Service Annual Survey

Attachment 3 - Detailed Electronic Worksheet Collection

Form No.

Description

Tax Status

NEW Separate Tax Status Form* (see Footnotes)

Tax Status (question 5)

Total Revenue (question 6)

Product Data (question 6)

Revenues from Electronic Sources (question 8)

Source of Revenue (question 9)

Analysis of Motor Carrier Operations (question 10)

Patient Visits (question 10)

Class of Customer (question 11)

Inpatient/ Outpatient Activity (question 11)

Year-end Inventories (question 12)

Electronic Health Records (question 12)

Exported Services Revenue (question 13)

Benefits Paid (Losses) OR Direct Losses Incurred (see Footnotes) (question 13)

Operating Expenses (question 14)

Hotel Management (question 15)

SA-22010A

Electric Power Generation, Transmission and Distribution; Natural Gas Distribution

T

x

x

x

x

x

SA-22010E

Electric Power Generation, Transmission and Distribution; Natural Gas Distribution

T

x

x

x

x

x

SA-22130A

Water, Sewage and Other Systems

T

x

x

x

x

x

SA-22130E

Water, Sewage and Other Systems

T

x

x

x

x

x

SA-48000A

Scenic and Sightseeing Transportation; Support Activities for Transportation

T

x

x

x

SA-48000E

Scenic and Sightseeing Transportation; Support Activities for Transportation

T

x

x

x

SA-48100A

Air Transportation

T

x

x

x

x

SA-48100E

Air Transportation

T

x

x

x

x

SA-48121A

Nonscheduled Chartered Passenger Air Transportation

T

x

x

x

x

SA-48121E

Nonscheduled Chartered Passenger Air Transportation

T

x

x

x

x

SA-48300A

Water Transportation

T

x

x

x

x

SA-48300E

Water Transportation

T

x

x

x

x

SA-48400A

Truck Transportation

T

x

x

x

x

x

x

SA-48400E

Truck Transportation

T

x

x

x

x

x

x

SA-48500A

Transit and Ground Passenger Transportation

T

x

x

x

x

SA-48500E

Transit and Ground Passenger Transportation

T

x

x

x

x

SA-48610A

Pipeline Transportation

T

x

x

x

x

SA-48610E

Pipeline Transportation

T

x

x

x

x

SA-49000A

Postal Service; Couriers and Messengers; Warehousing and Storage

T

x

x

x

SA-49000E

Postal Service; Couriers and Messengers; Warehousing and Storage

T

x

x

x

SA-51000A

Record Production; Other Sound Recording Industries

T

x

x

x

x

SA-51000E

Record Production; Other Sound Recording Industries

T

x

x

x

x

SA-51111A

Newspaper Publishers

T

x

x

x

x

x

x

x

SA-51111E

Newspaper Publishers

T

x

x

x

x

x

x

x

SA-51112A

Periodical Publishers

T

x

x

x

x

x

x

x

SA-51112E

Periodical Publishers

T

x

x

x

x

x

x

x

SA-51113A

Book Publishers

T

x

x

x

x

x

x

x

SA-51113E

Book Publishers

T

x

x

x

x

x

x

x

SA-51114A

Directory and Mailing List Publishers

T

x

x

x

x

x

x

x

SA-51114E

Directory and Mailing List Publishers

T

x

x

x

x

x

x

x

SA-51118A

Greeting Card Publishers

T

x

x

x

x

x

x

SA-51118E

Greeting Card Publishers

T

x

x

x

x

x

x

SA-51119A

All Other Publishers

T

x

x

x

x

x

x

SA-51119E

All Other Publishers

T

x

x

x

x

x

x

SA-51120A

Software Publishers

T

x

x

x

x

x

x

x

SA-51120E

