2 Current Surveys

Generic Clearance for Questionnaire Pretesting Research

Attachment D - Current Surveys

Cognitive Interviews for the ASM Unfilled Orders Question

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Attachment D – Current Surveys

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Location	Information

DEFINITION	OF	ESTABLISHMENT
The	reporting	unit	for	this	questionnaire	is	an	establishment.	An	establishment	is	generally	a	single	physical	location	where	business	is	conducted
or	where	services	or	industrial	operations	are	performed.

PHYSICAL	ADDRESS
Please	update	the	location's	physical	address	if	needed.
	
Name	1

Store/Plant

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Name	2

Number	and	Street

City,	town,	village,	etc.

State

ZIP	Code

Select	State	or	Territory

99999-9999

For	Census	Bureau	Use	Only
CFN

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Legal	Boundary	and	Municipality

EIN:	
Store	/	Plant:	
CFN:
LEGAL	BOUNDARY	AND	MUNICIPALITY

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

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

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	1:	Employer	Identification	Number

EIN:	
Store	/	Plant:	
CFN:
ITEM	1:	EMPLOYER	IDENTIFICATION	NUMBER
Is	the	Employer	Identification	Number	(EIN)	used	on	this	establishment's	latest	Internal	Revenue	Service	Form	941,	Employer’s	Federal	Quarterly	Tax
Return?
Yes
No

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	1:	Employer	Identification	Number	-	Enter/Update	EIN

EIN:	
Store	/	Plant:	
CFN:
ITEM	1:	EMPLOYER	IDENTIFICATION	NUMBER	-	ENTER	/	UPDATE	EIN
What	is	this	establishment’s	9-digit	Employer	Identification	Number	(EIN)	used	on	its	latest	Internal	Revenue	Service	Form	941,	Employer’s	Federal
Quarterly	Tax	Return?
EIN
99-9999999

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	3:	Operational	Status

EIN:	
Store	/	Plant:	
CFN:
ITEM	3:	OPERATIONAL	STATUS
Which	of	the	following	best	describes	this	establishment's	operational	status	at	the	end	of	2019?
In	operation
Under	construction,	development,	or	exploration
Temporarily	or	seasonally	inactive
Ceased	operation
Sold	or	leased	to	another	operator

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CEASED	OPERATION	OR	SOLD	OR	LEASED	INFORMATION

If	this	establishment	ceased	operation	or	was	sold	or	leased	to	another	operator,	what	was	the	date?
MMDDYYYY
MMDDYYYY

If	this	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?
Name	of	new	owner/operator

Mailing	Address	(Number	and	Street,
P.O.	Box,	etc.)

City,	town,	village,	etc.

State

ZIP	Code

Select	State	or	Territory

99999-9999

EIN

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99-9999999

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	4:	Months	in	Operation

EIN:	
Store	/	Plant:	
CFN:
ITEM	4:	MONTHS	IN	OPERATION

Check
if
None
What	was	the	number	of	months	in	operation	during	2019?

2019

	

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
General	Reporting	Guidelines

,	
EIN:	
Store	/	Plant:	
CFN:	
	
GENERAL	REPORTING	GUIDELINES
	

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Reporting	Period:
Responses	should	cover	calendar	year	2019.	
If	your	fiscal	year	covers	at	least	10	months	of	calendar	year	2019,	you	may	report	by	fiscal	year	on	all	items	EXCEPT	payroll.
Calendar	year	figures	for	payroll	may	be	available	from:
IRS	Form	941	(Employer’s	Quarterly	Federal	Tax	Return)
IRS	Form	944	(Employer’s	Annual	Federal	Tax	Return)
If	you	report	by	fiscal	year,	indicate	the	exact	dates	of	the	fiscal	year	on	the	submission	certification	screen.
Prior	Year	Data:
Where	available,	your	establishment's	Prior	Year	data	is	prelisted	in	the	2018	column.	
Check	these	figures	and	make	any	necessary	corrections	as	needed.	
If	2018	Inventories	figures	are	not	prelisted,	report	these	figures	in	the	appropriate	sections	as	instructed.	
	
