BLS-Green Form 334 Green Form 334513

Quarterly Census of Employment and Wages Green Goods and Services Sector Industry Pre-testing

Green form 334513 4_6

QCEW Green Goods and Services Sector Industry Pre-testing - Forms Testing

OMB: 1220-0181

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Green Goods and Services Survey

O.M.B. No. 1220−0181

Expires September 30, 2010

Shape1

Please return this form within 14 days. If you need help completing this form, contact information is listed on the last page. Thank you!

Statename


UI (10 digits)


Shape4 Shape3 Please report for location(s) in using Unemployment Insurance account number


1


What is the address where your business establishment is physically located?

Report data for the location below. If this address is no longer correct, please provide us with an updated address in the space provided.

Enter Physical Location Address Corrections Here

T_name

Phy_addr2

PHY_addr1

Phy_city, Phy_state phy_zip-phy_zip_ext


H

2

ave we identified your main business activity correctly?

We have listed below a description of your main business activity at this location. If this description is incorrect, please call 202-691-5185 or email [email protected].


NAICS code: 334513

Instruments and related products manufacturing for measuring, displaying and controlling industrial process variables

We have identified your main business activity as the following:

Does NOT include:

Establishments primarily engaged in manufacturing:

  • Instruments and related devices for measuring, displaying, indicating, recording, transmitting, and controlling industrial process variables


These processes may include:

  • Temperature, humidity, pressure, vacuum, combustion, flow, level, viscosity, density, acidity, concentration, and rotation




  • Glass hydrometers and thermometers for other nonmedical uses

  • Instruments and instrumentation systems for laboratory analysis of samples

  • Instruments for measuring or testing of electricity and electrical signals

  • Medical thermometers

  • Optical alignment and display instruments, optical comparators, and optical test and inspection equipment


W

3

hat is your business establishment’s fiscal year?

Please provide us with your fiscal year that includes April 15, 2009 for the location listed in Item 1.

Start of Fiscal Year


End of Fiscal Year

MM

DD

YYYY


MM

DD

YYYY








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4

hat is your business establishment’s employment?

Please provide us with the employment figure you reported on your State’s Quarterly Contributions Report for September 2009 for the location listed in Item 1. This figure is the count of all employees subject to State Unemployment Insurance taxes that worked or received pay for the pay period that included September 12th, 2009.

Employment for pay period that includes September 12, 2009


5

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What is your percent revenue from specific product lines?

In Columns 1 and 3, please estimate the percent of total revenue at the location listed in Item 1 for the following products. Please base your estimate on total revenue for your fiscal year from Item 3. The sum of Columns 1 and 3 should equal 100%.


Note: This section may best be completed by someone at your firm with access to financial data.


Percent of total revenue for fiscal year listed in Item 3

1


Percent of total revenue

2


Product line


3


Percent of total revenue

4


Product line


Absorption analyzers, industrial process type (e.g., infrared), manufacturing



Liquid concentration instruments, industrial process-type, manufacturing


Acidity (i.e., pH) instruments, industrial process type, manufacturing



Liquid level instruments, industrial process-type, manufacturing


Analyzers, industrial process control type, manufacturing



Magnetic flow meters, industrial process-type, manufacturing


Annunciators, relay and solid-state types, industrial display, manufacturing



Manometers, industrial process-type, manufacturing


Boiler controls, industrial, power, and marine-type, manufacturing



Measuring instruments, industrial process control-type, manufacturing


Buoyancy instruments, industrial process-type, manufacturing



Mechanical measuring instruments, industrial process-type, manufacturing


Chromatographs, industrial process-type, manufacturing



Meters, industrial process control-type, manufacturing


Combustion control instruments (except commercial, household furnace-type) manufacturing



Moisture meters, industrial process-type, manufacturing


Controllers for process variables (e.g., electric, electronic, mechanical, pneumatic operation) manufacturing



Panelboard indicators, recorders, and controllers, receiver industrial process-type, manufacturing


