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pdfAttachment D
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-0998
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Instrument
Path
11500
21110
21221
21238
2132A
Attachment
D-1
D-2
Sector
11
21
D-3
22
2211A
22110
22120
22130
Instrument Path Title
Support Activities for Crop and Animal Production
Crude Petroleum, Natural Gas, and Natural Gas Liquid Extraction
Gold, Silver, Lead, Zinc, Copper and Nickle Ore Mining
All Other Nonmetallic Mineral Mining
Support Activities for Coal, Metal, and Nonmetallic Minerals (except
Fuels) Mining (Consolidated)
Hydroelectric Power Generation
Electric Power Generation, Transmission and Distribution
Natural Gas Distribution
Water, Sewage and Other Systems
D-4
23
23610
23810
23830
23890
Residential and Nonresidential Building Construction
Foundation, Structure, and Building Exterior Contractors
Building Finishing Contractors
Other Specialty Trade Contractors
D-5
31-33
33153
33242
33591
33640
Nonferrous Metal Die-Casting Foundries
Metal Can Manufacturing
Primary Battery Manufacturing
Aircraft Manufacturing
D-6
42
42311
42435
42441
42542
Motor Vehicles
Clothing and Accessories
General-Line Groceries
Pharmaceuticals, Cosmetics, and Toiletries Agents and Brokers
D-7
44-45
44211
44512
44831
45111
Furniture Stores
Convenience Stores
Jewelry Stores
Sporting Goods Stores
D-8
48-49
48100
48400
48700
4930X
Air Transportation
Truck Transportation
Scenic and Sightseeing Transportation
Warehousing and Storage (Enterprise Support)
D-9
51
5160C
51213
51224
51314
Motion Picture and Video Production and Distribution and
Broadcasting Services (Classification)
Motion Picture and Video Exhibition
Sound Recording Studios and Other Sound Recording Industries
Directory and Mailing List Publishing
Attachment Sector
D-10
52
Instrument
Path
52111
52230
52321
52410
55111
5611C
56120
56150
5622X
Instrument Path Title
Monetary Authorities - Central Bank
Financial Transactions Processing and Other Activities Related to
Credit Intermediation
Securities and Commodity Exchanges
Health and Medical Insurance Carriers
Offices of Real Estate Agents and Brokers and Activities Related to
Real Estate
Real Estate Lessors
Automotive Equipment Rental and Leasing (Without Drivers)
Lessors of Nonfinancial Intangible Assets (except Copyrighted
Works)
Architectural and Landscape Architectural Services (Enterprise
Support)
Specialized Design Services
Computer Systems Design and Related Services and Management,
Scientific, and Technical Consulting Services (Classification)
Environmental Consulting and Other Scientific and Technical
Consulting Services
Corporate, Subsidiary, and Regional Managing Offices (Enterprise
Support)
Holding Companies
Office Administrative Services (Classification)
Facilities Support Services
Travel Arrangement and Reservation Services
Waste Treatment and Disposal (Enterprise Support)
61
6100C
61140
61150
61170
Educational Services (Classification)
Business Schools and Computer and Management Training
Technical and Trade Schools
Educational Support Services
D-16
62
6210C
6230C
62412
D-17
71
D-18
72
Ambulatory Health Care Services (Classification)
Nursing and Residential Care Facilities (Classification)
Services for the Elderly, Disables, and Intellectually and
Developmentally Disabled
Child Day Care Services
Spectator Sports
Promoters of Performing Arts, Sports, and Similar Events
Agents and Managers for Artists, Athletes, Entertainers, and Other
Public Figures
Museums, Historical Sites, and Similar Institutions
Accommodation, Food Services, and Drinking Places (Classification)
Traveler Accommodation
Rooming and Boarding Houses
Special Food Services
D-11
53
53100
53110
53210
53300
D-12
54
5403X
54140
5415C
54162
D-13
55
D-14
56
D-15
5511X
62441
71120
71130
71140
71210
7200C
72110
72130
72230
Attachment Sector
D-19
81
D-20
N/A
Instrument
Path
81210
81230
8127X
81349
92104
92304
93104
94204
94404
95104
95204
97204
Instrument Path Title
Personal Care Services
Drycleaning and Laundry Services
Parking Lots and Garages (Enterprise Support)
Civic, Social, and Other Membership Organizations
American Samoa - Mining, Utilities, Transportation, and
Warehousing
American Samoa - Construction
American Samoa - Manufacturing
American Samoa - Wholesale Trade
American Samoa - Retail Trade
American Samoa - Services
American Samoa - Finance, Insurance, Real Estate, Rental and
Leasing
American Samoa - Accommodation and Food Services
Instrument Search Functionality
User enters a write-in under "Specify additional product or service" label, user clicks the "Search"
button, user gets the table of search results, user selects products and services to add (if none apply the
user can select "None of these:.." with the write-in text at the end of the table of search results), and the
user clicks the "Add Selected Products/Services" to add the selected products and services.
Attachment D-1
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 11
Attachment Sector
Instrument
Path
Instrument Path Title
D-1
11500
11
Support Activities for Crop and Animal Production
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Agricultural Services
Cotton ginning
115111 001
Soil preparation, planting, and cultivating support services for crop production - including crop dusting and spraying, plowing, fertilizer
application, seeding, planting, thinning, and transplanting, pollinating, cultivating, weed and pest control, etc.
115112 001
Crop harvesting (primarily by machine) support services for crop production - including harvesting, combining, picking, threshing, hay
mowing, raking, baling, chopping, and silo filling
115113 001
Postharvest crop activities (except selling and cotton ginning) - including crop cleaning, sun drying, irradiation, shelling, fumigating, curing,
sorting, grading, packing, waxing, and cooling
115114 001
Farm labor contractors and crew leaders - supplying labor for agricultural production or harvesting (without providing farm operation
management services)
115115 001
Farm operation management services, on a contract or fee basis
115116 001
Support activities for animal production - including semen collection, breeding services for animals (except for sale), pedigree record
services, boarding and training horses (except racehorses), farrier services, poultry catching, poultry house cleaning, dairy herd
improvement activities, livestock spraying, sheep dipping and shearing, etc.
115210 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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 943 (Employer's Annual Federal Tax Return for Agricultural Employees)
If you report by fiscal year, indicate the exact dates of the fiscal year on the submission certification screen.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 28: Special Items - Primary Products or Services
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form
941, Employer’s Quarterly Federal Tax Return or Internal Revenue Service Form 943, Employer’s Annual Federal Tax Return for Agricultural Employees, and filed under the
Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
2022
$
,000.00
$
,000.00
19
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
20
Item 28: Special Items - Primary Products or Services
ITEM 28: SPECIAL ITEMS - PRIMARY PRODUCTS OR SERVICES
Please describe the three products or services that generated the largest sales, shipments, receipts, or revenue for this establishment in 2022.
Product or service #1
Product or service #2
Product or service #3
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
21
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
1000
characters remaining
22
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AG-11500_su.pdf Generated 2022-02-23 17:07:18
,000.00
23
Attachment D-2
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 21
Attachment Sector
D-2
21
Instrument
Path
Instrument Path Title
21110
21221
21238
2132A
Crude Petroleum, Natural Gas, and Natural Gas Liquid Extraction
Gold, Silver, Lead, Zinc, Copper and Nickle Ore Mining
All Other Nonmetallic Mineral Mining
Support Activities for Coal, Metal, and Nonmetallic Minerals (except
Fuels) Mining (Consolidated)
Location Information
DEFINITION OF DOMESTIC REPORTING UNIT
The reporting unit for this questionnaire is an oil and gas field mineral domestic reporting unit. An oil and gas field mineral domestic reporting unit represents oil and gas field activities
in one state or offshore area operated by the reporting company.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Where is the physical location of this domestic reporting unit?
Answer A if operations of this domestic reporting unit are physically located onshore. Answer B if operations are located offshore.
A. Onshore
(Select name of state from the drop-down list.)
B. Offshore
Complete a separate report for offshore exploration, drilling, and production operations for each of the following areas in which your company had offshore operations. An offshore well
is one that is bottomed at, or producing from, a point that lies seaward of the coastline. In general, the term "coastline" means the line of ordinary low water along that portion of the
coast that is in direct contact with the open sea and the line marking the seaward limit of inland waters.
