BLS-Green Form 238 Green Form 238212

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

Green form 238212 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: 238212

Nonresidential Electrical Contractors and Other Wiring Installation Contractors

We have identified your main business activity as the following:

Does NOT include:

Establishments primarily engaged in nonresidential:

  • Installation and servicing of electrical wiring and equipment

  • Work may include new work, additions, alterations, maintenance, and repairs




  • Installing and maintaining telecommunications lines by telecommunications companies

  • Constructing power and communication transmission lines

  • Burglar and fire alarm installation combined with sales, maintenance, or monitoring services


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









W

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


What is your percent revenue from specific business activities?

In Columns 1 and 3, please estimate the percent of total revenue at the location listed in Item 1 that comes from electrical and wiring jobs on EnergyStar or LEED (Leadership in Energy and Environmental Design) certified residential buildings or from weatherization or retrofitting projects that increase the energy efficiency of a residential building. Please base your estimate on total revenue for your fiscal year from Item 3. The sum of Columns 1 and 3 may not 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 from EnergyStar, LEED certified or projects that increase energy efficiency

2




Business activities


3



Percent of total revenue from EnergyStar, LEED certified or projects that increase energy efficiency

4




Business activities


Airport runway lighting contractors, nonresidential



Highway, street and bridge lighting and electrical signal installation, nonresidential


Alarm system (e.g., fire, burglar), electric, installation only, nonresidential



Home automation system installation, nonresidential


Audio equipment installation (except automotive) contractors, nonresidential



Home theater installation, nonresidential


Building automation system installation contractors, nonresidential



Humidity control system installation, nonresidential


Burglar alarm system, electric, installation only, nonresidential



Intercommunication (intercom) system installation, nonresidential


Cable splicing, electrical or fiber optic, nonresidential



Lighting system installation, nonresidential


Cable television hookup contractors, nonresidential



Low voltage electrical work, nonresidential


Communication equipment installation, nonresidential



Private driveway or parking area lighting contractors, nonresidential


Computer and network cable installation, nonresidential



Public address system installation, nonresidential


Control system (e.g., environmental, humidity, temperature) installation, nonresidential



Railroad signalling equipment installation, nonresidential


Electric contracting, nonresidential



Security and fire system, installation only, nonresidential


Electric power control panel and outlet installation, nonresidential



Smoke detection system, installation only, nonresidential


Electrical contractors, nonresidential



Snow melting cable, electric, installation, nonresidential


Electrical equipment and appliance installation, nonresidential



Sound equipment installation, nonresidential


Electrical wiring contractors, nonresidential



Surveillance system, installation only, nonresidential


Electrical work, nonresidential



Telecommunications equipment and wiring (except transmission line) installation contractors, nonresidential


Electrical, electrical wiring, and low voltage electrical work, nonresidential



Telephone equipment and building wiring installation, nonresidential


Electrician, nonresidential



Telephone installation contractors, nonresidential


Electronic containment fencing for pets, installation, nonresidential



Temperature control system installation, nonresidential


Electronic control installation and service, nonresidential



Traffic signal installation, nonresidential


Electronic control system installation, nonresidential



Tunnel lighting contractors, nonresidential


Environmental control system installation, nonresidential



Other (please specify):


Fiber optic cable (except transmission lines) installation, nonresidential



Other (please specify):


Fire alarm system, electric, installation only, nonresidential



Other (please specify):


W

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
File Modified0000-00-00
File Created2021-02-02

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