Providing	Estimates:
If	book	figures	are	not	available,	estimates	are	acceptable.	
How	to	Report	Dollar	Figures:
								Dollar	figures	should	be	rounded	to	thousands	of	dollars.																																																																	EXAMPLE	-	DO	NOT	ENTER	DATA
Check
if
None
EXAMPLE	-	if	a	dollar	figure	is	$2,036,355.25,	report	2036:

	

2019
$

2036

,000.00

																																																																																																																																																																						EXAMPLE	-	DO	NOT	ENTER	DATA

EXAMPLE	-	if	a	dollar	figure	is	"0"	(or	less	than	$500.00),	check	the	None	box:

X

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Check
if
None

2019
$

,000.00

How	to	Report	Percents:
								Percents	should	be	rounded	to	whole	percents.																																																																																	EXAMPLE	-	DO	NOT	ENTER	DATA
2019
EXAMPLE	-	if	figure	is	38.76%	of	total	sales,	report	39:

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

39

%

7

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	5:	Sales,	Shipments,	Receipts,	or	Revenue		Additional	Information

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	5:	SALES,	SHIPMENTS,	RECEIPTS,	OR	REVENUE
A. What	was	the	total	value	of	products	shipped	and	other
receipts	for	this	establishment?
(Report	detail	in	Item	22.)

Check
if
None

Exclude:
Freight	charges
Excise	taxes

2019

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Include:
All	products	physically	shipped	from	this
establishment	during	2019

2018

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

B. What	was	the	market	value	of	products	shipped	to	other
domestic	plants	of	your	company	for	further	assembly,
fabrication,	or	manufacture?
(This	is	a	breakout	of	the	$,000.00	reported	in	Item	5,	line
A.)
Include:
A	reasonable	portion	of	other	costs	(company
overhead)
A	reasonable	portion	of	profits
Exclude:
Products	that	are	shipped	to	or	on	order	from	your
company’s	sales	or	wholesale	offices	and	sold	to
customers	outside	your	company

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C. What	percent	of	the	$,000.00	reported	in	Item	5,	line	A
was	for	goods	that	were	ordered	or	whose	movement	was
controlled	or	coordinated	over	electronic	networks?
(Report	whole	percent.)	
E-shipments	are	online	orders	accepted	for	manufactured
products	from	customers.	These	include	shipments	to
other	domestic	plants	of	your	own	company	for	further
manufacture,	assembly,	or	fabrication.	The	price	and	terms
of	sale	for	these	shipments	are	negotiated	over	an	online
system.	Payment	may	or	may	not	be	made	online.
Include:
Electronic	Data	Interchange	(EDI)
E-mail
Internet
Extranet
Other	online	systems

	

%

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

%

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	7:	Employment,	Payroll,	and	Fringe	Benefits		Additional	Information

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	7:	EMPLOYMENT,	PAYROLL,	AND	FRINGE	BENEFITS

Exclude:
Full-	or	part-time	leased	employees	whose	payroll	was	filed	under	an	employee	leasing	company's	EIN	(Report	values	in	Item	16,	line	C1.)
Temporary	staffing	obtained	from	a	staffing	service	(Report	values	in	Item	16,	line	C1.)
Purchased	professional	and	technical	services	(Report	values	in	Item	16,	line	C9.)
Subcontractors	and	their	employees	(Report	cost	of	contract	work	in	Item	16,	line	A3.)
Fishermen,	agricultural	employees,	members	of	the	Armed	Forces,	and	pensioners	carried	on	your	active	rolls
A. What	was	the	number	of	production	workers	at	this	establishment	(direct	labor	including	first-line	supervisors)	for	the	pay	period	including:
Include:
Workers	engaged	in	fabricating,	processing,	assembling,	inspecting,	receiving,	packing,	warehousing,	shipping	(but	not	delivering),
maintenance,	repair,	janitorial,	guard	services,	product	development,	auxiliary	production	for	plant’s	own	use	(e.g.,	power	plant),
recordkeeping,	and	other	closely	associated	services	(including	truck	drivers	delivering	ready-mixed	concrete)
Check
if
None
	

2. June	12	(Q2)?

	

3. September	12	(Q3)?

	

4. December	12	(Q4)?

	

Sum	of	four	quarters	of	production	workers	at	this
establishment	(direct	labor	including	first-line
supervisors)	(Add	lines	A1	through	A4.)

