QSS-L5 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

Due Date

Need help or have questions?
Call 1-800-772-7851
(8:30 a.m. - 5:00 p.m. ET, M-F)
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.

Please provide your data online using the Internet link and the username/password below:
Return via Internet:
econhelp.census.gov/qss

To view Survey Results:
census.gov/services

Username:
Password:
In an effort to conduct this survey in a cost effective manner, you will no longer receive a paper form. Forms may be printed
for your records at the link listed above. If you would like to be mailed a paper form, please call the number listed above.
The responses obtained from this survey will provide policy makers and business leaders with an up to date picture of the
United States economic condition and are a key element in estimating the Gross Domestic Product (GDP) of the United
States.

21999016

In order to receive timely response, estimates for the quarter specified on the form are acceptable if book figures for the
quarter are not available. The Census Bureau is determined to provide the most accurate and useful data possible. We need
assistance from firms like yours to achieve this standard.

QSS-L5
(DRAFT)