Various Economic Area Pretesting Activities

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Shoe Stores

FORM

RT-44802

OMB No. 0607-0927: Approval Expires 12/31/2013

(10-27-2011)

(Please correct any errors in this mailing address.)

DUE DATE
FEBRUARY 12, 2013
Need help or have questions?
• Read the accompanying information sheet(s) before
answering the questions.
• Visit

RT-44802

econhelp.census.gov

• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.

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Report Online - It's fast and secure!
Go to:
econhelp.census.gov

U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001

Mail your
completed
form to:

- OR -

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.
• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.

• Please center numbers in
their respective boxes.
• Place an "X" inside the box.

Examples:

The reporting unit for this form is an establishment. An establishment is generally a single physical location
where business is conducted or where services or industrial operations are performed. For further clarification, see
information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown to the left of the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?

44802015

0021

2

Yes - Go to

2

0022

No - Enter current EIN (9 digits)

-

0025

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

0032

Yes - Go to line B
No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

2

ON PAGE 2
CONTINUE ON PAGE 2

Form RT-44802
2

Page 2

(10-27-2011)

PHYSICAL LOCATION - Continued
B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

No

0042

0043

No legal boundaries

0044

Do not know

0024

Do not know

C. In what type of municipality is this establishment physically located?
(Mark "X" only ONE box.)
0046

3

City, village,
or borough

Town or township

0047

0048

Other

OPERATIONAL STATUS
Which ONE of the following best describes this establishment's operational status at the end of 2012?
(Mark "X" only ONE box.)

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0011

In operation

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0015

Sold or leased to another operator - Give date at right
AND enter name and address of new owner or operator
and Employer Identification Number (EIN) below
0060

Month

Day

Year

0018

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

0016

Other - Specify
0815

4

Mark "X"
if None

MONTHS IN OPERATION

44802023

Number of months in operation during 2012 (If none, mark "X" and go to

HOW TO
REPORT
DOLLAR
FIGURES

5

. . . . . . . . . .

Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.
If a figure is $2,035,628.79:

Report

If a value is "0" (or less than $500.00):

Report

$ Bil.

0002

2012
Mil.

2

Thou.

0 3 6

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE

Sales of merchandise and other operating receipts (Exclude sales
taxes or other taxes collected.) . . . . . . . . . . . . . . . . . . .
6

30 .)

2012
Number

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

0100

Not Applicable.

CONTINUE ON PAGE 3

Form RT-44802

Page 3

(10-27-2011)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
7

EMPLOYMENT AND PAYROLL
Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal Revenue
Service Form 941, Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number
(EIN) shown to the left of the mailing address or corrected in 1 .
Exclude:
• Temporary staffing obtained from a staffing service.
• Contractors, subcontractors, or independent contractors.
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Purchased or managed services, such as janitorial, guard, or landscape services.
• Professional or technical services purchased from another firm, such as software consulting, computer
programming, engineering, or accounting services.
2012
Number

Mark "X"
if None

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For further clarification, see information sheet(s).

A. Number of employees for pay period including March 12 . . . . . . . . . . .
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)

Mark "X"
if None

1. Annual payroll . . . . . . . . . . . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March 2012) . . . . . . . . . . .

0310

0320

$ Bil.

2012
Mil.

Thou.

8 – 18 Not Applicable.
19 KIND OF BUSINESS
Which ONE of the following best describes this establishment's principal kind of business in 2012?
(Mark "X" only ONE box.)

44802031

0700

448 210 40 1

Family shoe store

448 210 40 5

Men's and women's shoe store

448 210 20 1

Women's shoe store

448 210 10 1

Men's shoe store

448 210 30 1

Children's and juveniles' shoe store

448 210 50 1

Athletic footwear store

448 210 40 3

Orthopedic shoe store

448 120 00 1

Women's clothing store

448 110 00 1

Men's clothing store

448 140 00 1

Family clothing store

811 430 00 2

Shoe repair shop

772 000 00 1

Other kind of business - Specify

0701

CONTINUE ON PAGE 4

Form RT-44802

Page 4

(10-27-2011)

20 CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2012?
0251

Yes

0252

No

B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2012?
0256

Yes

0257

No

C. Did this establishment require proof of business or professional license from new customers in 2012?
0276

Yes

0277

No

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D. Estimate the percentage of this establishment's total sales (reported in

) by class of customer.

1.

Household consumers and individuals . . . . . . . . . . . . . . . . . . . . . . . . .

0261

%

2.

Retailers for resale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0263

%

3.

Wholesalers/distributors for resale . . . . . . . . . . . . . . . . . . . . . . . . . . .

0264

%

4.

Repair shops for use in repair work . . . . . . . . . . . . . . . . . . . . . . . . . .

0265

%

5.

Manufacturing and mining industrial users for use as input goods in production . . . . .

0266

%

6.

Restaurants, hotels, food services, and contract feeding

. . . . . . . . . . . . . . . .

0267

%

7.

Businesses for end use in their own operation, not for resale or production . . . . . . .

0268

%

8.

Building contractors, heavy construction, and special trade contractors

. . . . . . . . .

0269

%

9.

Farmers for use in farm production . . . . . . . . . . . . . . . . . . . . . . . . . .

0270

%

. . . . . . . . . . . . . . . . . . . .