B. What	was	the	Average	number	of	annual	production
workers	at	this	establishment	(direct	labor	including
first-line	supervisors)?
(Divide	sum	of	four	quarters	of	production	workers	by
4	and	round	to	the	nearest	whole	number.)

2018	Number

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1. March	12	(Q1)?

2019	Number

	

	

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Include:
Full-	and	part-time	employees	working	at	this	establishment	whose	payroll	was	reported	on	Internal	Revenue	Service	Form	941,	Employer's
Quarterly	Federal	Tax	Return,	and	filed	under	the	Employer	Identification	Number	(EIN)
All	persons	on	paid	sick	leave,	paid	holidays,	and	paid	vacation	during	the	year	at	this	establishment

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
C. What	was	the	number	of	all	other	(non	production)
employees	at	this	establishment	for	the	first	quarter
(January	-	March	2019)?
Include:
Officers	at	this	establishment,	if	a	corporation
Supervision	above	line-supervisor	level
Sales	employees,	including	delivery	(truck	driver	and
helpers)
Advertising,	clerical,	credit,	collection,	purchasing,
finance,	legal,	executive,	and	technical	employees
Employees	installing	and	servicing	this
establishment's	products
Exclude:
Proprietors	and	partners,	if	an	unincorporated
concern
Temporary	staff	and	leased	employees	(Report	values
in	Item	16,	line	C1.)

	

D. HOURS	WORKED:
What	was	the	annual	number	of	hours	worked	by	the
production	workers	at	this	establishment	(direct
labor	including	first-line	supervisors)	reported	in
line	B?
Exclude:
Hours	paid	for	vacations,	holidays,	or	sick	leave
unless	an	employee	elects	to	work	during	their
vacation	period.	Report	only	actual	hours	worked
by	such	employee.	Overtime	hours	should	be
reported	as	actual	hours	worked	and	not	as
straight-time	equivalent	hours.

2019	Hours

2018	Hours
,000

	

,000

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TOTAL	(Add	lines	B	and	C.)

E. PAYROLL
What	was	the	annual	payroll	at	this	establishment	before	deductions	for:
Exclude:
Employer-paid	annual	cost	for	fringe	benefits	reported	in	lines	F1	through	F3
2019

2018

	

$

,000.00

$

,000.00

2. All	other	employees	reported	in	line	C?

	

$

,000.00

$

,000.00

TOTAL	(Add	lines	E1	and	E2.)

	

$

,000.00

$

,000.00

What	was	the	first	quarter	payroll	at	this
establishment	before	deductions	(January	-	March
2019)?

	

$

,000.00

$

,000.00

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1. Production	workers	reported	in	line	B?

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MA-10000	-	Annual	Survey	of	Manufactures
F.	EMPLOYER-PAID	ANNUAL	COST	FOR	FRINGE	BENEFITS
(This	is	the	employer’s	annual	cost	at	this	establishment	for	legally	required	programs	and	programs	not	required	by	law.	If	any	of	the	items	here	are
maintained	in	your	records	only	at	the	company	level,	allocate	their	costs	to	the	manufacturing	establishment.	You	may	distribute	the	total	on	the
basis	of	the	ratio	of	the	payroll	of	each	manufacturing	establishment	to	the	total	company	payroll	unless	you	have	developed	your	own	method	of
making	such	allocations.	Specify	the	method	used	and	the	approximate	portion	that	has	been	allocated	in	the	Item	31:	REMARKS	section	at	the	end
of	the	instrument.)	
									
Include:
Premium	equivalents	for	self-insured	plans	and	fees	paid	to	third-party	administrators	(TPAs)
Spread	on	stock	options	that	are	taxable	to	employees	at	this	establishment	as	wages

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2019	Annual	Survey	of	Manufactures	(ASM)

Exclude:
Employee	contributions
Disbursements	from	trusts	or	funds	to	satisfy	health	insurance	claims
What	were	the	employer's	annual	costs	at	this	establishment	for:

