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Generic Clearance for Questionnaire Pretesting Research

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Burden Statement                Accessibility                 Privacy        Security

   

Login

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

Action

Question

Preview

Errors/

Warnings

Num. Estabs.

In Survey

Survey

CFN

Store

Number

Name

Street

City

State

ZIP

EIN

NAICS

Submitted

By

  

1 / 4

250

NC-99001 (L)

123452015

01

Umbrella Corp.

123 Main St

Seattle

WA

99991

99-9999991

42000

John Smith

  

2 / 5

1

MA-10000 (L)

123462015

02

Capsule Corp.

456 Main St

Seattle

WA

99992

99-9999992

32000

Jane Doe

  

0 / 0

15

MA-10000 (L)

123472015

03

Bike Assembly

789 Main St

Portland

OR

99993

99-9999993

33000

Rico Suave

               
               

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

Title

Status

Mailing Address

Ok

Operational Status

Ok

Sold Operation Date and Information

Warning

Sales Shipments Receipts and Revenue

Ok

Exports

Warning

Employment

Error

Value of Inventories

Ok

Capital Expenditures

Ok

Rental Payments

Ok

Selected Production Costs and Electricity

Error

Other Operating Expenses

Warning

Details Of Sales Shipments Receipts or Revenue

Ok

Remarks

Ok

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

9

9

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

11

11

 

Burden Statement                Accessibility                 Privacy        Security

   

Select

Status

Errors/

Warnings

Form ID

CFN

Store

Number

Name

Street

 

In Progress

 

MA-10000 (L)

ADD_500001

   
        
        

Select

Status

Errors/

Warnings

Form ID

CFN

Store

Number

Name

Street

 

In Progress

 

NC-99001 (L)

ADD_500001

   
 

In Progress

 

MA-10000 (L)

ADD_500002

   
 

In Progress

 

MA-10000 (L)

ADD_500003

   

12

12

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

14

14

 

Burden Statement                Accessibility                 Privacy        Security

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

16

16

 

Burden Statement                Accessibility                 Privacy        Security

   

17

17

 

Burden Statement                Accessibility                 Privacy        Security

   

18

18

 

Burden Statement                Accessibility                 Privacy        Security

   

19

19

 

Burden Statement                Accessibility                 Privacy        Security

   

 

added

B

C

D

E

1

FORM_MAIL

RECORD_C

RECORD_ST

RECORD_N

RECORD_N

9

 

ADD_500000

   

<number>

<number>

 

Burden Statement                Accessibility                 Privacy        Security

   

21

21

 

Burden Statement                Accessibility                 Privacy        Security

   

Responses to-date

Global Widgets Inc.

 

Federal Tax ID

Employment

Annual Payroll

Payroll Q1

Receipts

  

($ thousands)

($ thousands)

($ thousands)

99-9999991

251

5587

22905

11076

99-9999992

522

12075

50791

32443

99-9999993

77

2119

8255

9546

99-9999994

1013

26914

110310

211489

99-9999995

801

22876

90413

178543

    ….

       ….

       ….

     ….

    ….

Total Establishments Reported

Total Employment

Total Annual Payroll

Total Payroll Q1

Total Receipts

122

7911

896152

2756891

4876952

22

22

 
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