Software Publishers

T

x

x

x

x

x

x

x

SA-51210A

Motion Picture and Video Production; Motion Picture and Video Distribution

T

x

x

x

x

x

x

SA-51210E

Motion Picture and Video Production; Motion Picture and Video Distribution

T

x

x

x

x

x

x

SA-51213A

Motion Picture and Video Exhibition

T

x

x

x

x

x

SA-51213E

Motion Picture and Video Exhibition

T

x

x

x

x

x

SA-51219A

Postproduction Services and Other Motion Picture and Video Industries

T

x

x

x

x

x

x

SA-51219E

Postproduction Services and Other Motion Picture and Video Industries

T

x

x

x

x

x

x

SA-51222A

Integrated Record Production/Distribution

T

x

x

x

x

x

SA-51222E

Integrated Record Production/Distribution

T

x

x

x

x

x

SA-51223A

Music Publishers

T

x

x

x

x

x

SA-51223E

Music Publishers

T

x

x

x

x

x

SA-51224A

Sound Recording Studios

T

x

x

x

x

x

SA-51224E

Sound Recording Studios

T

x

x

x

x

x

SA-51510A

Radio and Television Broadcasting

T

x

x

x

x

SA-51510E

Radio and Television Broadcasting

T

x

x

x

x

SA-51520A

Cable and Other Subscription Programming

T

x

x

x

x

SA-51520E

Cable and Other Subscription Programming

T

x

x

x

x

SA-51710A

Wired Telecommunications Carriers

T

x

x

x

x

x

SA-51710E

Wired Telecommunications Carriers

T

x

x

x

x

x

SA-51721A

Wireless Telecommunications Carriers (except Satellite)

T

x

x

x

x

x

SA-51721E

Wireless Telecommunications Carriers (except Satellite)

T

x

x

x

x

x

SA-51730A

Telecommunications Resellers

T

x

x

x

x

x

SA-51730E

Telecommunications Resellers

T

x

x

x

x

x

SA-51740A

Satellite Telecommunications

T

x

x

x

x

SA-51740E

Satellite Telecommunications

T

x

x

x

x

SA-51790A

All Other Telecommunications

T

x

x

x

SA-51790E

All Other Telecommunications

T

x

x

x

SA-51820A

Data Processing, Hosting, and Related Services

T

x

x

x

x

SA-51820E

Data Processing, Hosting, and Related Services

T

x

x

x

x

SA-51911A

News Syndicates

T

x

x

x

x

SA-51911E

News Syndicates

T

x

x

x

x

SA-51912A

Libraries and Archives

T/E

x

x

x

x

x

SA-51912E

Libraries and Archives

T/E

x

x

x

x

x

SA-51913A

Internet Publishing and Broadcasting and Web Search Portals

T

x

x

x

x

x

SA-51913E

Internet Publishing and Broadcasting and Web Search Portals

T

x

x

x

x

x

SA-51919A

All Other Information Services

T

x

x

x

x

SA-51919E

All Other Information Services

T

x

x

x

x

SA-52000A

Monetary Authorities-Central Bank; Securities and Commodity Exchanges ; Miscellaneous Intermediation ; All Other Financial Investment Activities; Direct Life Insurance Carriers; Direct Insurance (except Life, Health, and Medical) Carriers ; Agencies, Brokerages, and Other Insurance Related Activities

T

x

x

x

SA-52000E

Monetary Authorities-Central Bank; Securities and Commodity Exchanges ; Miscellaneous Intermediation ; All Other Financial Investment Activities; Direct Life Insurance Carriers; Direct Insurance (except Life, Health, and Medical) Carriers ; Agencies, Brokerages, and Other Insurance Related Activities