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

2. Retirement	Plans?
a. Defined	benefit	pension	plans	(qualified	and
nonqualified)	-	Plans	that	specify	the	benefit	to	be
paid	to	employees	upon	retirement,	generally	either
a	specific	amount	or	a	percentage	of	compensation.
Employer	contributions	are	based	on	actuarial
computations	that	include	employee's	compensation
and	years	of	service	and	are	not	allocated	to	specific
accounts	maintained	for	employees.
b. Defined	contribution	plans	-	Plans	that	define
the	employer	contributions	to	a	separate	account
provided	for	each	employee.	The	employee
"benefit"	at	retirement	depends	on	the	amount
contributed	and	the	results	of	the	account's	activity.
Examples:
Profit	sharing	plans
Money	purchases	(e.g.,	401k,	403b)
Stock	bonus	plans	(e.g.,	ESOPs)

Include:
Legally-required	fringe	benefits	(e.g.,	Social
Security,	workers	compensation	insurance,	state
disability	insurance	programs,	long-	and	short-	term
disability,	unemployment	tax,	and	Medicare)
Life	insurance	benefits
"Quality	of	life”	benefits	(e.g.,	childcare	assistance,
adoption	assistance,	subsidized	commuting,	longterm	care	insurance,	flexible	workplace,	employerprovided	home	PC,	etc.)
Employer	contributions	to	pre-tax	benefit	accounts
(e.g.,	health	savings	account)
Education	assistance
Stock	options
Other	benefits	not	specified	above	(e.g.,	job-related
travel	accident	insurance,	education	assistance,
wellness	programs,	fitness	centers,	employee
assistance	programs,	etc.)

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3. Payroll	taxes,	employer-paid	insurance	premiums,
and	other	employer-paid	benefits?

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1. Health	Insurance?	-	Insurance	premiums	on	hospitals,
medical	plans,	and	single-service	plans	such	as	dental,
vision,	and	prescription	drug	plans

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MA-10000	-	Annual	Survey	of	Manufactures
assistance	programs,	etc.)
Exclude:
Disbursements	from	trusts	or	funds	to	satisfy	health
insurance	claims

4. TOTAL	(Add	lines	F1	through	F3.)

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	9:	Value	of	Inventories		Additional	Information

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	9:	VALUE	OF	INVENTORIES
Report	inventories	at	cost	or	market	using	generally	accepted	accounting	practices,	and	report	all	inventories	owned	by	this	establishment	regardless
of	where	the	inventories	are	held.	If	this	establishment	is	part	of	a	multiple-establishment	company,	assign	to	each	establishment	those	inventories
that	the	establishment	is	responsible	for	as	if	it	owned	them.

A. Finished	goods	(final	output	of	this
establishment,	but	still	within	ownership)?
B. Work-in-process	(goods	that	have	been
substantially	transformed	in	the
manufacturing	process,	but	are	not	yet	the
final	output	of	the	establishment)?
C. Materials,	supplies,	fuels,	etc.	(goods	that	are
raw	inputs	to	the	manufacturing	process	and
will	be	substantially	altered	to	produce	this
establishment’s	output)?

TOTAL	(Add	lines	A	through	C.)

Check
if
None

Check
if
None

End	of	2019

	

$

,000.00

	

$

	

	

End	of	2018

	

$

,000.00

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

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What	was	the	value	of	inventories	owned	by	this	establishment	as	of	December	31	before	Last-In,	First-Out	(LIFO)	adjustment	(if	any)	for:

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	10:	Inventories	by	Valuation	Method		Additional	Information

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	10:	INVENTORIES	BY	VALUATION	METHOD

Of	the	$,000.00	reported	in	Item	9	as	the	total	value	of	inventories	owned	by	this	establishment	as	of	December	31,	2019	and	the	$,000.00
reported	in	Item	9	as	the	total	value	of	inventories	owned	by	this	establishment	as	of	December	31,	2018,	how	much	is	subject	to	the	following
valuation	methods:

Check
if
None

Check
if
None

End	of	2019

End	of	2018

	

$

,000.00

	

$

,000.00

2. Average	Cost?

	

$

,000.00

	

$

,000.00

3. Standard	Cost?

	

$

,000.00

	

$

,000.00

4. Other	non-LIFO	valuation	method(s)?

	

$

,000.00

	

$

,000.00

	

$

,000.00

	

$

,000.00

B. LIFO	Valuation	Method	(gross	LIFO	amount)?

	

$

,000.00

	

$

,000.00

TOTAL	Non-LIFO	and	LIFO	methods	(Add	TOTAL
of	lines	A1	through	A4	and	B.)