(For offshore areas, please see: https://www2.census.gov/programs-surveys/economic-census/2017/reference-maps/mining-offshore-area-map.docx)
For Census Bureau Use Only
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
1
CFN
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this domestic reporting unit's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this domestic reporting unit’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
9
Item 2F: Number of Domestic Reporting Units
ITEM 2F: NUMBER OF DOMESTIC REPORTING UNITS
2022
How many domestic reporting units operated under EIN at the end of 2022?
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this domestic reporting unit's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
11
Item 3A: Operational Status - Ceased Operation Date
If this domestic reporting unit ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
If this domestic reporting unit was sold or leased to another operator, what is the name, address, and 9-digit Employer Identification Number (EIN) of this domestic reporting unit's new
owner or operator?
Name of new owner/operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the domestic reporting unit's
primary business or activity.
Select only ONE.
Crude petroleum extraction
211120 001
Natural gas extraction, including natural gas liquids
211130 101
Drilling oil and gas wells, on a contract basis
213111 001
Support activities for oil and gas operations on a contract basis (excluding drilling wells), e.g., cementing wells, exploration services,
hydraulic fracturing, gathering services, etc.
213112 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
2036
,000.00
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations (domestic reporting units) operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the domestic reporting unit listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each domestic reporting unit individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
17
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What was the total value of products shipped and other receipts for this domestic reporting unit?
(Report details in Item 22.)
Include:
All products physically shipped during 2022
Receipts for services
Value of resales
Interplant transfers
Exports
Other miscellaneous receipts
Exclude:
Non-operating income such as royalties, interest, dividends, or the sale of fixed assets
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
$
,000.00
B. What was the value of products shipped for export for this domestic reporting unit?
(This is a breakout of the $,000.00 reported in A.)
Include:
Shipments going directly for export including shipments to foreign subsidiaries or foreign divisions of your
company and their affiliates:
Shipments to customers in the Panama Canal Zone, the Commonwealth of Puerto Rico, and U.S.
possessions
Shipments of your products to export firms and to other customers who export these items
Sales to the U.S. government to be shipped to foreign nations under military and economic assistance
programs
Exclude:
Sales to the U.S. Government overseas
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
18
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941, Employer's Quarterly Federal
Tax Return, and filed under the Employer Identification Number (EIN)
Persons on paid sick leave, paid holidays, and paid vacations during the year
Officers, if a corporation
Persons at a general office serving two or more plants if located at or near this domestic reporting unit
Employees paid on a per ton, car, or yard basis
Exclude:
Members of the Armed Forces and pensioners carried on your active payrolls
Proprietor or partners, if an unincorporated concern
Workers at manufacturing plants (including petroleum refineries), company stores, boardinghouses, bunkhouses, recreational centers, and auxiliary offices
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report these values in Item 16, line C1.)
Temporary staffing obtained from a staffing service (Report these values in Item 16, line C1.)
Purchased professional and technical services (Report these values in Item 16, line C9.)
Contractors and subcontractors and their employees (Report the cost of contract work in Item 16,line A3.)
A. EMPLOYMENT
1. What was the number of mining, production, development, and exploration workers (direct labor including
first-line supervisors) at this domestic reporting unit for the pay period including March 12 (Q1)?
Include:
Workers engaged in services closely associated with production and development operations such as:
Manual work
Tool use and machine operation
Materials and products, loading and hauling
Mineral properties care
Exploration and development work
Storage, shipping, maintenances, repair, and guard services
Auxiliary production for own use (i.e. power plant) record keeping
Regular maintenance and repair
Drilling and maintaining wells
Seismic testing or cementing walls
Exclude:
Supervisory employees above the first-line level (Report these in A2.)
Employees of contractors or subcontractors
Check
if
None
2022 Number
2. What was the number of other employees at this domestic reporting unit for the pay period including March 12
(Q1)?
Include:
Force-account construction employees and your payroll engaged in construction of major additions or
alterations to your facilities that are utilized as a separate work force
Nonproduction personnel engaged in supervision above the working supervisor level and employees
engaged in activities such as:
Sales, advertising, purchasing, finance
Highway trucking and other transportation
Credit, collection, executive, legal, clerical, and routine office functions
Personnel including cafeteria, medical, etc.
Professional (engineers, geologists, etc.) and technical workers
Exclude:
Proprietors and partners
Temporary staff and leased employees
Employees of contractors or subcontractors
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
19
TOTAL (Add lines A1 and A2.)
B. HOURS WORKED
What was the annual number of hours worked by the mining, production, development, and exploration workers
(direct labor including first-line supervisors) at this domestic reporting unit reported in A1?
Include:
All hours worked or paid (except hours paid for vacations, holidays, or sick leave)
Overtime hours (Report actual hours worked, not straight-time equivalent hours.)
Actual hours worked by an employee who elects to work during a vacation period
All hours worked for the entire year by a full and part-time mining, production, development, and
exploration workers of the type reported in A1
Exclude:
Hours of proprietors or partners
Hours worked by temporary staff or leased employees
Hours worked by employees of contractors or subcontractors
Check
if
None
2022 Hours
,000
C. PAYROLL
Report the gross earnings paid in calendar year 2022 to employees prior to such deductions as employee’s Social Security contributions, withholding taxes, group insurance
premiums, union dues, and savings bonds.
Payroll should equal the taxable Medicare wages and tips reported on the Internal Revenue Services (IRS) Form 941, Employer’s Quarterly Tax Return and definitions as described in
Circular E, Employer’s Tax Guide.
Include:
Commissions, dismissal pay and paid bonuses
Employee contributions to pension plans such as a 401(k) plan
Vacation and sick-leave pay
Salaries of officers
Spread on stock options that are taxable to employee as wages
Cash equivalent of compensation paid in kind such as:
Board and housing
Payments in the form of shared profits and special stock purchases that are subject to withholding tax
Exclude:
Payroll for temporary staff and leased employees
Payments to proprietor or partners
Payments to members of Armed Forces and pensioners carried on your active payroll
Royalty payments to unions
Payments to contract or subcontractors who performed work for you
Employer-paid annual cost for fringe benefits (Report these costs in D1 through D3.)
Check
if
None
2022
1. What was the annual payroll before deductions for mining, production, development, and exploration workers
(direct labor including first-line supervisors) of the type reported in A1 at this domestic reporting unit?
$
,000.00
2. What was the annual payroll before deductions for all other employees of the type reported in A2 at this domestic
reporting unit?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $,000.00 reported above, what was the first quarter payroll at this domestic reporting unit before
deductions (January - March 2022)?
$
,000.00
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
20
Item 7: Employment and Payroll - Continued
ITEM 7: EMPLOYMENT AND PAYROLL
D. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS
This is the employer’s annual cost at this domestic reporting unit for legally required programs and programs not required by law.
1. What were the employer’s annual costs at this domestic reporting unit for health insurance? (insurance premiums on
hospitals, medical plans, and single service plans such as dental, vision, and prescription drug plans)
Include:
Premium equivalents for self-insured plans and fees paid to third-party administrators (TPAs)
Exclude:
Employee contributions
Disbursements from trusts or funds to satisfy health insurance claims
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Retirement plans:
a. What were the employer’s annual costs at this domestic reporting unit for defined benefit pension plans? (Costs
include both qualified and nonqualified defined pension plans, as well as plans that specify the benefit to be
paid to employee upon retirement, generally either as a specified amount or a percentage of compensation.
Employer contributions are based on actuarial computations that include the employee's compensation and years
of service and are not allocated to specific accounts maintained for employees.)
b. What were the employer’s annual costs at this domestic reporting unit for defined contribution plans? (These
are 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)
3. What were the employer’s annual costs at this domestic reporting unit for employer-paid payroll taxes, insurance
premiums, and all other employer-paid benefits?
Include:
Life insurance benefits
“Quality of life” benefits (e.g., childcare assistance, subsidized commuting, etc.)
Education assistance
Legally-required fringe benefits
Social Security
Workers' compensation insurance
Unemployment tax
State disability insurance programs (long- and short-term disability – LTD and STD)
Medicare
Exclude:
Disbursements from trusts or funds to satisfy health insurance claims
TOTAL (Add lines D1 through D3.)
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
21
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
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Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES
Report inventories at cost or market using generally accepted accounting practices. Report the value of all inventories that are attributable to the domestic reporting unit’s operations
regardless of where the inventories are held or stored.
