Form MA-3000 Manufacturers' Unfilled Orders Survey

Appendix A
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

MANUFACTURERS’ UNFILLED ORDERS SURVEY

MA-3000
OMB No. 0607-0561: Approval Expires

(12-28-2012)

Please correct errors in name, address, and ZIP code. ENTER street and number if not shown.

DUE DATE:

Report by mail:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
OR
Report electronically:
econhelp.census.gov/ufo
User ID:

Password:

Need help or have questions
about completing this form?
Call: (301) 763-1779
YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations that receive this form to answer
the questions and return the report to the U.S. Census Bureau. By the same law, YOUR U.S. CENSUS BUREAU REPORT IS CONFIDENTIAL. It may
be seen only by persons sworn to uphold the confidentiality of U.S. Census Bureau information and may be used only for statistical purposes. Further,
copies retained in respondents’ files are immune from legal process.
Name of person to be contacted regarding this report (Please print or type)

Area Code

Number

Title

Extension

Area Code

Telephone

Number

Fax

IMPORTANT - Please read the instructions included with this form, then complete the survey below.
Provide company name (sold or acquired), address, and EIN (if applicable) below.
CHANGE IN OPERATIONAL STATUS

➤

Sold to another company

Period covered by data (if other than calendar year)
2012
2011
Month Day
Year
Month Day

– Provide company name (sold or acquired), address, and
EIN (if applicable) at right

Acquired another company

§?!?1¤

– Provide company name and address at right

DATE OF OPERATIONAL
STATUS CHANGE:

Line
No.

Selected Major Manufacturing Activities
(See Instructions)
U.S. MANUFACTURING ONLY
(a)

FROM

Year

FROM
Month

Day

Year

TO

Month

Day

Year

TO

U.S. Annual Sales
2012
(in thousands
of dollars)
(b)

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2012
(in thousands
of dollars)
(c)

U.S. Annual Sales
2011
(in thousands
of dollars)
(d)

1
2
3
4

Please continue on the reverse side for additional manufacturing activities and/or remarks.

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2011
(in thousands
of dollars)
(e)

30003016

Ceased operations

Appendix A

2
Line
No.

Selected Major Manufacturing Activities
(See Instructions)
U.S. MANUFACTURING ONLY
(a)

U.S. Annual Sales
2012
(in thousands
of dollars)
(b)

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2012
(in thousands
of dollars)
(c)

U.S. Annual Sales
2011
(in thousands
of dollars)
(d)

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2011
(in thousands
of dollars)
(e)

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

30003024

§?!?9¤

Remarks

CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Signature of authorized person

Date

BURDEN HOUR ESTIMATE: Public reporting burden for this collection is estimated to vary from 15 minutes to 1 hour per response, with an
average of 30 minutes per response including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Response to this collection of information is not required
unless it displays a valid approval number from the Office of Management and Budget (OMB). The eight-digit OMB Number appears in the
upper right corner of this report 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, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington,
DC 20233. You may email comments to [email protected]; use "Paperwork Project 0607-0561" as the subject.

Form MA-3000

(12-28-2012)