Coulometric analyzers, industrial process-type, manufacturing



Pneumatic controllers, industrial process type, manufacturing


Data loggers, industrial process-type, manufacturing



Potentiometric instruments (except X-Y recorders), industrial process-type, manufacturing


Density and specific gravity instruments, industrial process-type, manufacturing



Pressure gauges (e.g., dial, digital), industrial process-type, manufacturing


Differential pressure instruments, industrial process-type, manufacturing



Pressure instruments, industrial process-type, manufacturing


Digital displays of process variables manufacturing



Primary elements for process flow measurement (i.e., orifice plates) manufacturing


Display instruments, industrial process control-type, manufacturing



Primary process temperature sensors manufacturing


Draft gauges, industrial process-type, manufacturing



Process control instruments, industrial, manufacturing


Electric and electronic controllers, industrial process-type, manufacturing



Programmers, process-type, manufacturing


Electrodes used in industrial process measurement manufacturing



Pyrometers, industrial process-type, manufacturing


Electrolytic conductivity instruments, industrial process-type, manufacturing



Recorders, industrial process control-type, manufacturing

5


Electromagnetic flowmeters manufacturing



Refractometers, industrial process-type, manufacturing


Flow instruments, industrial process-type, manufacturing



Resistance thermometers and bulbs, industrial process-type, manufacturing


Fluidic devices, circuits, and systems for process control, manufacturing



Telemetering instruments, industrial process-type, manufacturing


Gas analyzers, industrial process-type, manufacturing



Temperature instruments, industrial process-type (except glass and bimetal thermometers), manufacturing


Gas and liquid analysis instruments, industrial process-type, manufacturing



Thermal conductivity instruments, industrial process-type, manufacturing


Gas chromatographic instruments, industrial process-type, manufacturing



Thermistors, industrial process-type, manufacturing


Gas flow instrumentation, industrial process-type, manufacturing



Thermocouples, industrial process-type, manufacturing


Gauges (i.e., analog, digital), industrial process-type, manufacturing



Thermometers, filled system industrial process-type, manufacturing


Humidity instruments, industrial process-type, manufacturing



Time cycle and program controllers, industrial process-type, manufacturing


Hydrometers, industrial process-type, manufacturing



Transmitters, industrial process control-type, manufacturing


Hygrometers, industrial process-type, manufacturing



Turbidity instruments, industrial process-type, manufacturing


Indicators, industrial process control-type, manufacturing



Turbine flow meters, industrial process-type, manufacturing


Industrial process control instruments manufacturing



Variable control instruments, industrial process-type, manufacturing


Infrared instruments, industrial process-type, manufacturing



Viscosimeters, industrial process-type, manufacturing


Instruments for industrial process control manufacturing



Water quality monitoring and control systems manufacturing


Level and bulk measuring instruments, industrial process-type, manufacturing



Other (please specify):


Liquid analysis instruments, industrial process-type, manufacturing



Other (please specify):




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6

hat is your contact information? For the person or persons who helped complete this form.

  1. Contact 1’s name: __________________________________________

Title:___________________________________

Phone number: (_____)________ - _____________________ email:__________________________________

Business website:______________________________________________

  1. Contact 2’s name: ____________________________________________

Title:___________________________________


Phone number: (_____)________ - _____________________ email:________________________________


D

7

o you have any questions about completing this form?

Please send an email to [email protected], or call (202)-691-5185.

Confidentiality Statement. The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. This report is authorized by law 29 U.S.C.2. Paperwork Reduction Act Statement. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate, and timely. We estimate that completing this form will take an average of 20 minutes. This estimate takes into account time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. If you have any comments regarding this survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Office of Industry Employment Statistics, Paperwork Reduction Project, 2 Massachusetts Avenue, N.E., Room 4840, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-0181 and expires on September 30, 2010. Without a currently valid number BLS would not be able to conduct this survey.

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleIndustry Verification Form, BLS 3023−NVS
AuthorPLASKIE_W
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File Created2021-02-02

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