Annual Survey of Manufactures

ATTACHMENT C
Department of Commerce
United States Census Bureau
Annual Survey of Manufactures (ASM)
OMB Control No. 0607-0449
Former MA-10000(S) Questionnaire

OMB No: 0607-0444
Approval Expires: 5/31/2018

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

UNITED STATES
CENSUS BUREAU

OMB No: 0607-0449
Approval Expires: 11/30/2017

Do Not Submit - For Informational Purposes ONLY.
Mailing this to Census does not fulfill your reporting obligation.

MA-10000(S) - Annual Survey of Manufactures
Mailing Address
MAILING ADDRESS
Attention - Enter Attention field/Contact
Name 1 - Enter Name 1

ABC COMPANY 57

Name 2 - Enter Name 2

ELECTRONIC COMPANY 57

Street - Enter street address

57 HEADQUARTERS ROAD

City - Enter city

SUITLAND

State - Enter state

MD

ZIP Code - Enter ZIP Code

20233

Store/Plant - Enter store/plant number

For Census Bureau Use Only
*CFN (census file number) - Unique identifier used for downloading and uploading data

4000000797

Electronic Batch Identification

X4000000.797

Employer Identification Number Validation
Is the Employer Identification Number (EIN) used on this establishment's latest 2016 Internal
Revenue Service Form 941, Employer's Federal Quarterly Tax Return? NOTE: If an EIN is not
shown, select 'No' to provide the EIN on the next screen.
Yes
No

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Employer Identifcation Number
What is this establishment's 9-digit Employer Identification Number (EIN) used on the latest 2016
Internal Revenue Service Form 941, Employer's Federal Quarterly Tax Return?
EIN (Employer Identification Number) - Enter EIN

Ownership or Control
Is your company owned or controlled by another domestic company?
Yes
No

Ownership or Control - Voting Stock Validation
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No

Ownership or Control - Management Policy
Does another domestic company have the power to control the management and policies of your
company?
No
Yes

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Ownership or Control - Percent of Voting Stock
What percent of voting stock was held by the owning or controlling company?
Less than 50%
More than 50%
50%

Ownership Or Control - Company Information
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or
controlling company?
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter name of the owning or controlling
company
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter address (Number and street) of the
owning or controlling company's home office
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter city of the owning or controlling
company's home office
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter state of the owning or controlling
company's home office
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter ZIP Code of the owning or controlling
company's home office
If AFFIL_OWNER_GT50 is "Yes" or AFFIL_CONTROL is "Yes - Enter Employer Identification Number (EIN)
of the owning or controlling company

Physical Location Validation
Is this establishment's physical location the same as the address shown above?
Yes
No

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Physical Location Information
What is this establishment's physical location?
If PHYSLOC_ADDR is "No" - Enter the physical location number and street address

57 HEADQUARTERS ROAD

If PHYSLOC_ADDR is "No" - Enter the physical location city, town, village, etc.

SUITLAND

If PHYSLOC_ADDR is "No" - Enter the physical location state

MD

If PHYSLOC_ADDR is "No" - Enter the physical location ZIP Code

20233

Legal Boundary and Municipality
Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
No legal boundaries
No
Do not know
Yes

In what type of municipality is this establishment physically located?
Do not know
City, village, or borough
Other
Town or township

Operational Status
Which of the following best describes this establishment's operational status at the end of 2016?

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Under construction, development, or exploration
In operation
Sold or leased to another operator
Ceased operation
Temporarily or seasonally inactive

When did the establishment cease operation OR was sold or leased to another operator?
Date - Enter date for ceased or sold/leased establishment

If the establishment was sold or leased to another operator, what is the name, address, and 9-digit
Employer Identification Number (EIN) of this establishment's new owner or operator?
Enter name of new owner or operator for sold/leased establishments
Enter new owner number and street (P.O. Box, etc.) address for sold/leased establishments
Enter new owner city, town, village, etc. for sold/leased establishments
Enter new owner state for sold/leased establishments
Enter new owner ZIP Code for sold/leased establishments
Enter new owner Employer Identification Number (EIN) for sold/leased establishments

Months In Operation
How many months was this establishment in operation during 2016?
Number of months in operation during 2016

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Sales, Shipments, Receipts, or Revenue
What was the total value of products shipped and other receipts?
Total value of products shipped and other receipts (Exclude freight charges and excise taxes.) (Report detail in the
"Products" tab.) (Report in thousands of dollars)
Prior year total value of products shipped and other receipts (Exclude freight charges and excise taxes.) (Report
detail in the "Products" tab.) (Report in thousands of dollars)

E-Shipments
What percent of the $,000.00 reported in total value of products shipped and other receipts, in the
SALES, SHIPMENTS, RECEIPTS, OR REVENUE area, were for goods that were ordered or
whose movement was controlled or coordinated over electronic networks? (Report whole percents.
Estimates are acceptable)
Percent of total reported for RCPT_TOT that were ordered, or whose movement was controlled or coordinated over
electronic networks (Report whole percents. Estimates are acceptable.)
Prior year percent of total reported for RCPT_TOT_PY that were ordered, or whose movement was controlled or
coordinated over electronic networks (Report whole percents. Estimates are acceptable.)

