Form BRDIS Advance Ques BRDIS Advance Ques BRDIS Advance Questionnaire

Attachment G

OMB No. 0607-0912 Approval Expires: 12-31-2015

Business Help Site
2016 Business R&D and Innovation Survey
Advance Information

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ID: ##########, COMPANY ABC
Census Bureau Staff Use Only
If you have any Questions, Please Contact: U.S. CENSUS BUREAU at (301)763-2547
Information for this company not yet updated.

1.

Is the following mailing address
correct?Attn: JOHN DOE
Company Name: COMPANY ABC
Street Address: 9999 N PARK DR
City: CITY State: ST ZIP: 99999-0000

Yes

No

2. Please complete the following contact information.
*Name: JOHN DOE
*Title:

Department:

TAX ACCOUNTANT

*Phone:

Fax:

*E-mail: [email protected]

Has your company ceased operations?
3. Yes
No
*Date your company ceased operations:

(mm-dd-yyyy format only)

4. Did another U.S. company, other than a holding company, own more than 50 percent of the voting interest

in your company during 2016?
Yes
No
* Company Name:
EIN (9 digits):
* Date Purchased:

(mm-dd-yyyy format only)

Did your company acquire more than 50 percent of the voting interest in

5.

Yes

another company during 2016?

No

* Company Name:
EIN (9 digits):
* Date Purchased:

(mm-dd-yyyy format only)

add another company

6.

Do you want to register for Secure Messaging Center to communicate securely with Census Bureau?
(By selecting "Yes", Please click on the link Secure Messaging Center on the Confirmation Page.)

Yes

No

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