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pdfU.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
MANUFACTURERS’ UNFILLED ORDERS SURVEY
MA-3000
OMB No. 0607-0561: Approval Expires 12/31/2018
(01-18-2018)
Please correct errors in name, address, and ZIP code. ENTER street and number if not shown.
DUE DATE:
Report by mail:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
OR
Report electronically:
https://portal.census.gov
Authentication Code:
Need help or have questions
about completing this form?
Call: (301) 763-1779
YOUR RESPONSE IS REQUIRED BY LAW. Title 13 United States Code (U.S.C.), Sections 131 and 182, authorizes this collection. Sections 224 and 225 require your response. The U.S. Census Bureau is required by Section 9 of the
same law to keep your information CONFIDENTIAL and can use your responses only to produce statistics. The Census Bureau is not permitted to publicly release your responses in a way that could identify your business, organization,
or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.
This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number is 0607-0561 and appears at the upper right of this page. Without this approval, we could not conduct this survey.
We estimate the time to complete this survey varies from 15 minutes for single divisional companies to 60 minutes for multi-divisional companies, with an average of 30 minutes. More information about this estimate and an address where
you may write with comments is on the back of this form.
Name of person to be contacted regarding this report (Please print or type)
Area Code
Number
Title
Email
Extension
Area Code
Telephone
Number
Fax
IMPORTANT - Please read the instructions included with this form, then complete the survey below.
Provide company name (sold or acquired), address, and EIN (if applicable) below.
For additional entries, go to "Remarks".
CHANGE IN OPERATIONAL STATUS
➤
Ceased operations
Sold to another company
Period covered by data (if other than calendar year)
2017
2016
Year
Month Day
Month Day
– Provide company name (sold or acquired), address, and
EIN (if applicable) at right
Acquired another company
FROM
Month
Day
Year
Month
DATE OF OPERATIONAL
STATUS CHANGE:
Selected In-Scope Manufacturing Activities
(See Instructions and Activities List)
U.S. MANUFACTURING ONLY
(a)
Line
No.
Code
Day
Year
Month
TO
Description
Day
Year
TO
Annual Sales
2017
Unfilled Orders
(Order Backlog) as
of Dec. 31, 2017
Annual Sales
2016
Unfilled Orders
(Order Backlog) as
of Dec. 31, 2016
(b)
(c)
(d)
(e)
1
,000
,000
,000
,000
2
,000
,000
,000
,000
3
,000
,000
,000
,000
4
,000
,000
,000
,000
Please continue on the reverse side for additional manufacturing activities and/or remarks.
30008015
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– Provide company name and address at right
Year
FROM
2
Selected In-Scope Manufacturing Activities
(See Instructions and Activities List)
U.S. MANUFACTURING ONLY
(a)
Line
No.
Code
Description
Annual Sales
2017
Unfilled Orders
(Order Backlog) as
of Dec. 31, 2017
Annual Sales
2016
Unfilled Orders
(Order Backlog) as
of Dec. 31, 2016
(b)
(c)
(d)
(e)
5
,000
,000
,000
,000
6
,000
,000
,000
,000
7
,000
,000
,000
,000
8
,000
,000
,000
,000
9
,000
,000
,000
,000
10
,000
,000
,000
,000
11
,000
,000
,000
,000
12
,000
,000
,000
,000
13
,000
,000
,000
,000
14
,000
,000
,000
,000
15
,000
,000
,000
,000
16
,000
,000
,000
,000
17
,000
,000
,000
,000
18
,000
,000
,000
,000
19
,000
,000
,000
,000
20
,000
,000
,000
,000
21
,000
,000
,000
,000
22
,000
,000
,000
,000
23
,000
,000
,000
,000
24
,000
,000
,000
,000
25
,000
,000
,000
,000
30008023
§?!q8¤
Remarks
CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
Signature of authorized person
Date
We estimate the time to complete this survey varies from 15 minutes for single divisional companies to 60 minutes for multi-divisional companies, with
an average of 30 minutes, 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: EID Survey Comments 0607-0561, U.S. Census Bureau, 4600 Silver Hill Road, Room
EID-7K071, Washington, DC 20233. You may email comments to [email protected]. Be sure to use “EID Survey Comments 0607-0561” as the
subject.
Form MA-3000
(01-18-2018)
| File Type | application/pdf |
| File Modified | 2018-03-26 |
| File Created | 2018-02-07 |