	

$

,000.00

	

$

,000.00

C. What	is	the	amount	of	LIFO	reserve	(if	any)?
(If	the	value	of	reserve	is	negative,	use	"-".)

	

$

,000.00

	

$

,000.00

Describe

TOTAL	(Add	lines	A1	through	A4.)

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1. First-In,	First-Out	(FIFO)?

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A. Non-LIFO	(Last-In,	First-Out)	valuation	methods

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MA-10000	-	Annual	Survey	of	Manufactures
Item	13:	Capital	Expenditures		Additional	Information

EIN:	
Store	/	Plant:	
CFN:
ITEM	13:	CAPITAL	EXPENDITURES
Include:
Dollar	value	of	capital	expenditures
Buildings,	structures,	and	equipment	used	directly	or	indirectly	by	this	establishment	to	produce	the	goods	and	services	reported	in	Item	5,	line
A	and	Item	22

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2019	Annual	Survey	of	Manufactures	(ASM)

What	were	the	capital	expenditures	for	new	and	used	depreciable	assets	in	2019	for:
A. New	and	used	buildings	and	other	structures?

2019

2018

	

$

,000.00

$

,000.00

1. Automobiles,	trucks,	etc.	for	highway	use?

	

$

,000.00

$

,000.00

2. Computers	and	peripheral	data	processing
equipment?

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

B. New	and	used	machinery	and	equipment?

3. All	other	expenditures	for	machinery	and
equipment?
TOTAL	(Add	lines	A	and	B1	through	B3.)

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Exclude:
The	value	of	land	on	which	structures	stand

Check
if
None

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	14:	Rental	Payments		Additional	Information

EIN:	
Store	/	Plant:	
CFN:
ITEM	14:	RENTAL	PAYMENTS
Include:
Operating	leases
Exclude:
Capital	leases	(leases	with	a	contract	to	own	at	the	end	of	the	lease)
At	this	establishment,	what	were	the	payments	for:
A. Rental	or	lease	of	buildings	and	other	structures?
Check
if
None

2019

2018

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

B. Rental	or	lease	of	machinery	and	equipment?
Include:
Production,	loading,	and	transportation	machinery
and	equipment
Construction	equipment
Tools
Office	equipment
Furniture
Vehicles
Exclude:
Computer	time-sharing	charges	for	machinery	and
equipment	rentals	from	computer	service	companies
where	the	computer	is	not	on	site	at	the
establishment

TOTAL	(Add	lines	A	and	B.)

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Include:
Job-site	trailers
Land	on	which	the	buildings	and	other	structures
stand

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	16:	Selected	Expenses		Additional	Information

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	16:	SELECTED	EXPENSES

A. For	this	establishment,	what	were	the	production-related	costs	in	2019	for:

Include:
Cost	of	production-related	materials	purchased
by	this	establishment	for	other	companies
(contractors).
Exclude:
Non-production-related	expenses	that	were	paid
to	other	companies	(contractors)	by	this
establishment.	(Report	these	expenses	on	the
next	screen	in	Item	16,	line	C.)

Check
if
None

2019

2018

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

5. Purchased	electricity?	(Report	comparable	quantity
on	line	B1.)

	

$

,000.00

$

,000.00

TOTAL	(Add	lines	A1	through	A5.)

	

$

,000.00

$

,000.00

2. Products	bought	and	sold	without	further	processing?
(Report	sales	in	Item	5,	line	A	and	in	Wholesaling
Services	product	codes	in	Item	22.)
3. Work	done	for	you	by	others	on	your	materials	(work
contracted	to	others)?	(Report	on	line	A1	the	cost	of
production-related	materials	purchased	by	this
establishment	for	other	companies	(contractors).)
4. Purchased	fuels	consumed	for	heat,	power,	or	the
generation	of	electricity?	(Report	on	line	B2	the
quantity	of	electricity	generated	(Gross	less
generating	station	use).)