T

x

x

x

SA-52200A

Credit Intermediation and Related Activities

T

x

x

x

x

SA-52200E

Credit Intermediation and Related Activities

T

x

x

x

x

SA-52311A

Investment Banking and Securities Dealing; Securities Brokerage

T

x

x

x

x

x

SA-52311E

Investment Banking and Securities Dealing; Securities Brokerage

T

x

x

x

x

x

SA-52312A

Commodity Contracts Dealing; Commodity Contracts Brokerage

T

x

x

x

x

x

SA-52312E

Commodity Contracts Dealing; Commodity Contracts Brokerage

T

x

x

x

x

x

SA-52390A

Portfolio Management; Investment Advice

T

x

x

x

x

x

SA-52390E

Portfolio Management; Investment Advice

T

x

x

x

x

x

SA-52400A

Direct Health and Medical Insurance Carriers

T

x

x

x

x

x

SA-52400E

Direct Health and Medical Insurance Carriers

T

x

x

x

x

x

SA-52410A

Direct Life Insurance Carriers

T

x

x

x

x

x

SA-52410E

Direct Life Insurance Carriers

T

x

x

x

x

x

SA-52412A

Direct Property and Casualty Insurance Carriers; Direct Title Insurance Carriers; Other Direct Insurance (except Life, Health, and Medical) Carriers

T

x

x

x

x

SA-52412E

Direct Property and Casualty Insurance Carriers; Direct Title Insurance Carriers; Other Direct Insurance (except Life, Health, and Medical) Carriers

T

x

x

x

x

SA-52413A

Reinsurance Carriers

T

x

x

x

x

SA-52413E

Reinsurance Carriers

T

x

x

x

x

SA-53000A

Passenger Car Rental; Passenger Car Leasing; Truck, Utility Trailer, and RV (Recreational Vehicle) Rental and Leasing; Consumer Goods Rental; General Rental Centers; Commercial and Industrial Machinery and Equipment Rental and Leasing; Real Estate; Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)

T

x

x

x

SA-53000E

Passenger Car Rental; Passenger Car Leasing; Truck, Utility Trailer, and RV (Recreational Vehicle) Rental and Leasing; Consumer Goods Rental; General Rental Centers; Commercial and Industrial Machinery and Equipment Rental and Leasing; Real Estate; Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)

T

x

x

x

SA-53110A

Lessors of Real Estate

T

x

x

x

x

SA-53110E

Lessors of Real Estate

T

x

x

x

x

SA-53120A

Offices of Real Estate Agents and Brokers; Activities Related to Real Estate

T

x

x

x

x

SA-53120E

Offices of Real Estate Agents and Brokers; Activities Related to Real Estate

T

x

x

x

x

SA-54000A

Environmental Consulting Services; Landscape Architectural Services; Drafting Services; Building Inspection Services; Geophysical Surveying and Mapping Services; Surveying and Mapping (except Geophysical) Services; Testing Laboratories; Other Scientific and Technical Consulting Services

T

x

x

x

x

SA-54000E

Environmental Consulting Services; Landscape Architectural Services; Drafting Services; Building Inspection Services; Geophysical Surveying and Mapping Services; Surveying and Mapping (except Geophysical) Services; Testing Laboratories; Other Scientific and Technical Consulting Services

T

x

x

x

x

SA-54002A

Media Buying Agencies; Media Representatives; Display Advertising; Specialized Design Services; Advertising Material Distribution Services; Other Services Related to Advertising; Other Professional, Scientific, and Technical Services

T

x

x

x

SA-54002E

Media Buying Agencies; Media Representatives; Display Advertising; Specialized Design Services; Advertising Material Distribution Services; Other Services Related to Advertising; Other Professional, Scientific, and Technical Services

