Corporation

0696

Other - Specify

0806

13 CAPITAL EXPENDITURES AND DEPRECIATION EXPENSES
Mark "X"
if None

98183049

Report the dollar value of capital expenditures and depreciation expenses.
A. Capital expenditures (Include purchases of equipment, spending on buildings
and structures that were capitalized, and capital lease agreements in 2012.) . .

0520

B. Depreciation expenses (Include depreciation charges taken against tangible
assets owned and used by your firm, tangible assets and improvements owned
by your firm within leaseholds, tangible assets obtained through capital lease
agreements, and amortization charges against intangible assets (e.g., patents,
copyrights) in 2012.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0540

$ Mil.

2012
Thou.

Dol.

14 and 15 Not Applicable.

CONTINUE ON PAGE 5

Form IA-98183

Page 5

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES
Mark "X"
if None

A. Operating expenses (Include payroll, fringe benefits, depreciation, etc. Exclude
cost of goods sold, interest, capital expenditures, and bad debt.) . . . . . . . .

0136

B. Net purchases of merchandise for resale. (Include amounts allowed for tradeins. Exclude returns, allowances, trade/cash discounts, and merchandise for
further processing.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0137

C. Interest (Include both short-term and long-term interest paid in 2012.) . . . . .

5050

$ Mil.

2012
Thou.

Dol.

17 and 18 Not Applicable.
19 KIND OF BUSINESS
Which ONE of the following best describes this establishment's principal kind of business in 2012?
(Mark "X" only ONE box.)
Health care and social assistance
0700

621 110 00 1

Office of physician (M.D. or D.O.)

621 210 00 2

Office of dentist

621 310 00 2

Office of chiropractor

621 320 00 3

Office of optometrist

621 390 00 1

Office of other health practitioners

621 610 00 6

Home health care services

624 110 00 C

Social assistance service for children and youth

624 120 00 C

Social assistance service for the elderly and disabled

624 410 00 7

Child day care services

772 000 00 B

Other health care and social assistance - Specify

0701

98183056

Repair and maintenance services
811 110 00 1

General automotive repair shop

811 120 00 1

Automotive body, paint, interior, glass repair, and maintenance

811 210 00 1

Electronic repair and maintenance

811 310 00 1

Commercial or industrial equipment repair and maintenance

811 400 00 5

Household goods repair and maintenance including home appliances, reupholstery, furniture,
footwear, leather goods, etc.

772 000 00 8

Other maintenance and repair services - Specify

0701

CONTINUE WITH

19

ON PAGE 6

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Form IA-98183

Page 6

(DRAFT)

19 KIND OF BUSINESS - Continued
Accommodations
0700

721 110 00 7

Hotel (except with casino) or motel

721 120 00 2

Hotel with casino

713 200 00 1

Gambling industries except hotels with casinos

772 000 00 4

Other traveler accommodation - Specify

0701

Food services
722 110 00 4

Full-service restaurant

722 210 00 1

Refreshment place, limited service restaurant, or fast food restaurant

722 410 00 9

Bar, tavern, pub, or other drinking place (alcoholic beverages)

722 320 00 3

Caterer for banquets, weddings, conferences, seminars, etc.

772 000 00 2

Other food services - Specify

0701

98183064

Information, professional, business, educational and personal services
511 000 00 3

Publishing industries (except internet) including newspaper, periodical, book, and software
publishers.

512 000 00 5

Motion picture and sound recording industries

515 100 00 2

Radio and television broadcasting

519 130 00 1

Internet publishing and broadcasting

517 000 00 3

Telecommunications including cellular, wired, satellite, cable, etc.

541 110 00 3

Office of lawyers

541 210 00 3

Accounting services including auditing, tax preparation, payroll, etc.

541 300 00 1

Architectural, engineering, and related services excluding landscaping

541 500 00 1

Computer systems design and related services

541 600 00 1

Management consulting services, including administrative and general management as well as
marketing consulting services

541 810 00 3

Advertising agency

541 900 00 1

Other professional, scientific, and technical services

561 310 00 4

Employment placement agency

561 700 00 4

Services to buildings and dwellings, including janitorial and landscaping services

611 620 00 1

Sports and recreation instruction services

713 120 00 1

Arcades or family fun centers
CONTINUE WITH

19

ON PAGE 7
CONTINUE ON PAGE 7

Form IA-98183

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
19 KIND OF BUSINESS - Continued
Information, professional, business, educational and personal services - Continued
0700

713 900 00 1

Amusement and recreation industries including golf courses and country clubs, marinas, fitness
and recreational sports centers, and bowling centers