B. For	this	establishment,	what	was	the	quantity	of:
1. Purchased	electricity?	(Quantity	comparable	to	cost
reported	in	line	A5)
2. Generated	electricity	(gross	less	generating	station
use)?	(Quantity	comparable	to	cost	reported	in	line
A4)
3. Electricity	sold	or	transferred	to	other
establishments?		(Also	include	quantity	on	lines	B1
and/or	B2.)

2019	Kilowatt	Hours

2018	Kilowatt	Hours

	

,000

,000

	

,000

,000

	

,000

,000

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1. Materials,	parts,	containers,	packaging,	supplies,	etc.
used	for	manufacturing	processes,	repairs,	services
for	others,	or	other	operating	supplies?

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures

Item	16:	Selected	Expenses	-	Continued

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	16:	SELECTED	EXPENSES

C. What	were	the	other	operating	expenses	paid	by	this	establishment	in	2019	for:

1. Temporary	staff	and	leased	employees?		(Professional
Employer	Organizations	and	staffing	agencies	for
personnel)
Include:
All	charges	for	payroll,	benefits,	and	services

Check
if
None

2019

2018

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

2. Expensed	equipment?		(Expensed	computer
hardware	and	other	equipment)
Include:
Copiers
Fax	machines
Telephones
Shop	and	lab	equipment
CPUs
Monitors
Laptops
Tablets
Exclude:
Packaged	software	(Report	on	line	C3.)
Leased	and	rented	equipment	(Report	in	Item
14,	line	B.)
3. Expensed	purchases	of	software?		(Purchases	of
prepackaged,	custom-coded	or	vendor-customized
software)
Include:
Software	developed	or	customized	by	others
Web-design	services	and	purchases
Licensing	agreements
Upgrades	of	software
Maintenance	fees	related	to	software	upgrades
and	alterations
Exclude:
Costs	associated	with	computer	software
developed	within	your	own	company
Capitalized	computer	software	costs

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Include:
Expenses	normally	considered	as	non-production-related	costs	purchased	from	other	companies

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MA-10000	-	Annual	Survey	of	Manufactures

4. Purchased	communication	services?
Include:
Telephone,	cellular,	and	fax	services
Computer-related	communications	(e.g.,
Internet,	connectivity,	online)
Other	wired	and	wireless	communication
services
Credit	card	transaction	fees

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

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2019	Annual	Survey	of	Manufactures	(ASM)

5. Data	processing	and	other	purchased	computer
services?

Exclude:
Services	provided	by	other	establishments	of
this	company	(such	as	a	separate	central	data
processing	unit)
Expensed	integrated	systems	(Report	in	line
C4.)
Repair	and	maintenance	of	computer	equipment
(Report	on	line	C6.)
Payroll	processing	and	credit	card	transaction
fees	(Report	payroll	processing	fees	on	line	C9
and	credit	card	transaction	fees	on	line	C4.)
Expenses	for	telecommunication	services	(e.g.,
Internet,	connectivity,	telephone)	(Report	on
line	C4.)

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Include:
Computer	facilities	management	services
Computer	input	preparation
Data	storage
Computer	time	rental
Optical	scanning	services
Other	computer-related	advice	and	services,
including	training

6. Purchased	repairs	and	maintenance	to	buildings
and/or	machinery	and	equipment?

Exclude:
Extensive	"repairs"	or	reconstruction	that	is
capitalized.	Report	these	as	a	capital
expenditure	in	Item	13.
Costs	of	materials,	parts,	and	supplies	directly
incurred	by	this	establishment	using	its	own
work	force	to	perform	repairs	and	maintenance

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Include:
Repairs	for	painting,	roof	repairs,	replacing
parts,	over-hauling	of	equipment,	and	other
repairs	chargeable	as	current	operating	costs
Cost	of	repair	and	maintenance	of	any	leased
property	if	this	establishment	assumes	the	cost

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures

7. Water,	sewer,	refuse	removal,	and	other	non-electric
utility	payments?
(Report	electric	utility	payments	on	line	A5.	If	the
costs	of	these	utilities	are	included	in	a	lease	or	rental
payment,	report	in	Item	14,	line	A.)
Include:
Cost	of	hazardous	waste	removal	or	treatment
Exclude:
Cost	of	refuse	removal	services	if	included	in
rental	payments
Machinery	or	equipment	reported	as	a	capital
expenditure	in	Item	13
Cost	of	salaries	paid	to	employees	of	this
establishment	whose	work	involves	refuse
removal	and/or	hazardous	waste	removal	or
treatment

