Various Economic Area Pretesting Activities

Generic Clearence for Questionnaire Pretesting Research

omb1129CFSenc1

Various Economic Area Pretesting Activities

OMB: 0607-0725

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2012 Commodity Flow Survey
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Help Telephone: 1-800-772-7851, option "3"
(M- F, 8:30am- 5:00pm ET)

Item A - Verification of Shipping Address
Verification of Shipping Address
Yes, the address listed below is correct.
No, the address is incorrect. (Enter corrections below.)
Enter your physical address.
Company Name 1

Company Name 2

Address

City

State

Zip Code

Selectstate
state
Select

-

Item B - Verification of Mailing Address
What address should the 2012 CFS questionnaire be mailed to?
Mail the 2012 CFS questionnaire to this establishment's shipping address.
Mail the 2012 CFS questionnaire to the address entered below.
Enter your mailing address.
Company Name 1

Company Name 2

Address

City

State
Selectstate
state
Select

Zip Code
-

Next

Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

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http://idc4.ssd.census.gov:3016/cfs/address/26[9/12/2011 1:10:33 PM]

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2012 Commodity Flow Survey
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Item C - Operating Status
Which one of the following best describes this establishment's operating status during the week of ? (Select only one.)
In Operation
Temporarily or seasonally inactive
Ceased Operation - Enter date ceased operation (MM-DD-YYYY):
Month
Month

Day
Day

Year
Year

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

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http://idc4.ssd.census.gov:3116/cfs/operating_status#[9/1/2011 11:22:36 AM]

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2012 Commodity Flow Survey
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Item D - Total Number of Outbound Shipments
For this survey, it is important to obtain information about a sample of the outbound shipments made from this establishment.
An outbound shipment in this survey is defined as a movement of commodities from your establishment to another single
location.
Remember to include only outbound shipments from your shipping address (address listed in Item A)
Also include customer pick-ups, parcels, and all other shipments
What was the total number of all outbound shipments for this establishment the week of 01/15/12 - 01/21/12?
Total Number of outbound shipments.................

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3016/cfs/outbound_shipments/26[9/12/2011 1:13:58 PM]

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Item E - Sampling Instructions
On the subsequent pages of this survey, we will be asking about all of your outbound shipments.

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3116/cfs/sampling_instructions#[9/1/2011 11:24:40 AM]

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2012 Commodity Flow Survey
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Help Telephone: 1-800-772-7851, option "3"
(M- F, 8:30am- 5:00pm ET)

Item F - Shipment Characteristics
Enter the shipment ID number.

Select the shipment date.
Day
Day

Month
Month

Enter the shipment value (excluding shipping costs) in whole dollars.
Estimates are acceptable.

Enter the net shipment weight in pounds.

Enter the commodity code.

Enter the commodity description.

Temperature controlled?
Yes
No
If a hazardous material, enter the 'UN' or 'NA'.

Enter the U.S. destination or U.S. Exit Port.
City:
State:

Selectstate
state
Select

Zip Code:
Select mode(s) of transport to U.S. destination. Select all that apply in order used.
Parcel delivery, courier, or U.S. Parcel Post
Private truck
For-hire truck
Railroad
Shallow draft vessel
Pipeline
Air
Other mode

http://idc4.ssd.census.gov:3116/cfs/shipment_characteristics#[9/1/2011 11:25:02 AM]

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Unknown
Export?
Yes
Foreign Destination (For export shipments only):
City:
Country:
Export mode:
No

Add/Save Shipment

Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3116/cfs/shipment_characteristics#[9/1/2011 11:25:02 AM]

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Help Telephone: 1-800-772-7851, option "3"
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Item G - Rush Deliveries
For this survey, rush deliveries require the purchase of a faster level of service by the shipper or buyer (e.g., same day/overnight
or 2-3 business days). It also includes faster service provided by hired carriers, as part of an arrangement. Excluded, are
shipments that would arrive in the same amount of time without the purchase of a faster level of service, and shipments
delivered by company operated vehicles.
Considering the shipments reported in Item F, did you use rush delivery service?
Yes
No

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3116/cfs/rush_deliveries#[9/1/2011 11:24:20 AM]

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2012 Commodity Flow Survey
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Help Telephone: 1-800-772-7851, option "3"
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Item H - Montly Value of Outbound Shipments
Which one of the following represents your best estimate of the total value of all outbound shipments originating from this
establishment for the most recently completed month? (Select only one.)
Less than $1 Million
$1 Million or more but less than $10 Million
$10 Million or more but less than $40 Million
$40 Million or more but less than $100 Million
$100 Million or more but less than $400 Million
$400 Million or more

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3116/cfs/value_of_shipments#[9/1/2011 11:25:24 AM]

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2012 Commodity Flow Survey
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Help Telephone: 1-800-772-7851, option "3"
(M- F, 8:30am- 5:00pm ET)

Contact
Please provide the information below for the contact person regarding this report.
Name:
Title:
Contact Number:

-

-

Fax Number:

-

-

Ext:

Remarks
Please use this space to clarify your responses, if appropriate.

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Form: CFS-1000s(2012)
OMB No.: 0607 -0921
Approval Expires: 09/30/2011

Burden Statement

Accessibility

http://idc4.ssd.census.gov:3116/cfs/remarks#[9/1/2011 11:23:58 AM]

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File Titlehttp://idc4.ssd.census.gov:3116/cfs/address
File Modified2011-09-13
File Created2011-09-01

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