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Employment
What were the number of
Employment: March 12 production workers
Employment: Prior year March 12 production workers
Employment: All other employees for pay period including March 12
Employment: Prior year all other employees for pay period including March 12
Employment: Sum of quarterly production workers (Add EMP_MAR12_PRDWRK, EMP_JUN12_PRDWRK,
EMP_SEP12_PRDWRK, and EMP_DEC12_PRDWRK.)
Employment: Prior year sum of quarterly production workers (Add EMP_MAR12_PRDWRK_PY,
EMP_JUN12_PRDWRK_PY, EMP_SEP12_PRDWRK_PY, and EMP_DEC12_PRDWRK_PY. )

Payroll
What was the annual payroll before deductions?
Item 7B1c: Total annual payroll before deductions (Exclude employer's cost for fringe benefits.) (Add Items 7B1a
and 7B1b.) (Report in thousands of dollars)
Item 7B1c: Prior year total annual payroll before deductions (Exclude employer's cost for fringe benefits.) (Add
Items 7B1a and 7B1b.) (Report in thousands of dollars)

What was the first quarter payroll before deductions (January-March 2016)?
Item 7B2: First quarter payroll (January-March 2016)(Exclude employer's cost for fringe benefits.) (Report in
thousands of dollars)
Item 7B2: Prior year first quarter payroll (January-March 2015)(Exclude employer's cost for fringe benefits.)
(Report in thousands of dollars)

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Value of Inventories
What were the total value of inventories, regardless of where held, before Last-in, First-out (LIFO)
adjustment (if any) owned by this establishment as of December 31?
Item 9B4: Inventories: Total, end of 2016 (Add Items 9B1 through 9B3.) (Report in thousands of dollars)
Item 9B4: Inventories: Total, end of 2015 (Add Items 9B1 through 9B3.) (Report in thousands of dollars)

Capital Expenditures
What were the total capital expenditures for new and used depreciable assets in 2016?
Item 13A3: Total capital expenditures, new and used depreciable assests in 2016 (Add Items 13A1 and 13A2.)
(Report in thousands of dollars)
Item 13A3: Prior year total capital expenditures, new and used depreciable assests in 2015 (Add Items 13A1 and
13A2.) (Report in thousands of dollars)

Rental Payments
What were the total cost for rental or lease of buildings and other structures, machinery and
equipment?
Item 14C: Total rental or lease payments (Add Items 14A and 14B.) (Report in thousands of dollars)
Item 14C: Prior year total rental or lease payments (Add Items 14A and 14B.) (Report in thousands of dollars)

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Selected Expenses
What was the total production related costs in 2016?
Item 16A6: Total selected production related costs (Add Items 16A1 through 16A5.) (Report in thousands of
dollars)
Item 16A6: Prior year total selected production related costs (Add Items 16A1 through 16A5.) (Report in thousands
of dollars)

Details of Sales Shipments Receipts or Revenue
Add Additional Product Codes
Product Class
Code

Product Class Description

3327100

Receipts for machine shop job work and job order
repairs

9998992

Contract work - Receipts for work done for others on
their materials

9998991

Resales - Sales of products bought and sold without
further manufacture, processing, or assembly [The cost
of such items should be reported in line A2 of the
SELECTED PRODUCTION COSTS AND
ELECTRICITY area of the SELECTED EXPENSES
section.]

9998999

Miscellaneous receipts [including receipts for repair
work, scrap, refuse, etc.]

7700000

TOTAL

Product Class Description Write-in

2016 Value

2015 Value

Remarks
(Please use this space for any explanations that may be essential in understanding your reported
data.) Maximum length is 1,000 characters.
Remarks - Enter any explanations that may be essential in understanding your reported data.

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OMB No: 0607-0444
Approval Expires: 5/31/2018
UNITED STATES
CENSUS BUREAU

2016 COS-ASM
(Report of Organization and Annual Survey of Manufactures)

OMB No: 0607-0449
Approval Expires: 11/30/2017

Number of Establishments
How many establishments operated under EIN at the end of 2016?
Number of establishments that operated under this EIN at the end of 2016

Added Location
What is this establishment's physical location?
Enter name of establishment
Enter secondary name of establishment
Enter store/plant number
Enter street address
Enter city
Enter state
Enter ZIP Code
Describe kind of business at this location

For employees that worked at more than one location, report the employment and payroll data for
employees at the ONE location where they spent most of their working time.
Number of employees for pay period including March 12, 2016
First quarter payroll (January-March 2016) (Report in thousands of dollars)
Annual payroll (Report in thousands of dollars)
Sales, Shipments, Receipts, or Revenue (Report in thousands of dollars)

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