Various Economic Area Pretesting Activities

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

OMB No. 0607-0938: Approval Expires 12/31/2013

(05-31-2012)

(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

MC-31000

econhelp.census.gov

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

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

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?

31000011

0021

2

Yes - Go to

2

No - Enter current EIN (9 digits)

0022

-

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
0035

Number and street

0036

City, town, village, etc.

No - Enter
physical
location

0037

State

0038

ZIP Code

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

2

ON PAGE 2
CONTINUE ON PAGE 2

Page 2

2

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

0042

No

0043

No legal boundaries

0040

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

0047

Town or township

0048

Other

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

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0015

Month

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

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

4

Mark "X"
if None

MONTHS IN OPERATION

30 .)

. . . . . . . . . .

0002

31000029

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

2012
Number

CONTINUE ON PAGE 3

Page 3

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

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.

2012
Mil.

2

Thou.

0 3 6

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None

A. Total value of products shipped and other receipts (Report detail
in 22 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$ Bil.

2012
Mil.

Thou.

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO
0100

B. Value of products exported (This is a breakout of the value
reported on line A.)

Report the value of products shipped for export. Include
shipments to customers in the Commonwealth of Puerto Rico,
and U.S. possessions, as well as the value of products shipped to
exporters or other wholesalers for export. Also, include the value
of products sold to the U.S. Government to be shipped to foreign
governments. Exclude products shipped for further manufacture,
assembly, or fabrication in the United States. . . . . . . . . . .
6

0130

E-SHIPMENTS
A. Did this plant use any electronic network to control or coordinate the flow of any of the shipments of goods
reported in 5 , line A? Or, were the orders for any of the shipments reported in 5 , line A, received over an
electronic network?
Electronic networks include:
• Electronic Data Interchange (EDI)
• E-mail
• Internet
• Extranet
• Other online systems
0181

Yes - Go to line B

0182

No - Go to

2012
Percent

7

0109

%

31000037

B. Percent of total reported in 5 , line A, that were ordered, or whose movement was controlled or
coordinated over electronic networks (Report whole percents. Estimates are acceptable.) . . . .

CONTINUE ON PAGE 4

Page 4

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:
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Temporary staffing obtained from a staffing service.
For further clarification, see information sheet(s).
A. Number of employees

a. March 12

2012
Number

Mark "X"
if None

1. Number of production workers for pay periods including:

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

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

0325

b. June 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0324

c. September 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0344

d. December 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0347

2. Add lines A1a through A1d . . . . . . . . . . . . . . . . . . . . . .

0329

3. Average annual production workers (Divide line A2 by 4 - omit fractions.)

.

0335

4. All other employees for pay period including March 12 . . . . . . . . . .

0336

5. TOTAL (Add lines A3 and A4.) . . . . . . . . . . . . . . . . . . . . . .

0337

B. Payroll before deductions (Exclude employer's cost for fringe benefits.)
Mark "X"
if None

31000045

1. Annual payroll
a. Production workers . . . . . . . . . . . . . . . . . . . .

0304

b. All other employees . . . . . . . . . . . . . . . . . . .

0305

c. TOTAL (Add lines B1a and B1b.) . . . . . . . . . . . . .

0300

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

0310

C. Payroll taxes, employer paid insurance premiums (including
health insurance and pension plans) and other employer paid
benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0220

$ Bil.

Mark "X"
if None

D. Number of hours worked by production workers (Annual hours worked by
production workers reported on lines A1a through A1d.) . . . . . . . . . . .

2012
Mil.

Thou.

2012
Hours
Thou.

0200

CONTINUE ON PAGE 5

Page 5

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
8

Not Applicable.

9

VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2012 and/or 2011?
0486

Yes - Go to line B

0487

No - Go to

13

B. Report inventories owned by this establishment as of December 31 before Last-in, First-out (LIFO) adjustment (if any).
Mark "X"
if None

End of 2012
Mil.

$ Bil.

Thou.

Mark "X"
if None

$ Bil.

End of 2011
Mil.

Thou.