812 110 00 5

Beauty shop, barber shop, facial, or nail salon

812 200 00 1

Death care services including funeral homes and cemeteries

812 300 00 1

Drycleaning and laundry services

541 920 00 1

Photographic studio, portrait

772 000 00 5

Other information, professional, business, educational, or personal services - Specify

0701

Transportation and storage services
561 510 00 1

Travel agency

561 520 00 2

Tour operator

485 000 00 3

Transit and ground transportation including bus, taxis, and limousine services

488 000 00 3

Support activities for air and water transportation

493 110 00 5

Warehousing and storage for general merchandise

562 110 00 1

Waste collection

772 300 00 6

Other transportation and storage services - Specify

0701

98183072

Retail
441 110 00 1

Motor vehicle dealer, new

441 120 00 6

Motor vehicle dealer, used

441 300 00 1

Automotive parts, accessories, and tire store

442 110 00 1

Furniture store

442 210 00 1

Floor coverings store

443 110 00 1

Household appliance/electronics store

443 120 00 1

Computer and/or software store

444 100 00 1

Building materials and supplies dealer including hardware stores and homecenters

445 110 00 6

Supermarket or grocery store

445 120 00 1

Convenience food store

446 000 00 3

Health and personal care stores including pharmacies and drug stores, beauty supplies, and
optical goods
CONTINUE WITH

19

ON PAGE 8
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Form IA-98183

Page 8

(DRAFT)

19 KIND OF BUSINESS - Continued
Retail - Continued
0700

447 100 00 1

Gasoline stations

448 110 00 3

Men's clothing store

448 120 00 1

Women's clothing store

448 130 00 1

Children's and infants' clothing store

448 140 00 1

Family clothing store

448 210 00 1

Shoe store

448 310 00 1

Jewelry store

448 320 00 1

Luggage and leather goods store

451 110 00 1

Sporting goods store

452 990 00 1

General merchandise store, including variety, dollar, and home and auto supply

453 110 00 1

Florist

453 220 00 8

Gift, novelty, craft, and souvenir store

453 210 00 7

Office supply/stationery/school supplies store

453 300 00 1

Used merchandise stores

772 000 00 9

Other retail business - Specify

0701

Wholesale
772 200 00 7

Merchant wholesaler, durable goods such as automobiles, furniture, construction materials,
equipment and supplies, computer and computer equipment, hardware, appliances, machinery,
etc. - Specify

772 200 00 8

Merchant wholesaler, nondurable goods such as paper, groceries, plastic materials, petroleum
and petroleum products, alcoholic beverages, etc. - Specify

0701

0701

98183080

Manufacturing
311 000 00 3

Food manufacturing

315 000 00 3

Apparel manufacturing

323 000 00 1

Printing and related support activities

327 000 00 2

Nonmetallic mineral products manufacturing

772 200 00 Y

Other manufacturing - Specify

0701

CONTINUE WITH

19

ON PAGE 9
CONTINUE ON PAGE 9

Form IA-98183

Page 9

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
19 KIND OF BUSINESS - Continued
Construction
0700

236 000 00 1

Building construction - residential and nonresidential construction or remodeling/additions to
buildings by general contractors or operative builders

237 000 00 4

Heavy and civil engineering construction including streets, bridges, sewers, land subdivision,
etc.

238 000 00 4

Specialty trade contractor including painting, electrical work, plumbing, site preparation
activities, etc.

Finance, insurance, and real estate
522 100 00 1

Depository credit intermediation including banks, savings institutions, and credit unions

522 290 00 8

Consumer finance or small loan company

524 110 00 1

Life, accident, health, and medical insurance carrier

524 210 00 I

Insurance agent or broker

531 110 00 2

Lessor of residential buildings and dwellings

531 120 00 2

Lessor of nonresidential buildings

531 210 00 3

Real estate agent or broker

772 000 00 6

Other finance, insurance and real estate - Specify

0701

Rental and leasing services, except real estate
532 100 00 1

Automotive equipment rental and leasing

532 200 00 4

Consumer goods rental including electronics, appliance, formal wear, video tape, or other
consumer good rentals

532 230 00 4

Video tape rental

532 290 00 5

Rental of personal items or items for the home including hospital beds, party supplies, etc.

772 300 00 1

Other business support services including security and cleaning - Specify

532 400 00 3

Commercial and industrial machinery and equipment rental and leasing

772 200 00 F

Other rental and leasing excluding real estate - Specify

98183098

0701

0701

Other kinds of business or activity
813 110 00 2

Church or other religious organization

772 200 00 G

Utility - Specify

0701

CONTINUE WITH

19

ON PAGE 10
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Form IA-98183

Page 10

(DRAFT)

19 KIND OF BUSINESS - Continued
Other kinds of business or activity - Continued
0700

814 110 00 1

Private household, employing domestic help, e.g., cooks, maids, etc.

