NC-99026 2012 Economic Census Classification Report

Attachment A
NC-99026 (draft)
Page 1 of 2
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

NC-99026

2012 ECONOMIC CENSUS
Classification Report

OMB No. : Approval Expires

(DRAFT)

NC-99026

Need help or have questions about filling out this
form?
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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.)

FROM THE ASSISTANT DIRECTOR
FOR ECONOMIC PROGRAMS
U.S. CENSUS BUREAU
We need your assistance to accurately classify your firm in the correct industry for the 2012 Economic Census.
Economic data are essential to business and government decision making, and reliable data for your business
require accurate industry classification.
Please complete all items on this form and return it within 30 days after receipt. Since this form
requests no operating data, it should take only a few minutes to complete.
If you wish to report online using our secure Web site, go to http://www.census.gov/econhelp/classforms. Your
username and password are located above the address label on this form.

99026015

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.
Thank you in advance for your cooperation.
Sincerely,

WILLIAM G. BOSTIC, JR.
We estimate that it will take an average of 5 minutes to complete this form. This includes time to read instructions, assemble and review information, and
record answers on the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to Paperwork Project 0607-0925, U.S. Census Bureau, 4600 Silver Hill Road, AMSD -3K138, Washington, DC 20233. You may email comments to [email protected]; use "Paperwork Project 0607-0925" as the subject. Respondents are not required to respond to any information
collection unless it displays a valid approval number from the Office of Management and Budget. This 8-digit number appears in the top right corner on the
front of the questionnaire.

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

CONTINUE ON PAGE 2

Attachment A
NC-99026 (draft)
Page 2 of 2
Form NC-99026
1

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 - Go to line B

0035

Number and street

0032

No - Enter
physical
location

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

2

City, village, or borough

0230

Town or township

0231

Other

0232

Do not know

PRINCIPAL BUSINESS OR ACTIVITY
A. Which ONE of the following best describes this establishment's major type of activity during the past 12 months?
(Mark "X" only ONE box.)
Construction

Manufacturing

Other - Specify

B. Which ONE of the following best describes this establishment's specific business or activity?
(Mark "X" only ONE box.)

99026023

See Attachment B.

3

CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
0072

Name of person to contact regarding this report

Telephone
0074

Area code

Number

-

Extension