| U.S. Department of Labor | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
| U.S. Department of Labor | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
	
| U.S. Department of Labor | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
	
	
Date
	
	
Attn: Contact_name (if missing use “Department of Accounting/Finance”)
T_name
BM_addr1
BM_addr2
BM_city, BM_state BM_zip-BM_zip_ext
	
	
Dear Employer:
The Bureau of Labor Statistics (BLS) of the U.S. Department of Labor needs your help. We need to hear from businesses like yours as we measure employment involved in the production of green goods and services. We need to hear from every company, even if your company is not involved in producing green goods or services, to get an accurate picture of the economy.
	
	
Green goods and services are defined as those that benefit the environment or conserve natural resources. Examples are listed on the following pages.
	
	
We are requesting that you participate by responding to the attached survey. Please complete and return the survey within 30 days of receipt.
	
	
Your business may have more than one location, and each location may be involved in a different activity. Please respond for the activities performed at the individual worksite identified in Question 1 of the survey.
	
	
If you have any questions, please contact our helpdesk by calling toll free at [toll-free number] or by emailing [_ _______@bls.gov].
	
	
Thank you for your participation.
	
	
Sincerely yours,
	 
Patricia M. Getz
Assistant Commissioner
Office of Industry Employment Statistics, Office of Employment and Unemployment Statistics
	
	
	
	
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 15 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-XXXX and expires on Month, Day Year. Without a currently valid number BLS would not be able to conduct this survey.
| U.S. Department of Labor | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
| 
				 | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
| 
				 | Bureau of Labor Statistics 2 Massachusetts Avenue, NE, Room 4840 Washington, DC 20212 
 | 
				 | 
U.S. Department of Labor
O.M.B. No. 1220−XXXX Expires Month, Day Year
Please complete and return this form within 30 days. If you need help completing this form, send an email to [email protected], or call tollfree#. Thank you!
	I 
		1 
								
		     Enter
		Physical Location Address Corrections Here
		   	 T_name					
		   	 ______________________________________________ Phy_addr2			
		                   	 ______________________________________________ PHY_addr1
					                    	
		______________________________________________ Phy_city,
		Phy_state  phy_zip - phy_zip_ext
		      	 ______________________________________________ 
		
	
	
	
	
	
	
	
	
	
	
	W 
		2
Please provide contact information for the person or persons who completed this form.
Primary contact’s name: _____________________________________
Title:_________________________________
Phone: (______)________ - ___________ __
email:________________________________
Business website:______________________
Secondary contact’s name: ____________________________________
Title:________________________________
Phone: (______)________ - _____________
email:_______________________________
	
	
	H 
		3
Please provide the number of employees, both full and part-time, who worked at the site listed in Question 1 during the pay period that includes January 12, 2010.
Include:
Full or part-time paid workers
Workers on paid leave
Workers assigned temporarily to other units
Incorporated firms - paid owners, officers, and staff
	
	
	
	
	
	
	
	
Do Not Include:
Contractors and temporary agency employees not on your payroll
Unpaid family workers
Workers on unpaid leave
Owners, proprietors, and partners of unincorporated firms
Workers not covered by unemployment insurance
| Number of employees for pay period that includes January 12, 2010 | 
| 
				 | 
	 
	
	
	
	
	
	
	
	
	
	
	
	
	D 
		4
Please consider the goods and services you produce for sale or for transfer within your company.
Do not consider internal green practices, such as recycling programs, use of renewable energy, use of green office products or cleaning materials, use of energy-efficient or pollution-reducing equipment or practices at the worksite, etc.
		
		 
					Green
					goods and services categories 
					Examples
					(this is not an exhaustive list) 
					Yes 
					No 
					Renewable
					energy. 
					 Products
					and services that:
					
					 generate
						electricity, heat, or fuel from non-fossil, renewable fuel
						sources generate
						electricity, heat, or fuel from waste 
					Construction
					or maintenance of: 
					-
					 Power plants generating energy from renewable sources, such as
					wind, 
					    hydro,
					biomass, geothermal, solar, and ocean 
					Installation
					of parts for use in a renewable source-fueled power plant, such 
					 
					 as
					solar cells or wind turbines 
					 
					 
					Energy
					efficiency.
					