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

1. Finished goods . . .

0461

0471

0463

0473

0462

0472

0460

0470

0466

0476

0490

0492

2. Work-in-process . . .
3. Materials, supplies,
fuels, etc. . . . . . .
4. Total inventories
(Add lines B1 through
B3.) . . . . . . . . .
5. LIFO reserve (Report
LIFO gross in 10 ,
line A.) . . . . . . .
6. Total inventories
after LIFO
adjustment (Line B4
minus line B5.) . . .

10 INVENTORIES BY VALUATION METHOD
Report how much of the inventory reported in
A. LIFO valuation
Mark "X"
method before
if None
adjustment (Report
LIFO reserve in 9 ,
line B5.) . . . . . . .

$ Bil.

9

, line B4, is subject to the following valuation methods.
End of 2012
Mil.

Thou.

Mark "X"
if None

0465

0475

0487

0485

0510

0508

$ Bil.

End of 2011
Mil.

Thou.

B. Any non-LIFO
valuation method Specify method

31000052

0895

C. TOTAL (Add lines A
and B. Total should
equal 9 , line B4.) . .
11 and 12 Not Applicable.

CONTINUE ON PAGE 6

Page 6

13 ASSETS, CAPITAL EXPENDITURES, RETIREMENTS, AND DEPRECIATION
(Refer to the instructions on how to report leasing arrangements.)
Report the dollar value of assets, capital expenditures, and depreciation.
A. Gross value of depreciable assets (acquisition costs) at the
beginning of the year . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

2012
Mil.

Thou.

0500

B. Capital expenditures for new and used depreciable assets in 2012
1. Capital expenditures for new and used buildings and other
structures (Exclude land.) . . . . . . . . . . . . . . . . . . .

0525

2. Capital expenditures for new and used machinery and
equipment . . . . . . . . . . . . . . . . . . . . . . . . . .

0530

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

3. TOTAL (Add lines B1 and B2.) . . . . . . . . . . . . . . . .

0520

C. Gross value of depreciable assets sold, retired, scrapped,
destroyed, etc. . . . . . . . . . . . . . . . . . . . . . . . . .

0510

D. Gross value of depreciable assets at the end of 2012 (Add lines A
and B3 minus C.) . . . . . . . . . . . . . . . . . . . . . . . .

0505

E. Normal depreciation charges for all tangible assets including
buildings, machinery, and equipment . . . . . . . . . . . . . . .

0540

F. Breakdown of expenditures for new and used machinery and
equipment by type (Reported on line B2.)
1. Automobiles, trucks, etc., for highway use . . . . . . . . . . .

0522

2. Computers and peripheral data processing equipment . . . . .

0523

3. All other expenditures for machinery and equipment . . . . . .

0524

4. TOTAL (Add lines F1 through F3.)

0529

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

31000060

14 RENTAL PAYMENTS
(Exclude capital leases (leases with a contract to own at the end of the
lease).)

Mark "X"
if None

A. Rental or lease of buildings, job-site trailers, and other structures
(Include land.) . . . . . . . . . . . . . . . . . . . . . . . . . .

0551

B. Rental or lease of construction equipment and tools, machinery,
office equipment, furniture, and vehicles . . . . . . . . . . . . .

0552

C. TOTAL (Add lines A and B.) . . . . . . . . . . . . . . . . . . .

0550

$ Bil.

15 Not Applicable.

CONTINUE ON PAGE 7

Page 7

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
16 SELECTED EXPENSES
Mark "X"
if None

A. Selected production related costs
1. Cost of materials, parts, containers, packaging, etc. used
(Report detail in 17 .) . . . . . . . . . . . . . . . . . . . . .

0421

2. Cost of products bought and sold as such without further
processing (Report sales in 22 .) . . . . . . . . . . . . . . . .

0426

3. Cost of purchased fuels consumed for heat, power, or the
generation of electricity . . . . . . . . . . . . . . . . . . .

0430

$ Bil.

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

4. Cost of purchased electricity (Report quantity on line B1.)

. . .

0425

5. Cost of work done for you by others on your materials . . . . .

0424

6. TOTAL (Add lines A1 through A5.) . . . . . . . . . . . . . .

0420

Mark "X"
if None

B. Quantity of Electricity
0436

2. Generated electricity (Gross less generating station use.) . . . .

0437

3. Electricity sold or transferred to other establishments (Include
on lines B1 or B2.) . . . . . . . . . . . . . . . . . . . . . .