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

8. Purchased	advertising	and	promotional	services?
Include:
Marketing	and	public	relations	services
Exclude:
Salaries	paid	to	employees	of	this	establishment
for	advertising	work
9. Purchased	professional	and	technical	services?
Include:
Management	consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll	processing
Architectural
Engineering
Other	professional	services	(i.e.	janitorial,
security,	or	landscape	services)
Exclude:
Salaries	paid	to	your	own	employees	for	these
services	(Report	in	Item	7.)
10. Governmental	taxes	and	licensing	fees?	(Payments
to	government	agencies	for	taxes	and	licenses)
Include:
Business	and	property	taxes
Exclude:
Income	taxes

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

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$

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MA-10000	-	Annual	Survey	of	Manufactures

11. All	other	operating	expenses	not	reported
elsewhere?
Exclude:
Purchases	of	merchandise	for	resale
Non-operating	expenses
Other	expenses	reported	in	Items	7,	13,	14,
and	16

	

$

,000.00

$

,000.00

	

$

,000.00

$

,000.00

Describe

TOTAL	(Add	lines	1	through	11.)

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MA-10000	-	Annual	Survey	of	Manufactures
Item	17:	Principal	Business	or	Activity

,	
EIN:	
Store	/	Plant:	
CFN:	
	

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2019	Annual	Survey	of	Manufactures	(ASM)

ITEM	17:	PRINCIPAL	BUSINESS	OR	ACTIVITY
Which	ONE	of	the	following	best	describes	this	establishment's	principal	kind	of	business	or	activity	in	2019?
If	none	of	the	provided	selections	seem	appropriate	or	selection	options	are	not	provided,	provide	a	specific	description	to	search	for	an	appropriate
business	activity.
Select	only	ONE.

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	22:	Detail	of	Sales,	Shipments,	Receipts,	or	Revenue

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	22:		DETAIL	OF	SALES,	SHIPMENTS,	RECEIPTS,	OR	REVENUE
Of	the	$,000.00	of	Sales,	Shipments,	Receipts,	or	Revenue	reported	in	Item	5,	what	was	the	value	of	each	product	or	service?

			Exclude:
Wholesale	products	(previously	Resales),	which	include	products	that	are	bought	from	other	establishments	or	transferred	from	other
establishments	of	your	company	and	then	sold	without	further	manufacture,	processing,	or	assembly	by	this	establishment.	Report
Wholesale	products	in	any	relevant	prelisted	product	code,	click	the	"Add	Product	Not	Listed"	button	and	search	for	an	existing	Wholesale
product,	or	use	the	section	for	"Add	product(s)	not	listed	above."
Products	made	from	materials	owned	by	others	(i.e.,	the	customer).	Report	your	commission	or	contract	receipts	in	the	appropriate
Contract	Manufacturing	product	line(s).
Freight	charged
Excise	taxes

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General	–	Please	do	not	combine	product	lines.	If	the	information	is	not	directly	available	from	your	records,	reasonable	estimates	are
acceptable.
	
The	manufactured	products	and	services	listed	below	are	generally	made	in	your	industry.	If	you	make	products	or	have	revenue	from	sources	not
listed,	click	the	“Add	Product	Not	Listed”	button	and	search	for	an	existing	product,	or	use	the	section	for	“Add	product(s)	not	listed	above.”	
	
Manufacturing	of	Products	–	Report	the	value	of	the	products	shipped	and	services	performed	at	the	net	selling	value,	free	on	board	(FOB)	plant	to
the	customer,	after	discounts	and	allowances.
	
			Include:
Products	made	elsewhere	by	others	from	materials	supplied	by	this	establishment.	Report	these	products	on	the	specific	lines	as	if	they	were
made	in	this	establishment.
Products	transferred	to	other	establishments	within	your	company.	These	products	should	be	assigned	the	full	economic	value	(market	value);
i.e.,	include	all	direct	costs	of	production	and	a	reasonable	proportion	of	all	other	costs	and	profits.