T

x

x

x

SA-54011A

Offices of Lawyers; Other Legal Services

T/E

x

x

x

x

x

x

x

SA-54011E

Offices of Lawyers; Other Legal Services

T/E

x

x

x

x

x

x

x

SA-54131A

Architectural Services

T

x

x

x

x

x

SA-54131E

Architectural Services

T

x

x

x

x

x

SA-54133A

Engineering Services

T

x

x

x

x

x

SA-54133E

Engineering Services

T

x

x

x

x

x

SA-54150A

Computer Systems Design and Related Services

T

x

x

x

x

x

SA-54150E

Computer Systems Design and Related Services

T

x

x

x

x

x

SA-54160A

Management Consulting Services

T

x

x

x

x

x

SA-54160E

Management Consulting Services

T

x

x

x

x

x

SA-54170A

Scientific Research and Development Services

T/E

x

x

x

x

x

x

x

SA-54170E

Scientific Research and Development Services

T/E

x

x

x

x

x

x

x

SA-54181A

Advertising Agencies

T

x

x

x

x

SA-54181E

Advertising Agencies

T

x

x

x

x

SA-54182A

Public Relations Agencies

T

x

x

x

x

SA-54182E

Public Relations Agencies

T

x

x

x

x

SA-54186A

Direct Mail Advertising

T

x

x

x

x

SA-54186E

Direct Mail Advertising

T

x

x

x

x

SA-54210A

Accounting, Tax Preparation, Bookkeeping, and Payroll Services

T

x

x

x

x

SA-54210E

Accounting, Tax Preparation, Bookkeeping, and Payroll Services

T

x

x

x

x

SA-56000A

Office Administrative Services; Facilities Support Services; Business Support Services; Convention and Visitors Bureaus; Investigation and Security Services; Services to Buildings and Dwellings; Other Support Services; Remediation Services

T

x

x

x

SA-56000E

Office Administrative Services; Facilities Support Services; Business Support Services; Convention and Visitors Bureaus; Investigation and Security Services; Services to Buildings and Dwellings; Other Support Services; Remediation Services

T

x

x

x

SA-56130A

Employment Placement Agencies; Temporary Help Services

T

x

x

x

x

SA-56130E

Employment Placement Agencies; Temporary Help Services

T

x

x

x

x

SA-56132A

Executive Search Services

T

x

x

x

x

SA-56132E

Executive Search Services

T

x

x

x

x

SA-56134A

Professional Employer Organizations

T

x

x

x

x

x

SA-56134E

Professional Employer Organizations

T

x

x

x

x

x

SA-56150A

Travel Agencies; All Other Travel Arrangement and Reservation Services

T

x

x

x

x

x

x

SA-56150E

Travel Agencies; All Other Travel Arrangement and Reservation Services

T

x

x

x

x

x

x

SA-56152A

Tour Operators

T

x

x

x

x

x

x

SA-56152E

Tour Operators

T

x

x

x

x

x

x

SA-56210A

Waste Collection

T

x

x

x

x

SA-56210E

Waste Collection

T

x

x

x

x

SA-56220A

Waste Treatment and Disposal

T

x

x

x

x

SA-56220E

Waste Treatment and Disposal

T

x

x

x

x

SA-56291A

Materials Recovery Facilities; All Other Waste Management Services

T

x

x

x

x

SA-56291E

Materials Recovery Facilities; All Other Waste Management Services

T

x

x

x

x

SA-61000A

Educational Services

T/E

x

x

x

x

SA-61000E

Educational Services

T/E

x

x

x

x

SA-62000A

Offices of Physicians; Offices of Dentists; Offices of Other Health Practitioners; Outpatient Care Centers; Home Health Care Services; Hospitals

T/E

x

x

x

x

x

x

x

SA-62000E

Offices of Physicians; Offices of Dentists; Offices of Other Health Practitioners; Outpatient Care Centers; Home Health Care Services; Hospitals

T/E

x

x

x

x

x

x

x

SA-62150A

Medical and Diagnostic Laboratories

T

x

x

x

x

x

x

SA-62150E

Medical and Diagnostic Laboratories

T

x

x

x

x

x

x

SA-62190A

Other Ambulatory Health Care Services

T/E

x

x

x

x

x

x

x

SA-62190E

Other Ambulatory Health Care Services

T/E

x

x

x

x

x

x

x

SA-62200A

General Medical and Surgical Hospitals; Psychiatric and Substance Abuse Hospitals; Specialty Hospitals

T/E

x

x

x

x

x

x

x

SA-62200E

General Medical and Surgical Hospitals; Psychiatric and Substance Abuse Hospitals; Specialty Hospitals