110 000 00 1

Crop or animal production or agricultural services

772 000 00 C

Other business or activity - Specify

0701

20 CLASS OF CUSTOMER
2012
Whole percent
of sales and
receipts

A. Estimate the percentage of sales generated from exports (Include all exports from the Northern
Mariana Islands to foreign countries, the United States, and U.S. territories.)

%

0262

2012
Whole percent
of sales and
receipts

98183106

B. Excluding the exports reported in line A, estimate the percentage of this establishment's total
sales (reported in 5 ) by class of customer:
1.

Household consumers (excluding visiting tourists) . . . . . . . . . . . . . . . . . . . . .

0261

2.

Visiting tourists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6252

3.

Retailers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0263

4.

Wholesalers

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0264

5.

Restaurants, food services, and nightclubs . . . . . . . . . . . . . . . . . . . . . . . . .

6259

6.

Hotels or other traveler accommodations . . . . . . . . . . . . . . . . . . . . . . . . . .

6255

7.

Travel agencies and other passenger transportation services

. . . . . . . . . . . . . . . .

6261

8.

Other service establishments including truck and passenger car rental and leasing . . . . . .

6262

9.

Apparel manufacturers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6265

10. Other manufacturer establishments and quarries . . . . . . . . . . . . . . . . . . . . . .

6266

11. Construction contractors

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0269

12. Banks, insurance, and real estate companies . . . . . . . . . . . . . . . . . . . . . . . .

6277

13. Governmental bodies (Federal and Commonwealth)

. . . . . . . . . . . . . . . . . . . .

0271

14. Farmers for farm use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0270

%
%
%
%
%
%
%
%
%
%
%
%
%
%

15. Other - Specify

0874

0272

16. TOTAL (Add lines B1 through B15 - should add to 100%) . . . . . . . . . . . . . . . . . .

%
1 0 0 %

21 Not Applicable.

CONTINUE ON PAGE 11

Form IA-98183

Page 11

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2012
Percent

HOW TO
REPORT
PERCENTS

If figure is 38.76% of total sales:

Report whole percents

3 9 %

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE

2012
Whole percent
of sales and
receipts

A. Percent of this establishment's sales, shipments, revenue, or other operating receipts (reported in
5 ), for products manufactured at this establishment . . . . . . . . . . . . . . . . . . . . . .

%

0110

B. Briefly describe your principal business activities and report as whole percent of total sales, shipments,
revenue, or other operating receipts reported in 5 (e.g., gasoline 60%, auto repairs 21%, oil 8%).
2012
Census Whole percent
use
of sales and
receipts

Description of principal business activities

0723

0720

0722

1.

19811

2.

19812

3.

19813

%
%
%

23 – 25 Not Applicable.
26 SPECIAL INQUIRIES
NOTE - Answer only if the principal kind of business reported in 19 for this establishment is HOTEL, MOTEL, OR
OTHER TRAVELER ACCOMMODATION. Otherwise, go to 27 .
2012

NUMBER AND TYPE OF ACCOMMODATIONS
1. Number of rooms, units, or quarters primarily rented as transient as of December 31,
2012 (Consists of the number which can be rented as single units. Suites of rooms
which cannot be subdivided should be counted as a single unit.) . . . . . . . . . . .

Number as of
December 31
2402

2. Were more than half of guestroom or unit rental receipts from transient guests?
Yes

2922

No

98183114

2921

CONTINUE ON PAGE 12

Form IA-98183

Page 12

(DRAFT)

27 OWNERSHIP
A. Citizenship of majority ownership of this establishment in 2012 (Mark "X" only ONE box.)
6086

U.S. citizen - CNMI born (Chamorro or Carolinian)

6097

U.S. citizen - CNMI born (NOT Chamorro or Carolinian)

6087

U.S. citizen - not CNMI born

6088

Japanese citizen

6089

Filipino citizen

6090

Korean citizen

6098

Chinese citizen

6085

Dual citizenship/other citizenship - Specify

0885

0699

Not known/not determinable (Such as publicly traded)

B. Gender of majority ownership of this establishment in 2012 (Mark "X" only ONE box.)
6077

Male-owned

6084

Female-owned

6078

50/50 Male/Female - Equal percent of ownership

6079

Not known/not determinable (Such as publicly traded)

28 and 29 Not Applicable.
REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

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

98183122

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

No - Enter time period covered

Month

Name of person to contact regarding this report

Area code
Telephone

Number

-

Internet e-mail address

Year

Month

FROM

Year

TO

Title

Extension

Area code

Number

Fax

Date
completed

Month

Day

Thank you for completing your 2012 ECONOMIC CENSUS form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.

Year