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2019	Annual	Survey	of	Manufactures	(ASM)
MA-10000	-	Annual	Survey	of	Manufactures
Item	28:	Special	Inquiries	-	Industrial	Robots	and	Robotic	Equipment

,	
EIN:	
Store	/	Plant:	
CFN:	
	
ITEM	28:	SPECIAL	INQUIRIES	-	INDUSTRIAL	ROBOTS	AND	ROBOTIC	EQUIPMENT

REPORTING	INDUSTRIAL	ROBOTIC	EQUIPMENT
Estimates	are	acceptable.
In	(A),	report	capital	expenditures	for	new	and	used	industrial	robotic	equipment	for	this	establishment.	Include	other	one-time	costs,	including
software	and	installation.
In	(B)	and	(C),	report	the	number	of	industrial	robots	in	operation	at	this	establishment	and	purchased	for	this	establishment.
For	robots	purchased	as	part	of	a	work	cell	or	other	integrated	robotic	equipment,	it	may	not	be	possible	to	report	the	expenditures	on	only	the
robots.	In	this	case,	report	the	expenditures	on	the	integrated	robotic	equipment.
				Examples	of	operations	industrial	robotic	equipment	can	perform	may	include:
Palletizing
Pick	and	place
Machine	tending
Machine	handling
Dispensing
Welding
Packing/repacking

	

A. What	were	the	capital	expenditures	for	new	and	used
industrial	robotic	equipment,	including	software,
installation,	and	other	one-time	costs?

B. What	was	the	number	of	industrial	robots	IN	OPERATION
at	this	plant?	Refer	to	instructions	above	for	definitions.
If	you	are	unable	to	provide	the	number	of	industrial	robots
IN	OPERATION,	please	explain:

Check
if
None
	

2019
$

2018
,000.00

2019	Number
	

2019_MA-10000_mu.pdf Generated at 2019-11-21 06:37 AM

$

2018	Number

,000.00

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					Exclude:
Automated	guided	vehicles	(AGVs)
Driverless	forklifts
Automated	storage	and	retrieval	systems
CNC	machining	equipment

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INDUSTRIAL	ROBOTIC	EQUIPMENT
Industrial	robotic	equipment	(or	industrial	robots)	are	automatically	controlled,	reprogrammable,	and	multipurpose	machines	used	in	the
industrial	automated	operations.
Industrial	robots	may	be	mobile,	incorporated	into	stand-alone	stations,	or	integrated	into	a	production	line.
An	industrial	robot	may	be	part	of	a	robotic	cell	(or	work	cell)	or	incorporated	into	another	piece	of	equipment.
Industrial	robots	are	commonly	used	in	operations	such	as	welding,	material	handling,	machine	tending,	dispensing,	cleanroom,	and	pick	and
place.

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MA-10000	-	Annual	Survey	of	Manufactures

C. What	was	the	number	of	industrial	robots	PURCHASED	for
this	plant?	Refer	to	instructions	above	for	definitions.
If	you	are	unable	to	provide	the	number	of	industrial	robots
PURCHASED,	please	explain:

	

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MA-10000	-	Annual	Survey	of	Manufactures
Item	31:	Remarks

,	
EIN:	
Store	/	Plant:	
CFN:	
	

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2019	Annual	Survey	of	Manufactures	(ASM)

ITEM	31:	REMARKS	(Optional	-	Enter	remarks	only	if	necessary)
Please	use	this	space	only	for	any	explanations	that	may	be	essential	in	understanding	your	reported	data.		(Maximum	length	is	1,000	characters.)

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26

U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
FORM

MANUFACTURERS’ UNFILLED ORDERS SURVEY

MA-3000
OMB No. 0607-0561: Approval Expires 10/31/2021

(01-28-2020)

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)
2019
2018
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
2019

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2019

Annual Sales
2018

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2018

(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.

30009013

§?!{.¤

– 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
2019

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2019

Annual Sales
2018

Unfilled Orders
(Order Backlog) as
of Dec. 31, 2018

(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

30009021

§?!{6¤

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

(01-28-2020)


File Typeapplication/pdf
AuthorBlynda K Metcalf (CENSUS/EWD FED)
File Modified2020-09-10
File Created2020-09-10

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