| 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 
					Landfill
					gas/solid waste energy production Waste-to-Energy
					facilities 
					 
					 
					Wind
					power production 
					 
					 
					Solar
					power production 
					 
					 
					Hydroelectric
					power generation 
					 
					 
					Biomass
					energy generation 
					 
					 
					Geothermal
					energy or steam production 
					 
					 
					Ocean
					(tidal, wave, current, and thermal) energy production 
					 
					 
					Other
					renewable energy production (please specify): 
					 
					 
					Pollution
					mitigation and greenhouse gas reduction.
					
					 Products
					and services that: reduce
						or eliminate pollution or greenhouse gases 
					Sewage
					treatment plants Water
					treatment plants Landfill
					gas/solid waste energy production Waste-to-Energy
					facilities Nuclear
					energy production 
					 
					 
					Recycling
					and reuse. Products
					and services that: collect,
						reuse, remanufacture, or recycle compost
						waste materials 
						 
					Waste
					management services: 
					 Solid
							and hazardous waste collection Solid
							waste landfills, incinerators, combustors Hazardous
							waste treatment and disposal Remediation
							services Materials
							recovery Septic
							tank services 
					 
					 
					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
		all
		are checked NO,
		please stop
		here and return the survey. Thank you. 
		 
		      If
		any
		are checked yes, please go to Question 5. 
 
	
	
	
	
	
	
	
	
	
	
	
	
	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
Yes 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
	E 
		%   
		 stimate
	for
stimate
	for 
	 
		            %
	
	P 
		For internal use only: NAICS
		2213 562 GGS
		Identifier 
		 
 
 
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | viegas_r | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-31 |