T/E

x

x

x

x

x

x

x

SA-62300A

Nursing and Residential Care Facilities

T/E

x

x

x

x

x

x

SA-62300E

Nursing and Residential Care Facilities

T/E

x

x

x

x

x

x

SA-62400A

Social Assistance

T/E

x

x

x

x

x

x

SA-62400E

Social Assistance

T/E

x

x

x

x

x

x

SA-71000A

Agents and Managers for Artists, Athletes, Entertainers, and Other Public Figures; Amusement Arcades; Gambling Industries

T

x

x

x

SA-71000E

Agents and Managers for Artists, Athletes, Entertainers, and Other Public Figures; Amusement Arcades; Gambling Industries

T

x

x

x

SA-71002A

Promoters of Performing Arts, Sports, and Similar Events; Museums, Historical Sites, and Similar Institutions; Other Amusement and Recreation Industries

T/E

x

x

x

x

x

x

SA-71002E

Promoters of Performing Arts, Sports, and Similar Events; Museums, Historical Sites, and Similar Institutions; Other Amusement and Recreation Industries

T/E

x

x

x

x

x

x

SA-71110A

Performing Arts Companies

T/E

x

x

x

x

x

x

x

SA-71110E

Performing Arts Companies

T/E

x

x

x

x

x

x

x

SA-71120A

Spectator Sports

T

x

x

x

x

SA-71120E

Spectator Sports

T

x

x

x

x

SA-71150A

Independent Artists, Writers, and Performers

T

x

x

x

x

SA-71150E

Independent Artists, Writers, and Performers

T

x

x

x

x

SA-71311A

Amusement and Theme Parks

T

x

x

x

x

SA-71311E

Amusement and Theme Parks

T

x

x

x

x

SA-72000A

Other Traveler Accommodation; RV (Recreational Vehicle) Parks and Recreation Camps; Rooming and Boarding Houses; Food Services and Drinking Places

T

x

x

x

SA-72000E

Other Traveler Accommodation; RV (Recreational Vehicle) Parks and Recreation Camps; Rooming and Boarding Houses; Food Services and Drinking Places

T

x

x

x

SA-72100A

Traveler Accommodation

T

x

x

x

x

x

SA-72100E

Traveler Accommodation

T

x

x

x

x

x

SA-81000A

Repair and Maintenance; Personal and Laundry Services

T

x

x

x

SA-81000E

Repair and Maintenance; Personal and Laundry Services

T

x

x

x

SA-81300A

Grantmaking, Civic, Professional, and Similar Organizations

E

x

x

x

x

x

SA-81300E

Grantmaking, Civic, Professional, and Similar Organizations

E

x

x

x

x

x

Footnotes:

Tax Status:

T: Taxable, T/E: Taxable and Tax-Exempt, E: Tax-Exempt

*A separate taxable and tax-exempt form will be created for each applicable form number marked (x).

Question 1A:

Mailing Address

Question 1B:

Survey Coverage

Question 2:

EIN (E forms only)

Question 3:

Organizational Change

Question 4:

Reporting Period

Question 5:

Tax Status, Number of Establishments (SA-72100A/E)

Question 6:

Sales, Receipts, or Revenue

Question 7:

Sales Tax (Only the first year of new sample)

Question 8:

Revenues from Electronic Sources

Question 9:

Source of Revenue

Question 10:

Analysis of Motor Carrier Operations (sub-sector 484), Patient Visits (sub-sector 621)

Questioin 11:

Class of Customer, Inpatient/Outpatient Activity

Question 12:

Inventories, Electronic Health Records

Question 13:

Export Revenue, Benefits Paid (Losses) (SA-52400A/E & SA-52410A/E), Direct Losses Incurred (SA-52412A/E and SA-52413A/E)

Question 14:

Operating Expenses

Question 15:

Hotel Management (SA-72100A/E)

Question 16:

N/A

Question 17:

Remarks

Question 18:

Contact Information