What was the value of mined products and supplies owned by this domestic reporting unit as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:
A. Crude petroleum, including lease condensate?
Include:
Stocks of raw products awaiting treatment or
processing
Stockpiles of products ready for shipment
Check
if
None
Check
if
None
2022
2021
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
B. Materials, parts, supplies, fuels, etc.?
Include:
Natural gas and natural gas liquids received from
other domestic reporting units for processing
Cost of items to be used for extracting and
beneficiating
TOTAL (Add lines A and B.)
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
23
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this domestic reporting unit as of December 31, 2022 and the $,000.00 reported in Item 9 as the total
value of inventories owned by this domestic reporting unit as of December 31, 2021:
Check
if
None
Check
if
None
2022
2021
A. What was the amount subject to Last-In, First-Out (LIFO)
gross (gross LIFO amount)?
$
,000.00
$
,000.00
B. What was the amount not subject to LIFO valuation
method?
$
,000.00
$
,000.00
TOTAL (Sum of lines A and B should equal TOTAL in Item
9.)
$
,000.00
$
,000.00
C. What was the amount of LIFO reserve (if any)? [LIFO
reserve represents the excess of current period cost over
the LIFO carrying value. LIFO reserve is the difference
between the current cost (i.e., FIFO) of inventories (gross
value) and the LIFO carrying value (net value).]
$
,000.00
$
,000.00
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
24
Item 13: Capital Expenditures
ITEM 13: CAPITAL EXPENDITURES
Report the actual outlays during 2022, not the final value of buildings or other structures completed or equipment put in place during the year. These expenditures are of the type for which
depreciation or amortization accounts are ordinarily maintained.
Capital expenditures during 2022 may be determined by the following computation:
(a) Cost of additions completed during the year, plus
(b) Work-in-progress at the end of the year, minus
(c) Work-in-progress at the beginning of the year.
Include labor and installation costs whether on contract or by your own forces
Exclude the cost of maintenance and repairs charged as current operating expense
A. What were the capital expenditures for new and used buildings, structures, machinery, and equipment for this domestic
reporting unit?
Include:
Buildings and structures directly related to mineral exploration, development, and production
Machinery, such as hoists, cranes, crushers, separators, and power plants
Exploration, development, production, and processing plant machinery
Value of the equipment produced and used
Equipment such as excavators, loaders, locomotives, tractors, hoists, drills, compressors, pumps
Transportation equipment, such as automobiles, trucks, and similar equipment
Office equipment, such as computers and peripheral data processing equipment, as well as furniture and fixtures
for offices, cafeterias, and change rooms
Replacements as well as additions to new capacity
Values from construction by your own employees, where capitalized
Value of improvements and capitalized repairs to machinery and equipment including those done to assets
transferred from other domestic reporting units of this company
Expenditures for old or existing plants and for second-hand equipment acquired from others (including U.S.
Government)
Gross book value of machinery or equipment transferred from other domestic reporting units of your company
Exclude:
Company houses and general recreational facilities
Value of land
Cost of maintenance and repairs charged as current operating expense
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. What were the capital expenditures for mineral exploration and development for this domestic reporting unit?
Include:
All intangible development and exploration outlays that were charged to a capital or Office of Minerals Exploration
account
Capitalized expenditures for entries, shafts, rail and other road construction, test boring, surveying, etc.
Capitalized expenditures for oil and gas field exploration and for drilling oil, gas, dry, and service wells through
completion of the well
TOTAL (Add lines A and B.)
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
25
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS
Report rental payments made to other companies for use of depreciable assets such as buildings, other structures, machinery, and equipment. Include rental payments for land.
Domestic reporting units involved with leasing arrangements for equipment and/or buildings, report lease equipment according to the type of lease negotiated with the producer or the
lessor.
Include:
Operating leases (Report the periodic payments made to the producer or lessor.)
Exclude:
Capital leases (leases with a contract to own at the end of the lease) (Report cost, at market value, of acquisitions of building and equipment during the year as a capital
expenditure, Item 13.)
At this domestic reporting unit, what were the payments for:
A. Rental or lease of buildings and other structures?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. Rental or lease of machinery and equipment?
Include:
Production machinery and equipment
Loading machinery and equipment
Transportation machinery and equipment
Construction equipment
Tools
Office equipment
Furniture
Vehicles
TOTAL (Add lines A and B.)
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
26
Item 15: Mineral Property Expenses
ITEM 15: MINERAL PROPERTY EXPENSES
Report mineral property expenses charged to current accounts.
Check
if
None
A. What were the lease rents for mineral properties for this domestic reporting unit?
2022
$
,000.00
B. Current Operation Expenses
Include:
Acquisition costs for mineral land and rights that were not capitalized
Cost of royalty payments related to mineral production
Labor costs whether on a contract basis or by your own forces associated with exploration and development or the acquisition of mineral properties
Intangible development and exploration outlays charged to a current account
Expenses for mineral properties charged to current accounts, such as:
all supplies, machinery, equipment, parts, fuel, power, etc., used for development or exploration (whether purchased or received from other domestic reporting units of
your company) and charged as current operating expenses
cost of maintenance and repairs associated with development or exploration activity that is charged to current accounts
Exclude:
Lease rents (Report separately in A.)
1. What were the current operating expenses for exploration, development, and mineral land and rights for this
domestic reporting unit?
$
,000.00
2. What were the current operating expenses for royalty payments for this domestic reporting unit?
$
,000.00
TOTAL (Add lines B1 and B2.)
$
,000.00
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
27
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
SELECTED EXTRACTION/MINING/QUARRYING COSTS AND ELECTRICITY
Include costs incurred in mining processes such as supplies, resales, contract work, fuels, and electricity.
A. What were the extraction/mining/quarrying-related costs in 2022 for this domestic reporting unit for:
1. Materials, parts, and supplies used; and minerals received for preparation? (Report detail in Item 18.)
Include:
Cost of extraction/mining/quarrying-related materials purchased for other companies (contractors)
Cost of materials purchased or received from other domestic reporting units of your company
Exclude:
Non-extraction/mining/quarrying-related expenses that were paid to other companies (Report these
expense details in C.)
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Products bought and sold without further processing (products bought and resold in the same condition as when
purchased)? (Report these sales in Wholesaling Services product codes in Item 22.)
Exclude:
oil, gas or natural gas liquids (if applicable)
3. Work done for you by others on your materials (work contracted to others)? [Report in A1 the materials, parts, and
supplies purchased for other companies (contractors).]
4. Purchased fuels consumed for heat, power, or the generation of electricity? (Report detail in Item 19.)
Report the total amount actually paid or payable for all purchased fuels consumed.
Include:
Fuels or coal consumed at this domestic reporting unit, but produced at another domestic reporting unit of
your company (Assign commercial values to them.)
Fuel used to power on-site trucks, forklifts, or motor vehicles
Anthracite, lignite, bituminous, and subbituminous coal, coke, natural and manufactured gas, gasoline,
wood, purchased steam, and all other fuels
Exclude:
Gas purchased for gas lift
Crude petroleum, natural gas, and coal produced at the domestic reporting unit and used for heat, power,
or the generation of electricity
5. Purchased electricity? (Report comparable quantity in B1.)
Report total amount actually paid or payable for electric energy purchased during 2022 from other companies or
received from other domestic reporting units of your company.
Exclude value of electricity generated and used at this domestic reporting unit
TOTAL (Add lines A1 through A5.)
B. For this domestic reporting unit, what was the quantity of:
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
28
Check
if
None
1. Purchased electricity? (quantity comparable to cost reported in A5)
2022 Kilowatt Hours
,000
2. Generated electricity? (gross less generating station use)
When a figure is reported on this line, include data relating to the activity of the power stations in other sections of
this questionnaire. For example, include the number of employees assigned to the power station, their wages, and
hours worked in the figures reported in Item 7 and the cost of fuels used to generate electricity, in Item 16, line A4
and Item 18.
Include energy generated at the drilling site that was used for lighting or other purposes.
3. Electricity sold or transferred to other domestic reporting units? (Also include quantity in B1 and/or B2.)
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
,000
,000
29
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
OTHER OPERATING EXPENSES
C. What were the other operating expenses paid by this domestic reporting unit in 2022 for:
Include:
Costs for each of these services purchased from other companies that are paid directly by this domestic reporting unit
Expenses normally considered nonproduction related costs
Exclude:
Salaries paid to employees of this domestic reporting unit for any of the specified services (Report in Item 7.)
