Form MA-3000 Manufacturers' Unfilled Orders Survey

Manufacturers' Unfilled Orders Survey

Attachment A - Form MA-3000

Manufacturers' Unfilled Orders Survey

OMB: 0607-0561

Document [pdf]
Download: pdf | pdf
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
File Modified2020-01-28
File Created2020-01-28

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