0271

%

11. Export sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0262

%

0272

%

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

10. Governmental bodies (Federal, state, and local)

44802049

5

2012
Whole percent of
sales and receipts

12. Other - Specify

0874

13. TOTAL

CONTINUE ON PAGE 5

Form RT-44802

Page 5

(10-27-2011)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
21 METHOD OF SELLING
Which ONE of the following best describes this establishment's principal method of selling in 2012?
(Mark "X" only ONE box.)
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)

0751

Store or display showroom (selling from a fixed or permanent location with physical displays of priced
merchandise and/or from a counter)

0752

0753

Warehouse or office (including telephone/fax orders or outside sales representatives)

0754

Mail order

0755

Home shopping via television

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Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party
plan, or temporary kiosk sales)

0756

0757

Vending machines

0758

Other - Specify

0759

2012

HOW TO
REPORT
PERCENTS

Percents should be rounded to
whole percents.

Report thousands of dollars OR whole percents.
Estimates are acceptable.
$ Bil.
Mil.
Thou.
Percent

3 9

If figure is 38.76% of total sales: Report

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
(Report sales for each product line sold by this establishment, either as a dollar figure or as a whole percent of total
sales (reported in 5 ). See HOW TO REPORT DOLLAR FIGURES on page 2 and HOW TO REPORT PERCENTS above.)
2012
Report thousands of dollars OR whole percents.
Estimates are acceptable.

Description of sales, shipments, receipts, or revenue

$ Bil.

1.

a. Men's footwear, including dress and casual footwear

. . .

b. Women's footwear, including dress and casual footwear

44802056

Mil.

Thou.

Percent

Footwear, including accessories (Report women's hosiery on
line 2 and men's hosiery on line 3.)

20261

.

20262

c. Children's footwear, including boys', girls', infants', and
toddlers' dress and casual footwear . . . . . . . . . . . . . .

20263

d. Men's and women's outdoor hiking/sports boots

20264

. . . . . .

e. Men's athletic footwear, including tennis shoes/sneakers

.

20265

f. Women's athletic footwear, including tennis shoes/
sneakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20266

CONTINUE WITH

22

ON PAGE 6

CONTINUE ON PAGE 6

Form RT-44802

Page 6

(10-27-2011)

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
2012
Report thousands of dollars OR whole percents.
Estimates are acceptable.

Description of sales, shipments, receipts, or revenue

$ Bil.

1.

20267

h. Footwear accessories, including polishes, laces, trees,
storage bags, etc. . . . . . . . . . . . . . . . . . . . . . . . . .

20268

i. Add lines 1a through 1h

. . . . . . . . . . . . . . . . . . .

20260

Women's, juniors', and misses' wear, including accessories
(Report girls', infants', and toddlers' wear on line 5 and
footwear on line 1.) . . . . . . . . . . . . . . . . . . . . . . . . . .

20220

Men's wear, including accessories (Report boys' wear on line
5 and footwear on line 1.) . . . . . . . . . . . . . . . . . . . . . .

20200

4.

Costumes and unisex clothing

20250

5.

Children's wear, including boys', girls', and infants' and
toddlers' clothing and accessories (Report footwear on line 1.)

20240

6.

Sporting goods and recreational equipment

. . . . . . . . . . .

20530

7.

Jewelry, including watches, watch attachments, novelty
jewelry, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20400

All other merchandise (Report receipts for services on line 9.)
Specify principal lines and estimated sales below . . . . . . . .

29810

a.

29811

b.

29812

c.

29813

All nonmerchandise receipts, including receipts from repairs,
rentals, storage, and other services provided to customers
EXCLUDING SALES AND OTHER TAXES . . . . . . . . . . . . .

29900

3.

8.

44802064

9.

Thou.

Percent

Footwear, including accessories - Continued
g. Children's athletic footwear, including boys', girls', infants',
and toddlers' tennis shoes/sneakers . . . . . . . . . . . . . .

2.

Mil.

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10. TOTAL (Should equal

5

. . . . . . . . . . . . . . . . . . .

if reporting in dollars.)

. . . . . . . .

29990

1 0 0

23 Not Applicable.

CONTINUE ON PAGE 7

Form RT-44802

Page 7

(10-27-2011)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
24 SHIPPING AND HANDLING
A. Did this establishment have any receipts from customers for shipping and handling of merchandise in 2012?
0981

Yes - Go to line B

0982

No - Go to

2012
Estimates are acceptable
$ Bil.
Mil.
Thou.

26

B. Receipts of this establishment from customers for shipping and handling
of merchandise . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0985

C. Are receipts for shipping and handling included in sales and receipts (reported in
0988

Yes

0989

No

25 Not Applicable.
26 SPECIAL INQUIRIES

5

)?

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A. CONCESSION
Did this establishment conduct business as a department or concession in an establishment operated by another
firm in 2012?
2241

Yes

2242

No

B. FRANCHISE
1. Was this establishment operating under any trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0235

44802072

27 – 29 Not Applicable.

CONTINUE ON PAGE 8

Form RT-44802

Page 8

(10-27-2011)

REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

$$CENSUS_REMARKS$$

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30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Is the time period covered by this report a
calendar year?

44802080

Yes

Month

No - Enter time period covered

Telephone

-

Year

TO
Title

Number

-

Month

FROM

Name of person to contact regarding this report

Area code

Year

Extension

-

Area code

Fax

E-mail address

Number

Month

Day

Date
completed

Thank you for completing your 2012 ECONOMIC CENSUS form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.

Year