Cost of mining activities contracted or subcontracted to others (Report on A3.)
1. Temporary staff and leased employees? [total costs paid to Professional Employer Organizations (PEOs) and
staffing agencies for personnel]
Include:
All charges for payroll, benefits, and services
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report in 3.)
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
4. Purchased communication services?
Include:
Telephone, cellular, and fax services
Computer-related communications (e.g., Internet, connectivity, online)
Credit card transaction fees
Other wired and wireless communication services
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
30
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
Exclude:
Services provided by other domestic reporting units of this company (such as a separate central data
processing unit)
Expensed integrated systems (Report in 4.)
Repair and maintenance of computer equipment (Report in 6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in 9 and credit card
transaction fees in 4.)
Expenses for telecommunication services, e.g., Internet, connectivity, telephone, etc. (Report in 4.)
$
,000.00
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof, replacing parts, over-hauling of equipment, and other repairs chargeable as
current operating costs
Cost of repair and maintenance of any leased property if the domestic reporting unit assumes the cost
Exclude:
Materials, parts, and supplies used for repairs and maintenance performed by this domestic reporting unit’s
employees (Report in A1.)
Extensive “repairs” or reconstruction that is capitalized (Report these as a capital expenditure in Item 13.)
Costs incurred directly by this domestic reporting unit in using its own work force to perform repairs and
maintenance work
Repairs and maintenance provided by the building or machinery owner as part of the rental contract
7. Water, sewer, refuse removal, and other non-electric utility payments? (Report electric utility payments on line
A5. If the cost of these utilities is included in a lease or rental payment, report in Item 14 line A.)
Include:
Cost of hazardous waste removal
8. Purchased advertising and promotional services?
Include:
Printed materials
Media coverage
Marketing and public relations services
Exclude:
All salaries paid to employees of the domestic reporting unit for advertising work
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
31
9. Purchased professional and technical services?
Include:
Management consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll processing
Architectural
Engineering
Other professional services
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
$
,000.00
10. Governmental taxes and licensing fees? (payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
11. All other operating expenses not reported elsewhere?
Exclude:
Purchases of merchandise for resale (Report on line A2.)
Non-operating expenses
Describe
TOTAL (Add lines C1 through C11.)
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Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
Report:
Delivered cost of individual items listed below. Delivered cost is the amount paid or payable after discounts and including freight and other direct charges incurred by the
domestic reporting unit in acquiring the materials. The figures reported should represent the total purchase cost of supplies, minerals received for preparation, etc., actually used
or processed during 2022. Include purchases, interplant transfers, and withdrawals from inventories. Do not combine material lines. If the information is not directly available
from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Estimated quantity and cost of minerals received for processing on a custom or toll basis, as if purchased.
Minerals mined and also processed at this domestic reporting unit.
Include:
Minerals received from other domestic reporting units for preparation which were used or processed during 2022
Cost of materials and supplies not covered in the pre-listed material codes (Report these in material code 00970098 - "All other supplies".)
Supplies purchased by this domestic reporting unit for use by companies performing contract work at this domestic reporting unit
Exclude:
Associated labor costs of the kind reported in Item 7 and Item 16, line A3
Payments made for contract services performed, including payments for supplies and equipment furnished by the contractor incidental to this work
Unit of
Measure
Description
Quantity
1. Parts and attachments for mining, mineral preparation, construction, and
conveying machinery and equipment
Census
Material
Code
Value
$
,000.00
33300009
$
,000.00
33351506
3. Metal valves, pipe fittings, and related assemblies, excluding fluid power and
forgings
$
,000.00
33291000
4. Miscellaneous iron, steel, and ferroalloy ingot, shapes, and forms (excluding
castings, forgings, bars, structural shapes, wire, sheet, strip, and semifinished
shapes)
$
,000.00
33110090
5. Cement
$
,000.00
32730020
6. Drilling fluids (drilling mud and drilling mud materials; mud thinners, thickeners,
and purifiers)
$
,000.00
32599803
7. All basic organic and inorganic chemicals, excluding petrochemicals
$
,000.00
32518000
8. Petroleum lubricating oil and greases, including hydraulic oils
$
,000.00
32419100
9. Refined petroleum products, including coke, solvents, oils, and waxes
$
,000.00
32411000
10. Nonmetallic minerals, including stone, sand, refractory minerals, and chemical
materials, excluding fertilizer materials
$
,000.00
21230000
2. Drill bits and reamers
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
33
1000 bbl
$
,000.00
21111201
1000 bbl
$
,000.00
21111103
mil ft3
$
,000.00
21111011
14. Water purchased
$
,000.00
00999828
15. All other supplies
$
,000.00
00970098
$
,000.00
11. Natural gas liquids received for further processing
12. Domestic crude petroleum
13. Natural gas processed
Describe
TOTAL
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77100000
34
Item 19: Fuels Used
ITEM 19: FUELS USED
Of the $,000.00 of purchased fuels in 2022, reported on Item 16, line A4, how much was for the following specified fuels?
Report:
Delivered cost of fuels received, not cost per unit. Delivered cost is the amount paid or payable after discounts, including freight and other direct charges incurred by the
domestic reporting unit in acquiring the fuels. Do not combine fuel lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Include:
Fuels purchased from other companies or transferred from other domestic reporting units of your company and used at this domestic reporting unit for the production of heat,
power, or generated electricity. The fuels transferred from other domestic reporting units of your company should be estimated at market value.
Cost of fuels not covered in the pre-listed fuel codes (Report these in fuel code 00960018 - "Other fuels".)
Unit of
Measure
Description
1. Diesel fuel
2. Gasoline used as a fuel
3. Gas (natural, manufactured, and mixed) used as a fuel
Quantity
Consumed
Cost, including delivery cost
(freight-in)
Census
Fuel Code
barrels
$
,000.00
32411021
1000 gal
$
,000.00
32411015
mil ft3
$
,000.00
21111015
$
,000.00
00960018
4. Other fuels (liquefied petroleum gas, coke, wood, etc.)
Describe
5. Crude petroleum produced and used in the same plant as a fuel
6. Natural gas produced and used in the same plant as a fuel
7. Residue gas produced and used at this plant as a fuel
TOTAL
1000 bbl
21111101
mil ft3
21111003
3
ft
21111029
mil
$
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
,000.00
00772000
35
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The mined products and services listed below are generally produced in your industry. They include products shipped and services performed by this domestic reporting unit. Select
the items that apply to your domestic reporting unit. If you mine products or have revenue from other sources not listed, you will report them in the next section.
Description
Select
1. Extraction of crude petroleum, including lease condensate (volumes corrected to 60 degrees F)
2. Extraction of natural gas (volumes adjusted to a pressure base of 14.73 lb absolute at 60 degrees F)
3. Extraction of residue gas (volumes adjusted to a pressure base of 14.73 lb absolute at 60 degrees F) from natural gas liquids
Product Code
1000350000
1000025000
1000050000
1000425000
4. Extraction of isopentane and natural gasoline
1000450000
5. Extraction of propane (C3) (at least 80 percent purity)
1000475000
6. Extraction of butane (C4) (at least 80 percent purity)
7. Extraction of plant condensate from natural gas liquids plants
1000500000
1000525000
8. Extraction of ethane (C2) (at least 80 percent purity)
9. Extraction of gas mixtures (C2, C3, and C4) from natural gas liquids plants
10. Extraction of other natural gas liquids, including raw or unfractionated natural gas liquid streams with less than 80 percent purity
1000550000
1000575000
1001100000
11. Recovered elemental sulfur from natural gas
1001600000
12. Oil and gas well directional drilling control
13. Drilling oil and gas wells, including drilling in, spudding in, or tailing in
1001625000
1001650000
14. Reworking oil and gas wells
15. Oil and gas field exploration services, excluding mapping and surveying services
1001675000
1001700000
16. Cementing oil and gas wells
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
36
1001725000
17. Oil and gas well logging
1001750000
18. Hydraulic fracturing of oil and gas wells
19. Running, cutting, and pulling casings, tubes, or rods for oil and gas wells
1001775000
1001800000
20. Oil and gas field gathering services
1001825000
21. Perforating oil and gas well casings
22. Installing oil and gas field production equipment, including wellhead fittings, pumps, and engines
1001850000
1001875000
23. Pumping oil and gas wells but not operating leases
1001900000
24. Other oil and gas field repair and maintenance services
1001925000
25. All other oil and gas field services
All other sales, shipments, receipts, or revenue from this domestic reporting unit
26. Wholesale sales of oil well and pipeline machinery and equipment
4002125000
4003325000
27. Wholesale sales of crude oil
28. Natural gas distribution and support services (except marketing and brokering)
29. Leasing of rights to explore for and exploit natural resources
30. Transportation of natural gas by pipeline, excluding gas field gathering services
31. Transportation of crude oil and other commodities by pipeline, excluding oil field gathering services
32. Scientific and technical consulting services, not elsewhere classified
6000030000
7010200000
7011150000
7011175000
7012270000
Add product/service not listed
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
37
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Report:
The value of the products shipped and services performed at the net selling value, free on board (FOB) quarry or plant to customer, after discounts or allowances.