0438

Thou.

2012
Kilowatt-hours
Mil.

Thou.

31000078

1. Purchased electricity (Quantity comparable to cost reported on
line A4.) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bil.

2012
Mil.

CONTINUE ON PAGE 8

Page 8

GENERAL INSTRUCTIONS

Manufacturing Activities

Respondents are not required to respond to any
information collection unless it displays a valid approval
number from the Office of Management and Budget
(OMB). The OMB 8-digit number appears in the upper
right corner of this report form.

Report all activities (manufacturing, fabricating,
processing, and assembling) conducted within the
establishment.

Report all value figures in thousands of dollars, total
plant hours in thousands of hours, and all electricity
quantity figures in thousands of kilowatt-hours for the
manufacturing establishment.
When actual book figures cannot be provided without
high cost to your company, reasonable amounts of
estimating or prorating are acceptable.
If you require an extension of time to complete this
report or if there are any other questions regarding this
report, please -

Include
•
•
•
•
•
•
•

Maintenance of plant and equipment
Receiving and shipping activities
Warehousing and storage
Research
Recordkeeping
Health and safety
Cafeteria and other services unless operated as
separate establishments

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

• Call 1-800-233-6136 for toll-free assistance, 8:00 a.m.

to 6 p.m., Eastern Time, Monday through Friday, or

• Visit our website at econhelp.census.gov, or

• Write to the U.S. Census Bureau, 1201 Tenth Street,

Jeffersonville, IN 47134-0001

Please include the 11-digit Census File Number (CFN)
shown to the left of the mailing address of the report
form.
DEFINITION OF ESTABLISHMENT AND
MANUFACTURING ACTIVITY

An establishment is generally a single physical location
where business is conducted or where services or
industrial operations are performed. Further clarification
is provided in the General Instructions.
Manufacturing activity involves the mechanical, physical,
or chemical transformation of materials, substances,
or components into new products. The assembling of
component parts of manufactured products is considered
manufacturing, except in cases where the activity is
appropriately classified in Sector 23, Construction.

31000086

Who Should Report

Exclude

• Sales branches and sales offices
• Research laboratories
• Retail stores
• Mining activities and general administrative offices

The Manufacturing Sector also includes establishments
engaged in the following activities:
• Apparel jobbing and contracting
• Assembling from purchased components
• Commission processing of materials owned by

others

• Job casting, stamping, and machining
• Lapidary work
• Machine shops, including those operating on a job-

order basis

• Manufacturing and delivering ready-mixed concrete
• Milk pasteurizing and bottling
• Plating, galvanizing, polishing, etc., of materials
•
•
•
•
•

owned by others
Poultry dressing
Printing book, periodical, etc.
Sawmills
Seafoods, fresh-packaged or frozen
Wood preserving

Since data will be published for industries and States,
separate reports are required for each manufacturing
establishment (plant).

Descriptions of some of these activities are provided
in the DETAILED INSTRUCTIONS, 22 .

An establishment is a single physical location where
manufacturing is performed. If your company operates at
different physical locations, even if they are producing the
same line of goods, a separate report must be filed for
each location.

WHAT PERIOD SHOULD EACH REPORT COVER?

If your company operates in two or more distinct lines of
manufacturing at the same location, file a separate report
for each activity.

Each report should cover the calendar year 2012.
If book records are not on a calendar-year basis,
carefully prepared estimates are acceptable.
If an establishment began to operate or ceased to
operate during 2012, report only the part of the year
that the establishment was in operation.
If the operator changed during the year, report only
for that part of the year that your company operated
the establishment. Report in 3 the appropriate
information on changes in operator or operational
status.
Specify in the certification,
the report covers.

30 ,

the exact period that

CONTINUE ON PAGE 9

Page 9

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

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

31000094

This page intentionally left blank for processing purposes.

CONTINUE ON PAGE 10

Page 10

PY
O
C
N
TIO
A
T
R
M
R
O
P
O
F
E
IN
OR
T
E
S
U
T
O
N
DO

31000102

This page intentionally left blank for processing purposes.

CONTINUE ON PAGE 11