QSS -9E Quarterly Services Survey

OMB No. 0607-0907: Approval Expires: 08/31/2015
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

QUARTERLY SERVICES SURVEY

FORM

QSS-9E

(DRAFT)

Due Date

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or
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YOUR CENSUS REPORT
IS CONFIDENTIAL. This
report is authorized by law
(Title 13, United States Code,
Sections 131 and 182). Under
Section 9 of the same law, your
report to the Census Bureau 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. The law also provides
that information that you report
cannot be used for taxation,
regulation, or investigation and
are exempt from release under
the Freedom of Information Act.
Further, copies of your response
retained in your files are immune
from legal process.

Return via Internet:
econhelp.census.gov/qss

(Please correct any errors in name, address, and ZIP Code.)

Return via Fax:
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To view Survey Results:
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GENERAL INSTRUCTIONS
• Any significant change in this Employer Identification Number's (EIN) operations should be noted in 8
• For establishments sold or acquired during the quarter(s), report data only for the period the establishments
were operated by this EIN
• Estimates are acceptable if book figures are not available
• Enter "0" where applicable
Bil.
Mil.
Thou.
Dol.
• Dollars should be rounded to the nearest dollar
1 030280456
• If a figure is $1,030,280,456 it should be reported as

21976014

Include:
• All accommodation establishments located in the U.S (including the District of Columbia) reporting payroll on its
latest Employer's Federal Tax Return (Treasury Form 941 or 944), under the EIN shown in 2
• Data for auxiliary facilities primarily engaged in supporting services to this EIN's establishment(s) such as
warehouses, garages, central administrative offices, and repair services
Exclude:
• Data for franchised establishments not owned or managed by this EIN
• Departments and concessions operated by other firms in this EIN's establishment(s)
• Data for establishments located in U.S Territories (such as Puerto Rico, American Samoa, Guam, U.S. Virgin
Islands and Northern Mariana Islands)

CONTINUE ON PAGE 2

Form QSS-9E
1

Page 2

(DRAFT)

SURVEY COVERAGE
Did this EIN provide the business activities described below?

Yes
No - Specify this EIN's business activity

2

FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Does this firm report payroll under EIN
Yes
EIN (9 digits)
No - Enter current 9-digit EIN AND date payroll was first
reported for this EIN . . . . . . . . . . . . . . . . . . . . . . . . .

Month

3

Day

Year

ORGANIZATIONAL CHANGE
A. Did this EIN experience any acquisitions, sales, mergers, and/or divestitures in the
Yes
No - Go to

4

B. Which of the following organizational changes occurred in the
Check all that apply. If more than one organizational change occurred during the reporting period, explain in
Month

Acquisition
Merger
Sale

Day

8

.

Year

Date of organizational change . . . . . . . . . . . . . . . .
AND
Enter detailed information below

21976022

Divestiture
Name of company

EIN (9 digits)

Address (Number and street, P.O. Box, etc.)

City, town, village, etc.

State

ZIP Code

-

CONTINUE ON PAGE 3

Form QSS-9E
4

Page 3

(DRAFT)

REPORTING PERIOD
What time period is covered by the data provided in this report?
Beginning Date

Calendar quarter

Month

Day

Year

Month

End Date
Day
Year

Other - Report beginning and ending dates . . . . . . . . . . . . . . . . . . . .

5

SALES, RECEIPTS, OR REVENUE
Include:
• Revenue from room and board
• Revenues from camp tuition and camper fees
• Receipts from guest rooms or unit rentals
• Receipts from rentals of public rooms such as
ballrooms, conference rooms, etc.
• Sales of meals, alcoholic beverages, and other
merchandise
• Sales of gaming operations
• Site rental and equipment usage fees
• Receipts from valet, laundry, parking, and other
guest services provided by this EIN
• Credit and cash net sales of merchandise

Exclude:
• Taxable establishments only - grants and donations
• Occupancy taxes
• Carrying or other finance charges
• Commissions (such as vending machine operators,
government lottery tickets, or other stores)
• Non-operating receipts (such as interest income,
income from investments, and receipts from the
rental or sale of real estate)
• Sales made by departments and concessions
operated by other firms in this EIN's
accommodation establishment(s)
Deduct:
• The actual value of rebates and discounts granted
to the purchaser, even if granted as an increase in
trade-in allowances

$ Bil.

What was this EIN's total revenue in the
6 and 7

Thou.

Dol.

. . . . . .

Not Applicable.

8

REMARKS - Please use this space to explain any significant quarter-to-quarter changes, to clarify responses, or indicate
where data were estimated.

9

CONTACT INFORMATION
Name of person to contact regarding this report (Please print)

Area code

21976030

Mil.

Telephone

Number

-

Title

Extension

Area code
Fax

Number

-

Website

THANK YOU
for completing your QUARTERLY SERVICES SURVEY.
We suggest you keep a copy for your records.
Public reporting burden for this collection of voluntary information is estimated to average 15 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.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
ECON Survey Comments 0607-0907, U.S. Census Bureau, 4600 Silver Hill Road, Room EMD-8K122, Washington, DC 20233. You may e-mail comments to
[email protected]; use "ECON Survey Comments 0607-0907" as the subject. PLEASE INCLUDE FORM NAME AND NUMBER IN ALL
CORRESPONDENCE.
Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and Budget.
This 8-digit number appears in the top right corner on the front of this form.