					 Products
					and services that: reduce
						energy consumption improve
						energy efficiency 
						 
					Installation
					or maintenance of: EnergyStar
						certified products, such as dishwashers and washing machines Products
						eligible for use in LEED or Green Globe certified projects,
						such as windows, floorings, and tiles 
						 SmartGrid
						meters, sensors, and automatic electric transmission devices Construction
					of ISO 21930:2007-compliant projects Construction
					of LEED certified buildings Construction
					of Green Globes/ANSI/GBI certified commercial buildings Construction
					of EnergyStar buildings Weatherization
					and retrofitting projects 
					 
					 
					Pollution
					mitigation and greenhouse gas reduction.
					
					 Products
					and services that: reduce
						or eliminate pollution or greenhouse gases 
					Construction
					or maintenance of: 
					-
					 Power plants generating energy from waste sources, such as
					landfill gas or municipal solid waste 
					Installation
					or maintenance of: ANSI
						environmental certified products, such as NSF/ANSI 140 and 332
						certified goods (carpeting and floor coverings) Products
						on the USDA Biopreferred product list, such as carpets and
						fluid-filled transformers Products
						listed with the EPA Environmentally preferable purchasing
						program, such as pipes and roofing materials Scrubbers
						and other pollution control mechanisms in power plants and
						other factories 
					 
					 
					Recycling
					and reuse. Products
					and services that: collect,
						reuse, remanufacture, or recycle compost
						waste materials 
						 
					Construction
					or maintenance of: Recycling
						or composting facilities 
					Collecting
					and recycling or composting contruction material scrap or waste.
					
					 Deconstructing
					existing structures for the purpose of recycling or reusing
					construction materials 
					 
					 
					Natural
					resources conservation.
					
					 Products
					and services that: reduce
						the environmental impact of agricultural production improve
						natural resources conservation 
					Installation
					or maintenance of WaterSense-certified products, such as toilets
					and showerheads Construction
					or maintenance of stormwater management structures and systems 
					 
					 
					Other. Does
					this worksite produce any green goods or services not described
					above? Green goods or services are those that benefit the
					environment or conserve natural resources.  
					 
					If
					yes, please describe here: 
					 
					 
					
			
		
				 
			
				 
			
						
					
					
					
					
				 
			
						
						
					
					
					
				 
			
						
					
						
					
					
					
				 
			
						
						
					
					
					
				 
			
						
					
					
				 
		
					
					
					
					
					
					
		
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	 
		      If
		any
		are checked yes, please go to Question 5. 
	
	
	
	 
		 If
		all
		are checked NO,
		please stop
		here and return the survey. Thank you. 
		 
	
	
	
	
	
	
	
	W 
		5 
					Start
					of Fiscal Year 
					 
					End
					of Fiscal Year 
					MM 
					DD 
					YYYY 
					 
					MM 
					DD 
					YYYY 
					 
					 
					 
					 
					 
					 
					 
			
		
				 
			
					
				 
			
					
				 
		
					
					
					
					
					
					
					
		
Please provide us with your worksite’s 2010 fiscal year.
	
	
	
	
	
	
	 
		6
	
During the fiscal year in Question 5, did this worksite have any revenue from the sales of goods or services in the categories checked ‘yes’ in Question 4?
	
	
Revenue from sales includes:
Income a worksite receives from the sale of goods and services
Market value of goods produced and services rendered for transfers within your company
Revenue from sales does not include:
Royalties, taxes, interest payments, and all other non-operational revenue
		N o
		                  Go to Question 8
o
		                  Go to Question 8
		Y es
		                 Go to Question 7
es
		                 Go to Question 7      
		
	
	
	( 
		7
	E 
		%   
		 stimate
	the percent of sales revenue for
stimate
	the percent of sales revenue for 
		%   
		
	
		 Please
	stop
	here and return this completed survey.  Thank you.
					Please
	stop
	here and return this completed survey.  Thank you.
	
	
	( 
		8 If
	no to Question 6) What percentage of this worksite’s
	employment listed in Question 3 primarily works on the products or
	services checked ‘yes’
	in
	Question 4?
If
	no to Question 6) What percentage of this worksite’s
	employment listed in Question 3 primarily works on the products or
	services checked ‘yes’
	in
	Question 4?    
	
	E 
		%   
		 stimate
	for
stimate
	for 
	 
		            %
	
	P 
		For internal use only: NAICS
		23 GGS
		Identifier 
		 
 
 
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | viegas_r | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-31 |