Quantities in the unit of measure specified. Note: Short tons equal to 2,000 pounds.
Include:
All products mined, quarried, extracted, or leached from this domestic reporting unit
Material withdrawn from stockpiles, i.e. for leaching, sale, etc.
Products shipped on consignment
Prepared minerals from crude materials mined at this domestic reporting unit, purchased, or received from other domestic reporting units of your company
Concentrated ores, metals, and agglomerates from ores mined at this domestic reporting unit, or purchased or received from other domestic reporting units of your company
Estimated value of products treated on a custom or toll basis
Products transferred to other domestic reporting units of your company for treatment, preparation, milling, or other use
Bonuses or other credits for minerals contained, as well as royalties
Quantity of production of crude ore mined for treatment at this domestic reporting unit
Exclude:
Penalties for impurities
Wholesaling products (previously Resales), which include products that are bought from other domestic reporting units or transferred from other domestic reporting units of your
company and then sold without further treatment, processing, preparation, or milling by this domestic reporting unit. Report these products in the appropriate wholesaling
product line(s) you selected or else "Add product/service not listed" at the end of this item.
Freight charged
Excise taxes
Description
Quantity
Shipped
Unit of
Measure
Quantity
Produced
Unit of
Measure
Product
Code
Value
1. Extraction of crude petroleum, including
lease condensate (volumes corrected to
60 degrees F)
1000 bbl
$
,000.00
1000350000
2. Extraction of natural gas (volumes
adjusted to a pressure base of 14.73 lb
absolute at 60 degrees F)
mil ft3
$
,000.00
1000025000
3. Extraction of residue gas (volumes
adjusted to a pressure base of 14.73 lb
absolute at 60 degrees F) from natural
gas liquids
mil ft3
$
,000.00
1000050000
4. Extraction of isopentane and natural
gasoline
1000 bbl
1000 bbl
$
,000.00
1000425000
5. Extraction of propane (C3) (at least 80
percent purity)
1000 bbl
1000 bbl
$
,000.00
1000450000
6. Extraction of butane (C4) (at least 80
percent purity)
1000 bbl
1000 bbl
$
,000.00
1000475000
7. Extraction of plant condensate from
natural gas liquids plants
1000 bbl
1000 bbl
$
,000.00
1000500000
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
38
8. Extraction of ethane (C2) (at least 80
percent purity)
1000 bbl
1000 bbl
$
,000.00
1000525000
9. Extraction of gas mixtures (C2, C3, and
C4) from natural gas liquids plants
1000 bbl
1000 bbl
$
,000.00
1000550000
10. Extraction of other natural gas liquids,
including raw or unfractionated natural
gas liquid streams with less than 80
percent purity
1000 bbl
1000 bbl
$
,000.00
1000575000
11. Recovered elemental sulfur from natural
gas
$
,000.00
1001100000
12. Oil and gas well directional drilling
control
$
,000.00
1001600000
13. Drilling oil and gas wells, including
drilling in, spudding in, or tailing in
1000 ft
$
,000.00
1001625000
14. Reworking oil and gas wells
$
,000.00
1001650000
15. Oil and gas field exploration services,
excluding mapping and surveying
services
$
,000.00
1001675000
16. Cementing oil and gas wells
$
,000.00
1001700000
$
,000.00
1001725000
18. Hydraulic fracturing of oil and gas wells
$
,000.00
1001750000
19. Running, cutting, and pulling casings,
tubes, or rods for oil and gas wells
$
,000.00
1001775000
20. Oil and gas field gathering services
$
,000.00
1001800000
$
,000.00
1001825000
22. Installing oil and gas field production
equipment, including wellhead fittings,
pumps, and engines
$
,000.00
1001850000
23. Pumping oil and gas wells but not
operating leases
$
,000.00
1001875000
24. Other oil and gas field repair and
maintenance services
$
,000.00
1001900000
25. All other oil and gas field services
$
,000.00
1001925000
17. Oil and gas well logging
21. Perforating oil and gas well casings
All other sales, shipments, receipts, or revenue from this domestic reporting unit
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
39
26. Wholesale sales of oil well and pipeline
machinery and equipment
$
,000.00
4002125000
27. Wholesale sales of crude oil
$
,000.00
4003325000
28. Natural gas distribution and support
services (except marketing and
brokering)
$
,000.00
6000030000
29. Leasing of rights to explore for and
exploit natural resources
$
,000.00
7010200000
30. Transportation of natural gas by pipeline,
excluding gas field gathering services
$
,000.00
7011150000
31. Transportation of crude oil and other
commodities by pipeline, excluding oil
field gathering services
$
,000.00
7011175000
32. Scientific and technical consulting
services, not elsewhere classified
$
,000.00
7012270000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this domestic reporting unit a cooperative?
Yes
No
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Item 28: Special Items - Multiple Investors
ITEM 28: SPECIAL ITEMS - MULTIPLE INVESTORS
Does this location have multiple investors?
Yes
No
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Item 28: Special Items - Multiple Investors - Continued
ITEM 28: SPECIAL ITEMS - MULTIPLE INVESTORS
1. List each investor, their address, and their percentage of investment in 2022
Name
Street
City
ZIP Code
State
99999-9999
2022
.00%
2. List each investor, their address, and their percentage of investment in 2022
Name
Street
City
ZIP Code
State
99999-9999
2022
.00%
3. List each investor, their address, and their percentage of investment in 2022
Name
Street
City
State
ZIP Code
99999-9999
2022
.00%
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4. List each investor, their address, and their percentage of investment in 2022
Name
Street
City
ZIP Code
State
99999-9999
2022
.00%
5. List each investor, their address, and their percentage of investment in 2022
Name
Street
City
State
ZIP Code
99999-9999
2022
.00%
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44
Item 28: Special Items - Water Use
ITEM 28: SPECIAL ITEMS - WATER USE
1. What was this domestic reporting unit’s water intake in 2022, that is, the quantity of new water introduced into the domestic reporting unit for the first time, regardless of source or
quality?
Include water used in the production process and auxiliary operations (such as cooling and condensing, boiler feed, sanitary and domestic use). Report to the nearest thousand.
,000 gallons
2. Did this domestic reporting unit recirculate or reuse any water during 2022?
Yes
No
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Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s gross water use in 2022, that is, the quantity of water that would have been required if no water had been recirculated or reused?
For example, if total water intake was 500 million gallons and, of these 500 million gallons, 100 million gallons were used twice for cooling purposes and once for washing products or
materials, the total water required would be 300 million gallons, plus the 400 million gallons not recirculated, for a total of 700 million gallons of gross water use (less consumption and
evaporation loss). Report to the nearest thousand.
,000 gallons
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Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s main source of new water in 2022? Select only ONE.
Public water system includes water supplied by a water utility (whether municipally- or privately-owned) whose primary purpose is the supply of water to the general public and/or
industrial users. Self-supplied water systems include water obtained by this domestic reporting unit through its own system of pumps, pipes, hoses, etc. Also include here water obtained
from another company that is not primarily a water utility.
Public water system (municipally- or privately-owned utility)
Self-supplied surface water system (rivers, streams, lakes)
Self-supplied ground water system (wells, deep springs)
Self-supplied tide water system (estuaries, bays, oceans)
Self-supplied mine water (underground mines, quarries, open pits, water produced with oil)
Other sources (e.g., rainwater, truck deliveries)
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Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
Which of the following types of water was mainly supplied by the public water system? Select only ONE.
Potable
Reclaimed wastewater
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48
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this domestic reporting unit sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this domestic reporting unit purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this domestic reporting unit use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as
registering for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this domestic reporting unit use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this domestic reporting unit use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this domestic reporting unit use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into standalone stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this domestic reporting unit use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
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51
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
Yes
No
Do not know
6. In 2022, did this domestic reporting unit use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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52
Item 29: Business Technologies - Touchscreens/Kiosks for customer interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this domestic reporting unit acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
53
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this domestic reporting unit acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
54
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this domestic reporting unit acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
55
Item 29: Business Technologies - Industrial Robots
ITEM 29 BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this domestic reporting unit acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
56
Item 29: Business Technologies - Service Robots
ITEM 29 BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this domestic reporting unit acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
57
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this domestic reporting unit acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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58
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
1000
characters remaining
59
Item 32: Number of Domestic Reporting Units - Domestic Reporting Unit Information
ITEM 32: NUMBER OF DOMESTIC REPORTING UNITS - DOMESTIC REPORTING UNIT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MI-21110_su.pdf Generated 2022-02-23 16:18:55
,000.00
60
Location Information
DEFINITION OF DOMESTIC REPORTING UNIT
The reporting unit for this questionnaire is a mineral domestic reporting unit which is a location where mineral operations are performed. It represents a working or group of workings at
a given locality in which operations are conducted as a unit or are unified by common management or joint handling of some parts of the mining or concentration process.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
LEGAL BOUNDARY AND MUNICIPALITY
Is this domestic reporting unit physically located inside the legal boundaries of the city, town, village, etc.?
Yes
No
No legal boundaries
Do not know
In what type of municipality is this domestic reporting unit physically located?
City, village, or borough
Town or township
Other
Do not know
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this domestic reporting unit's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this domestic reporting unit’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Domestic Reporting Units
ITEM 2F: NUMBER OF DOMESTIC REPORTING UNITS
2022
How many domestic reporting units operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this domestic reporting unit's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
11
Item 3A: Operational Status - Ceased Operation Date
If this domestic reporting unit ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
If this domestic reporting unit was sold or leased to another operator, what is the name, address, and 9-digit Employer Identification Number (EIN) of this domestic reporting unit's new
owner or operator?
Name of new owner/operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
14
Item 4A: Primary Business or Activity
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this domestic reporting unit's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the domestic reporting unit's
primary business or activity.
Select only ONE.
Gold ore mining
212221 001
Silver ore mining
212222 001
Copper, nickel, lead, and zinc mining
212230 001
Uranium-radium-vanadium ore mining
212291 001
Iron ore mining
212210 001
All other metal ore mining
212299 001
Support activities for metal mining, e.g., sinking mine shafts and driving mine tunnels services, overburden stripping, etc.
213114 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
15
Item 4B: Type of Operation
ITEM 4B: TYPE OF OPERATION
What type(s) of operation occurred at this domestic reporting unit?
If mine is under development or exploration, or maintenance is being performed, indicate method most likely to be used when production is started or resumed.
Include:
Production, development, and exploration operations
A. What mining methods are used at this domestic reporting unit?
(Check ALL that apply.)
440
Surface (including open-pit, strip-pit, dredge, quarry, auger)
444
Underground
450
Other (including culm or silt bank, in-situ, well, brine well)
432
No mine or quarry or abandoned mine or quarry
B. What processing and/or treatment methods are used at this domestic reporting unit?
(Check ALL that apply.)
470
Agglomeration, concentration, or other treatment methods
474
Crushing, grinding, washing, evaporation, drying, calcining, flotation, air separation, expanding, sizing, screening, sawing,
turning, planing, etc.
468
No processing or treatment methods
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
2036
,000.00
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations (domestic reporting units) operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the domestic reporting unit listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each domestic reporting unit individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
18
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What was the total value of products shipped and other receipts for this domestic reporting unit?
(Report details in Item 22.)
Include:
All products physically shipped during 2022
Receipts for services
Value of resales
Interplant transfers
Exports
Other miscellaneous receipts
Exclude:
Non-operating income such as royalties, interest, dividends, or the sale of fixed assets
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
$
,000.00
B. What was the value of products shipped for export for this domestic reporting unit?
(This is a breakout of the $,000.00 reported in A.)
Include:
Shipments going directly for export including shipments to foreign subsidiaries or foreign divisions of your
company and their affiliates:
Shipments to customers in the Panama Canal Zone, the Commonwealth of Puerto Rico, and U.S.
possessions
Shipments of your products to export firms and to other customers who export these items
Sales to the U.S. government to be shipped to foreign nations under military and economic assistance
programs
Exclude:
Sales to the U.S. Government overseas
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19
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941, Employer's Quarterly Federal
Tax Return, and filed under the Employer Identification Number (EIN)
Persons on paid sick leave, paid holidays, and paid vacations during the year
Officers, if a corporation
Persons at a general office serving two or more plants if located at or near this domestic reporting unit
Employees paid on a per ton, car, or yard basis
Exclude:
Members of the Armed Forces and pensioners carried on your active payrolls
Proprietor or partners, if an unincorporated concern
Workers at manufacturing plants (including petroleum refineries), company stores, boardinghouses, bunkhouses, recreational centers, and auxiliary offices
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report these values in Item 16, line C1.)
Temporary staffing obtained from a staffing service (Report these values in Item 16, line C1.)
Purchased professional and technical services (Report these values in Item 16, line C9.)
Contractors and subcontractors and their employees (Report the cost of contract work in Item 16,line A3.)
A. EMPLOYMENT
1. What was the number of mining, production, development, and exploration workers (direct labor including
first-line supervisors) at this domestic reporting unit for the pay period including March 12 (Q1)?
Include:
Workers engaged in services closely associated with production and development operations such as:
Manual work
Tool use and machine operation
Materials and products, loading and hauling
Mineral properties care
Exploration and development work
Storage, shipping, maintenances, repair, and guard services
Auxiliary production for own use (i.e. power plant) record keeping
Regular maintenance and repair
Drilling and maintaining wells
Seismic testing or cementing walls
Exclude:
Supervisory employees above the first-line level (Report these in A2.)
Employees of contractors or subcontractors
Check
if
None
2022 Number
2. What was the number of other employees at this domestic reporting unit for the pay period including March 12
(Q1)?
Include:
Force-account construction employees and your payroll engaged in construction of major additions or
alterations to your facilities that are utilized as a separate work force
Nonproduction personnel engaged in supervision above the working supervisor level and employees
engaged in activities such as:
Sales, advertising, purchasing, finance
Highway trucking and other transportation
Credit, collection, executive, legal, clerical, and routine office functions
Personnel including cafeteria, medical, etc.
Professional (engineers, geologists, etc.) and technical workers
Exclude:
Proprietors and partners
Temporary staff and leased employees
Employees of contractors or subcontractors
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
20
TOTAL (Add lines A1 and A2.)
B. HOURS WORKED
What was the annual number of hours worked by the mining, production, development, and exploration workers
(direct labor including first-line supervisors) at this domestic reporting unit reported in A1?
Include:
All hours worked or paid (except hours paid for vacations, holidays, or sick leave)
Overtime hours (Report actual hours worked, not straight-time equivalent hours.)
Actual hours worked by an employee who elects to work during a vacation period
All hours worked for the entire year by a full and part-time mining, production, development, and
exploration workers of the type reported in A1
Exclude:
Hours of proprietors or partners
Hours worked by temporary staff or leased employees
Hours worked by employees of contractors or subcontractors
Check
if
None
2022 Hours
,000
C. PAYROLL
Report the gross earnings paid in calendar year 2022 to employees prior to such deductions as employee’s Social Security contributions, withholding taxes, group insurance
premiums, union dues, and savings bonds.
Payroll should equal the taxable Medicare wages and tips reported on the Internal Revenue Services (IRS) Form 941, Employer’s Quarterly Tax Return and definitions as described in
Circular E, Employer’s Tax Guide.
Include:
Commissions, dismissal pay and paid bonuses
Employee contributions to pension plans such as a 401(k) plan
Vacation and sick-leave pay
Salaries of officers
Spread on stock options that are taxable to employee as wages
Cash equivalent of compensation paid in kind such as:
Board and housing
Payments in the form of shared profits and special stock purchases that are subject to withholding tax
Exclude:
Payroll for temporary staff and leased employees
Payments to proprietor or partners
Payments to members of Armed Forces and pensioners carried on your active payroll
Royalty payments to unions
Payments to contract or subcontractors who performed work for you
Employer-paid annual cost for fringe benefits (Report these costs in D1 through D3.)
Check
if
None
2022
1. What was the annual payroll before deductions for mining, production, development, and exploration workers
(direct labor including first-line supervisors) of the type reported in A1 at this domestic reporting unit?
$
,000.00
2. What was the annual payroll before deductions for all other employees of the type reported in A2 at this domestic
reporting unit?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $,000.00 reported above, what was the first quarter payroll at this domestic reporting unit before
deductions (January - March 2022)?
$
,000.00
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
21
Item 7: Employment and Payroll - Continued
ITEM 7: EMPLOYMENT AND PAYROLL
D. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS
This is the employer’s annual cost at this domestic reporting unit for legally required programs and programs not required by law.
1. What were the employer’s annual costs at this domestic reporting unit for health insurance? (insurance premiums on
hospitals, medical plans, and single service plans such as dental, vision, and prescription drug plans)
Include:
Premium equivalents for self-insured plans and fees paid to third-party administrators (TPAs)
Exclude:
Employee contributions
Disbursements from trusts or funds to satisfy health insurance claims
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Retirement plans:
a. What were the employer’s annual costs at this domestic reporting unit for defined benefit pension plans? (Costs
include both qualified and nonqualified defined pension plans, as well as plans that specify the benefit to be
paid to employee upon retirement, generally either as a specified amount or a percentage of compensation.
Employer contributions are based on actuarial computations that include the employee's compensation and years
of service and are not allocated to specific accounts maintained for employees.)
b. What were the employer’s annual costs at this domestic reporting unit for defined contribution plans? (These
are 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)
3. What were the employer’s annual costs at this domestic reporting unit for employer-paid payroll taxes, insurance
premiums, and all other employer-paid benefits?
Include:
Life insurance benefits
“Quality of life” benefits (e.g., childcare assistance, subsidized commuting, etc.)
Education assistance
Legally-required fringe benefits
Social Security
Workers' compensation insurance
Unemployment tax
State disability insurance programs (long- and short-term disability – LTD and STD)
Medicare
Exclude:
Disbursements from trusts or funds to satisfy health insurance claims
TOTAL (Add lines D1 through D3.)
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22
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
23
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES
Report inventories at cost or market using generally accepted accounting practices. Report the value of all inventories that are attributable to the domestic reporting unit’s operations
regardless of where the inventories are held or stored.
What was the value of inventories for mined products and supplies owned by this domestic reporting unit as of December 31 before Last-In, First-Out (LIFO) adjustment (if any)
for:
A. Mined or quarried products?
Include:
Stocks of raw products awaiting treatment or
preparation
Stockpiles of products (raw, prepared minerals, or
quarried products) ready for shipment
Check
if
None
Check
if
None
2022
2021
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
B. Materials, parts, supplies, fuels, etc.?
Include:
Stockpiles of minerals received from other reporting
units for further processing
Cost of items to be used for extracting and
beneficiating
TOTAL (Add lines A and B.)
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
24
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this domestic reporting unit as of December 31, 2022 and the $,000.00 reported in Item 9 as the total
value of inventories owned by this domestic reporting unit as of December 31, 2021:
Check
if
None
Check
if
None
2022
2021
A. What was the amount subject to Last-In, First-Out (LIFO)
gross (gross LIFO amount)?
$
,000.00
$
,000.00
B. What was the amount not subject to LIFO valuation
method?
$
,000.00
$
,000.00
TOTAL (Sum of lines A and B should equal TOTAL in Item
9.)
$
,000.00
$
,000.00
C. What was the amount of LIFO reserve (if any)? [LIFO
reserve represents the excess of current period cost over
the LIFO carrying value. LIFO reserve is the difference
between the current cost (i.e., FIFO) of inventories (gross
value) and the LIFO carrying value (net value).]
$
,000.00
$
,000.00
Describe
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25
Item 13: Capital Expenditures
ITEM 13: CAPITAL EXPENDITURES
Report the actual outlays during 2022, not the final value of buildings or other structures completed or equipment put in place during the year. These expenditures are of the type for which
depreciation or amortization accounts are ordinarily maintained.
Capital expenditures during 2022 may be determined by the following computation:
(a) Cost of additions completed during the year, plus
(b) Work-in-progress at the end of the year, minus
(c) Work-in-progress at the beginning of the year.
Include labor and installation costs whether on contract or by your own forces
Exclude the cost of maintenance and repairs charged as current operating expense
A. What were the capital expenditures for new and used buildings, structures, machinery, and equipment for this domestic
reporting unit?
Include:
Buildings and structures directly related to mineral exploration, development, and production
Machinery, such as hoists, cranes, crushers, separators, and power plants
Exploration, development, production, and processing plant machinery
Value of the equipment produced and used
All mining loading, transportation, and similar equipment for use at mines
Equipment such as excavators, loaders, locomotives, tractors, hoists, drills, compressors, pumps
Transportation equipment, such as automobiles, trucks, and similar equipment
Office equipment, such as computers and peripheral data processing equipment, as well as furniture and fixtures
for offices, cafeterias, and change rooms
Replacements as well as additions to new capacity
Values from construction by your own employees, where capitalized
Value of improvements and capitalized repairs to machinery and equipment including those done to assets
transferred from other domestic reporting units of this company
Expenditures for old or existing plants and for second-hand equipment acquired from others (including U.S.
Government)
Gross book value of machinery or equipment transferred from other domestic reporting units of your company
Exclude:
Company houses and general recreational facilities
Value of land
Cost of maintenance and repairs charged as current operating expense
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. What were the capital expenditures for mineral exploration and development for this domestic reporting unit?
Include:
All intangible development and exploration outlays that were charged to a capital or Office of Minerals Exploration
account
Capitalized expenditures for entries, shafts, rail and other road construction, test boring, surveying, etc.
C. What were the capital expenditures for mineral land and rights for this domestic reporting unit?
Include:
All capital expenditures for acquiring either undeveloped or developed acreage
Capitalized lease bonuses and any other outlays necessary to acquire leases, mineral rights, and fee lands
incident to mineral exploration, development, or production
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
26
$
TOTAL (Add lines A through C.)
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
,000.00
27
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS
Report rental payments made to other companies for use of depreciable assets such as buildings, other structures, machinery, and equipment. Include rental payments for land.
Domestic reporting units involved with leasing arrangements for equipment and/or buildings, report lease equipment according to the type of lease negotiated with the producer or the
lessor.
Include:
Operating leases (Report the periodic payments made to the producer or lessor.)
Exclude:
Capital leases (leases with a contract to own at the end of the lease) (Report cost, at market value, of acquisitions of building and equipment during the year as a capital
expenditure, Item 13.)
At this domestic reporting unit, what were the payments for:
A. Rental or lease of buildings and other structures?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. Rental or lease of machinery and equipment?
Include:
Production machinery and equipment
Loading machinery and equipment
Transportation machinery and equipment
Construction equipment
Tools
Office equipment
Furniture
Vehicles
TOTAL (Add lines A and B.)
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
28
Item 15: Mineral Property Expenses
ITEM 15: MINERAL PROPERTY EXPENSES
Report mineral property expenses charged to current accounts.
Check
if
None
A. What were the lease rents for mineral properties for this domestic reporting unit?
2022
$
,000.00
B. Current Operation Expenses
Include:
Acquisition costs for mineral land and rights that were not capitalized
Cost of royalty payments related to mineral production
Labor costs whether on a contract basis or by your own forces associated with exploration and development or the acquisition of mineral properties
Intangible development and exploration outlays charged to a current account
Expenses for mineral properties charged to current accounts, such as:
all supplies, machinery, equipment, parts, fuel, power, etc., used for development or exploration (whether purchased or received from other domestic reporting units of
your company) and charged as current operating expenses
cost of maintenance and repairs associated with development or exploration activity that is charged to current accounts
Exclude:
Lease rents (Report separately in A.)
1. What were the current operating expenses for exploration, development, and mineral land and rights for this
domestic reporting unit?
$
,000.00
2. What were the current operating expenses for royalty payments for this domestic reporting unit?
$
,000.00
TOTAL (Add lines B1 and B2.)
$
,000.00
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29
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
SELECTED EXTRACTION/MINING/QUARRYING COSTS AND ELECTRICITY
Include costs incurred in mining processes such as supplies, resales, contract work, fuels, and electricity.
A. What were the extraction/mining/quarrying-related costs in 2022 for this domestic reporting unit for:
1. Materials, parts, and supplies used; and minerals received for preparation? (Report detail in Item 18.)
Include:
Cost of extraction/mining/quarrying-related materials purchased for other companies (contractors)
Cost of materials purchased or received from other domestic reporting units of your company
Exclude:
Non-extraction/mining/quarrying-related expenses that were paid to other companies (Report these
expense details in C.)
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Products bought and sold without further processing (products bought and resold in the same condition as when
purchased)? (Report these sales in Wholesaling Services product codes in Item 22.)
Exclude:
oil, gas or natural gas liquids (if applicable)
3. Work done for you by others on your materials (work contracted to others)? [Report in A1 the materials, parts, and
supplies purchased for other companies (contractors).]
4. Purchased fuels consumed for heat, power, or the generation of electricity? (Report detail in Item 19.)
Report the total amount actually paid or payable for all purchased fuels consumed.
Include:
Fuels or coal consumed at this domestic reporting unit, but produced at another domestic reporting unit of
your company (Assign commercial values to them.)
Fuel used to power on-site trucks, forklifts, or motor vehicles
Anthracite, lignite, bituminous, and subbituminous coal, coke, natural and manufactured gas, gasoline,
wood, purchased steam, and all other fuels
Exclude:
Gas purchased for gas lift
Crude petroleum, natural gas, and coal produced at the domestic reporting unit and used for heat, power,
or the generation of electricity
5. Purchased electricity? (Report comparable quantity in B1.)
Report total amount actually paid or payable for electric energy purchased during 2022 from other companies or
received from other domestic reporting units of your company.
Exclude value of electricity generated and used at this domestic reporting unit
TOTAL (Add lines A1 through A5.)
B. For this domestic reporting unit, what was the quantity of:
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30
Check
if
None
1. Purchased electricity? (quantity comparable to cost reported in A5)
2022 Kilowatt Hours
,000
2. Generated electricity? (gross less generating station use)
When a figure is reported on this line, include data relating to the activity of the power stations in other sections of
this questionnaire. For example, include the number of employees assigned to the power station, their wages, and
hours worked in the figures reported in Item 7 and the cost of fuels used to generate electricity, in Item 16, line A4
and Item 18.
Include energy generated at the drilling site that was used for lighting or other purposes.
3. Electricity sold or transferred to other domestic reporting units? (Also include quantity in B1 and/or B2.)
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
,000
,000
31
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
OTHER OPERATING EXPENSES
C. What were the other operating expenses paid by this domestic reporting unit in 2022 for:
Include:
Costs for each of these services purchased from other companies that are paid directly by this domestic reporting unit
Expenses normally considered nonproduction related costs
Exclude:
Salaries paid to employees of this domestic reporting unit for any of the specified services (Report in Item 7.)
Cost of mining activities contracted or subcontracted to others (Report on A3.)
1. Temporary staff and leased employees? [total costs paid to Professional Employer Organizations (PEOs) and
staffing agencies for personnel]
Include:
All charges for payroll, benefits, and services
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report in 3.)
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
4. Purchased communication services?
Include:
Telephone, cellular, and fax services
Computer-related communications (e.g., Internet, connectivity, online)
Credit card transaction fees
Other wired and wireless communication services
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32
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
Exclude:
Services provided by other domestic reporting units of this company (such as a separate central data
processing unit)
Expensed integrated systems (Report in 4.)
Repair and maintenance of computer equipment (Report in 6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in 9 and credit card
transaction fees in 4.)
Expenses for telecommunication services, e.g., Internet, connectivity, telephone, etc. (Report in 4.)
$
,000.00
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof, replacing parts, over-hauling of equipment, and other repairs chargeable as
current operating costs
Cost of repair and maintenance of any leased property if the domestic reporting unit assumes the cost
Exclude:
Materials, parts, and supplies used for repairs and maintenance performed by this domestic reporting unit’s
employees (Report in A1.)
Extensive “repairs” or reconstruction that is capitalized (Report these as a capital expenditure in Item 13.)
Costs incurred directly by this domestic reporting unit in using its own work force to perform repairs and
maintenance work
Repairs and maintenance provided by the building or machinery owner as part of the rental contract
7. Water, sewer, refuse removal, and other non-electric utility payments? (Report electric utility payments on line
A5. If the cost of these utilities is included in a lease or rental payment, report in Item 14 line A.)
Include:
Cost of hazardous waste removal
8. Purchased advertising and promotional services?
Include:
Printed materials
Media coverage
Marketing and public relations services
Exclude:
All salaries paid to employees of the domestic reporting unit for advertising work
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33
9. Purchased professional and technical services?
Include:
Management consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll processing
Architectural
Engineering
Other professional services
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
$
,000.00
10. Governmental taxes and licensing fees? (payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
11. All other operating expenses not reported elsewhere?
Exclude:
Purchases of merchandise for resale (Report on line A2.)
Non-operating expenses
Describe
TOTAL (Add lines C1 through C11.)
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34
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
Report:
Delivered cost of individual items listed below. Delivered cost is the amount paid or payable after discounts and including freight and other direct charges incurred by the
domestic reporting unit in acquiring the materials. The figures reported should represent the total purchase cost of supplies, minerals received for preparation, etc., actually used
or processed during 2022. Include purchases, interplant transfers, and withdrawals from inventories. Do not combine material lines. If the information is not directly available
from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Estimated quantity and cost of minerals received for processing on a custom or toll basis, as if purchased.
Minerals mined and also processed at this domestic reporting unit.
Include:
Minerals received from other domestic reporting units for preparation which were used or processed during 2022
Cost of materials and supplies not covered in the pre-listed material codes (Report these in material code 00970098 - "All other supplies".)
Supplies purchased by this domestic reporting unit for use by companies performing contract work at this domestic reporting unit
Exclude:
Associated labor costs of the kind reported in Item 7 and Item 16, line A3
Payments made for contract services performed, including payments for supplies and equipment furnished by the contractor incidental to this work
Unit of
Measure
Description
Quantity
Census
Material
Code
Value
1. Parts and attachments for mining, mineral preparation, construction, and
conveying machinery and equipment
$
,000.00
33300009
2. Explosive materials, including ammonium nitrate, and blasting accessories
$
,000.00
32592000
3. Lime, including quicklime and hydrated lime and dead-burned dolomite
$
,000.00
32741001
4. Tires and inner tubes
$
,000.00
32621100
5. All basic organic and inorganic chemicals, excluding petrochemicals
$
,000.00
32518000
$
,000.00
21220001
$
,000.00
00970098
6. Crude ore and residues received for concentration, excluding placer operations
short tons
7. All other supplies
Describe
8. Crude ore and residues mined and concentrated at same domestic reporting unit
and material processed in placer operations
short tons
21220002
$
TOTAL
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
,000.00
77100000
35
Item 19: Fuels Used
ITEM 19: FUELS USED
Of the $,000.00 of purchased fuels in 2022, reported on Item 16, line A4, how much was for the following specified fuels?
Report:
Delivered cost of fuels received, not cost per unit. Delivered cost is the amount paid or payable after discounts, including freight and other direct charges incurred by the
domestic reporting unit in acquiring the fuels. Do not combine fuel lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Include:
Fuels purchased from other companies or transferred from other domestic reporting units of your company and used at this domestic reporting unit for the production of heat,
power, or generated electricity. The fuels transferred from other domestic reporting units of your company should be estimated at market value.
Cost of fuels not covered in the pre-listed fuel codes (Report these in fuel code 00960018 - "Other fuels".)
Unit of
Measure
Description
1. Diesel fuel
2. Gasoline used as a fuel
3. Gas (natural, manufactured, and mixed) used as a fuel
4. Other fuels (liquefied petroleum gas, coke, wood, etc.)
Quantity
Consumed
Cost, including delivery cost
(freight-in)
Census
Fuel Code
barrels
$
,000.00
32411021
1000 gal
$
,000.00
32411015
mil ft3
$
,000.00
21111015
$
,000.00
00960018
$
,000.00
00772000
Describe
TOTAL
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
36
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The mined products and services listed below are generally produced in your industry. They include products shipped and services performed by this domestic reporting unit. