Attachment C - Information Sheet_NC-99001(L)

Attachment C
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2020-2022 Report of Organization
OMB Control Number 0607-0444
Form NC-99001(L) Information Sheet

2020 Instructions
Report of Organization

NC-99001(L):
This survey contains questions about the organization, questions about each of the pre-identified
locations of this organization, and questions for any locations being added to this organization (if any).
Estimates are acceptable if book figures are not readily available.
This survey is completed online by one of the following options:
•

The ‘Download Spreadsheet Template’ option requires downloading the spreadsheet from
the online instrument, filling out the spreadsheet, and uploading the completed spreadsheet
back to the instrument.

•

The online option is a question-by-question response driven approach. You navigate through
the survey, provide responses to questions, and click the ‘Save and Continue’ button.

Once data are completed, review and correct the responses (as needed) and submit the responses within the
online instrument.
Burden Statement
We estimate this survey will take an average of 3.4 hours to complete, which includes 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: ESMD Survey Comments
0607- 0444, U.S. Census Bureau, 4600 Silver Hill Road, Room ESMD-5H160, Washington, DC
20233. You may e-mail comments to [email protected]. Be sure to use “ESMD
Survey Comments 0607-0444” as the subject.
Response to this collection of information is not required unless it displays a valid approval
number from the Office of Management and Budget (OMB). The OMB eight-digit number
appears in the upper right corner of the instrument.
Ceased Operation or Sold or leased to another operator - If your organization ceased operation or
sold or leased to another operator before 2020, complete the Operational Status section of the
survey for each location (e.g., Closed or Sold) along with the effective date of the status change. If
your organization was in operation for any part of 2020, a completed survey is required for the
portion of the year in 2020 in which your organization was in operation.
Census File Number (CFN) - A CFN has been assigned to your company. Always refer to the complete
number in any correspondence with the U.S. Census Bureau.
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Employer Identification Number (EIN) - The EIN is the nine-digit taxpayer identification number
assigned by the Internal Revenue Service (IRS) and used by all business firms and other legal entities to
file federal employment tax returns such as Forms 941 and 943; and federal income tax returns such as
Forms 1065, 1120, and 990 series.
Company - An economic unit comprising one or more establishments under common ownership or
control.
Subsidiary - A company that is owned or controlled by another firm or company. Subsidiaries include
firms in which your company owns more than 50 percent of the outstanding voting stock, as well as
firms in which your company has the power to direct or cause the direction of the management and
policies.
Establishment - An establishment is a single physical location where business is conducted or where
services or industrial operations are performed (for example: a factory, mill, store, hotel, movie theater,
mine, farm, and administrative office). If distinctly separate activities are performed at the same location,
and if there is significant employment in each activity, then each activity should be treated as a separate
establishment, except agricultural production as explained below (for example: construction activities
operated out of the same physical location as a lumber yard).
For firms engaged in construction, real estate management or operation, transportation, communication,
electric, gas, and sanitary services, and similar types of physically dispersed activities, it is not necessary
to list separately each individual site, project, field, network, line, or system. It is only necessary to report
for main or branch offices, terminals, stations, etc., which are either (a) directly responsible for
supervising such activities, or (b) the base from which personnel operate to carry out these activities.
Foreign Locations - Report a foreign location only if any of the employees at the location are reported on
an IRS Form 941 for an EIN that is also used to report employees at domestic locations. You only need to
report one foreign location for each such EIN. If more than one such establishment exists for an EIN,
consolidate the employment and payroll data at the headquarters location, using foreign employees as the
secondary name.
MAILING ADDRESS
This information is what the U.S. Census Bureau has on file for this establishment and lists the location
this survey was mailed to. Respondents may update ATTN, Name 1, Name 2, Street, City, State, and ZIP
Code fields if the information displayed is incorrect.
ITEM 1A: OWNERSHIP OR CONTROL
Select the suitable answer to indicate if your company is owned or controlled by another domestic
company.
ITEM 1B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Select the suitable answer to indicate if another domestic company owns more than 50 percent of the
voting stock of your company.
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ITEM 1C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Select the suitable answer to indicate if another domestic company has the power to control the
management and policies of your company.
ITEM 1D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
Select the suitable answer to indicate the percentage of voting stock held by the owning or controlling
company. Franchisees should not list their franchisor as a controlling company unless they own more
than 50 percent of the voting stock.
ITEM 1E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
Enter the name, address, and Employer Identification Number (EIN) of the owning or controlling
company.
Note: Do not list the company for which you operate a franchise.
ITEM 1F: FOREIGN OWNERSHIP OR CONTROL
Select the suitable answer to indicate if a foreign entity (company, individual, government, etc.) owns
directly or indirectly 10 percent or more of the voting stock or other equity rights of your company.
ITEM 1G: FOREIGN OWNERSHIP OR CONTROL - COMPANY INFORMATION
Enter the name, address, and country of the foreign entity (company, individual, government).
ITEM 1H: FOREIGN OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK OWNED
Select the suitable answer to indicate the percentage of voting stock owned directly or indirectly by a
foreign entity (company, individual, government).
All direct and indirect ownership interests held by the foreign entity should be summed to determine
the foreign entity’s percentage of ownership.
ITEM 1I: FOREIGN AFFILIATES
Select the suitable answer to indicate if this company alone, or with its domestic affiliates, owns 10
percent or more of the voting stock of an incorporated foreign business enterprise, or an equivalent
interest in an unincorporated business enterprise, including ownership of real estate.

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ITEM 2A: RESEARCH AND DEVELOPMENT
Select the suitable answer to indicate if your company performed or funded research and
development in 2020.
Research and Development (R&D) is planned, creative work aimed at discovering new knowledge or
developing new or significantly improved goods and services.
This includes:
•
•
•

activities aimed at acquiring new knowledge or understanding without specific immediate
commercial applications or uses (basic research)
activities aimed at solving a specific problem or meeting a specific commercial objective
(applied research)
systematic use of research and practical experience to produce new or significantly improved
goods, services, or processes (development)

The term research and development excludes:
•
•
•
•
•

routine product testing, quality control, and technical services unless they are an integral part
of an R&D project
market research
efficiency surveys or management studies
literary, artistic, or historical projects
prospecting or exploration for natural resources

ITEM 2B: RESEARCH AND DEVELOPMENT EXPENSES
Select the suitable answer to indicate your company’s worldwide expenses for research and
development in 2020.
ITEM 3A: PROFESSIONAL EMPLOYER ORGANIZATION
Select the suitable answer to indicate if your company leased 50 percent or more of its permanent fulland part-time workforce from a Professional Employer Organization during 2020.
Permanent workforce excludes temporary staffing from a staffing service and contractors.
ITEM 3B: BUSINESS COOPERATIVE
Select the suitable answer to indicate if your company is a cooperative.
A cooperative is a business or organization owned by, controlled by, and operated for the benefit of
members using its services. Members (also known as user-owners) can be individuals or organizations, and
benefit from the use of services, products, and/or earnings generated by the co-op. This includes purchasing
co-ops, member/patron organizations, member-controlled non-profits, consumer co-ops, marketing co-ops,
worker co-ops, etc.

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ITEM 5A: PRE-IDENTIFIED LOCATIONS OF OPERATION
This section of the survey contains questions for all the pre-listed locations of the organization.
A. Location Information
For each location, please update the following information as needed: Major Activity, Name, Secondary
Name, Store or plant No., Physical Location (Number and Street), City, State, and ZIP Code.
Ceased Operation or Sold or leased to another operator
If the location ceased operation or sold or leased to another operator before the survey year,
please select “Ceased Operation” or “Sold or leased to another operator” and select a date for
each Pre-listed location. If the location did operate in any part of the survey year, we require
a response for the portion of the survey year in which your location was in operation.
Special Instructions for Off-Site Employees and Selected Industries
Off-Site Employees e.g., work at home, virtual office, telecommuting, field or remote personnel
Include employment and payroll data for these employees at regional or district offices, if
available. If there are no regional or district offices, consolidate and report the data for these
employees by state. Enter an appropriate description in the Secondary Name field.
Agricultural production

Establishments having any agricultural production, regardless of whether it is the major activity,
should be listed separately and the employment and payroll data allocated if appropriate.
Agricultural production includes the raising of/or production of crops (including horticultural
products,) poultry, or livestock for sale.
Construction establishment

A construction establishment is a relatively permanent office, or other place of business, where
the usual business activities related to construction are conducted. With some exceptions, a
relatively permanent office is one which has been established for the management of more
than one project or job and which is expected to be maintained on a continuing basis.
Banks

When checking the pre-listing of your establishments, list only the EINs used to report either
Federal employment taxes (IRS Form 941) or income (IRS Forms 1065, 1120, and 990). DO NOT
LIST EINs assigned to trust funds or estates managed by the bank and reported on IRS Form
1041, U.S. Fiduciary Income Tax Return. Report main and branch locations as separate
establishments. Individual ATM outlets should not be listed as separate establishments.
Retail departments or concessions

List as a separate establishment (including specific street address) those retail or service outlets
operated by your firm as a department of a retail or service establishment, such as shoe
departments or beauty salons in department stores, meat or bakery departments in grocery
stores, or millinery departments in clothing stores.
Medical

Part-time offices should not be considered as separate establishments. List only the offices that
are staffed on a full-time basis and include the employment and payroll for the part-time
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offices. Home health care services should not consider the customers’ locations as separate
establishments. Employment and payroll for these locations should be included with the main
or branch office from which the work is supervised.
Legal

Part-time, temporary, or special offices should not be considered separate establishments for
purpose of this report. Data for such locations should be included with the controlling main or
branch location where the service is primarily performed.

B.

Employment and Payroll

Enter the number of employees for the pay period including March 12th, the first quarter payroll, and
the annual payroll for the location for the survey year.
Employment:
Please use the number of employees, both full- and part-time whose payroll was reported
on your organization's Internal Revenue Service Form(s) 941, Employer's Quarterly Federal
Tax Return. Include as employees all persons on paid sick leave, paid holidays, and paid
vacations; include salaried officers and executives of incorporated firms.
Exclude full- or part-time leased employees whose payroll was filed under an employee
leasing company's EIN and temporary staffing obtained from a staffing service.
Payroll:
Include the total of wages paid, tips reported, and other compensation paid to your
employees in the calendar year, whether or not subject to income or social security
taxes. Include all wages, salaries, commissions, fees, bonuses, vacation allowances, sick
leave pay, severance pay, the amount of reported tips, and the value of taxable fringe
benefits. Also, include any employee contributions to a qualified pension plan, such as the
401(k) plan. Also, include the spread on stock options that are taxable to employees as
wages.
For incorporated businesses, include the salary of all officers and executives.
Exclude pensions, annuities, supplemental unemployment compensation benefits,
nontaxable fringe benefits, and commissions and fees paid to independent contractors.
Also, exclude employer contributions for pension plans, health insurance, and qualified
benefits under a cafeteria plan. For unincorporated businesses, exclude the profit or
compensation paid to proprietors or partners.
The sum of payroll reported for individual establishments for an EIN should equal the
taxable Medicare wages and tips reported on Item 5c of IRS form 941, Employer’s
Quarterly Federal Tax Return plus the spread on stock options that are taxable to
employees.

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C.

Operational Status

Select the box that is applicable to the operation of your location during the survey year.
•

If the establishment ceased operation,
o Enter the ceased operation date in the CEASED OPERATION OR SOLD OR LEASED
INFORMATION response section.

•

If the establishment sold or leased to another operator,
o Enter the sold operation date in the CEASED OPERATION OR SOLD OR LEASED
INFORMATION response section.
o Also, enter the name and address of this establishment’s new owner or operator.

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ITEM 5B: ADDITIONAL LOCATIONS OF OPERATION
This survey contains questions for locations being added to the organization.
Do not add locations from the pre-identified locations section, or locations for which you
received an MA-10000 survey.
A. Location Information
For each new establishment being added, enter the EIN, Name, Secondary name, Store or plant No.,
Physical Location, City, State, ZIP Code, and date establishment opened or is expected to open.
Special Instructions for Off-Site Employees and Selected Industries
Off-Site Employees e.g., work at home, virtual office, telecommuting, field or remote personnel
Include employment and payroll data for these employees at regional or district offices, if available.
If there are no regional or district offices, consolidate and report the data for these employees by
state. Enter an appropriate description in the Secondary Name field.
Agricultural production
Establishments having any agricultural production regardless of whether it is the major activity
should be listed separately and the employment and payroll data allocated if appropriate.
Agricultural production includes the raising of/or production of crops (including horticultural
products), poultry, or livestock for sale.
When adding establishments engaged in agricultural production, be sure to give the type of crops,
livestock, etc.
Construction establishment
A construction establishment is a relatively permanent office, or other place of business, where the
usual business activities related to construction are conducted. With some exceptions, a relatively
permanent office is one which has been established for the management of more than one project
or job and which is expected to be maintained on a continuing basis.
Banks
When adding establishments, list only the EINs used to report either Federal employment taxes (IRS
Form 941) or income (IRS Forms 1065, 1120, and 990). DO NOT LIST EINs assigned to trust funds or
estates managed by the bank and reported on IRS Form 1041, U.S. Fiduciary Income Tax Return.
Report main and branch locations as separate establishments. Individual ATM outlets should not be
listed as separate establishments.
Retail departments or concession
List as a separate establishment (including specific street address) those retail or service outlets
operated by your firm as a department of a retail or service establishment, such as shoe
departments or beauty salons in department stores, meat or bakery departments in grocery stores,
or millinery departments in clothing stores.
Medical
Part-time offices should not be considered as separate establishments. List only the offices that are
staffed on a full-time basis and include the employment and payroll for the part-time offices. Home
health care services should not consider the customers’ locations as separate establishments.
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Employment and payroll for these locations should be included with the main or branch office from
which the work is supervised.
Legal
Part-time, temporary, or special offices should not be considered separate establishments for
purpose of this report. Data for such locations should be included with the controlling main or
branch location where the service is primarily performed.

B.

Employment and Payroll
Enter the number of employees for the pay period including March 12th, the first quarter payroll,
and the annual payroll for the location for the survey year.
Employment:
Please use the number of employees, both full- and part-time whose payroll was reported on
your organization's Internal Revenue Service Form(s) 941, Employer's Quarterly Federal Tax
Return. Include as employees all persons on paid sick leave, paid holidays, and paid vacations;
include salaried officers and executives of incorporated firms.
Exclude full- or part-time leased employees whose payroll was filed under an employee
leasing company's EIN and temporary staffing obtained from a staffing service.
Payroll:
Include the total of wages paid, tips reported, and other compensation paid to your
employees in the calendar year, whether or not subject to income or social security taxes.
Include all wages, salaries, commissions, fees, bonuses, vacation allowances, sick leave pay,
severance pay, the amount of reported tips, and the value of taxable fringe benefits. Also,
include any employee contributions to a qualified pension plan, such as the 401(k) plan. Also,
include the spread on stock options that are taxable to employees as wages.
For incorporated businesses, include the salary of all officers and executives.
Exclude pensions, annuities, supplemental unemployment compensation benefits,
nontaxable fringe benefits, and commissions and fees paid to independent contractors.
Also, exclude employer contributions for pension plans, health insurance, and qualified
benefits under a cafeteria plan. For unincorporated businesses, exclude the profit or
compensation paid to proprietors or partners.
The sum of payroll reported for individual establishments for an EIN should equal the taxable
Medicare wages and tips reported on Item 5c of IRS form 941, Employer’s Quarterly Federal
Tax Return plus the spread on stock options that are taxable to employees.

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C.

Major Activity Code
Select the Activity Code that best describes the activity of this establishment and describe the
principal products or services.

D.

Former Owner or Operator Information
If this establishment was acquired, enter the Name of the former owner, the Mailing Address
(Number and Street), City, State, ZIP Code, and the date this location was acquired.

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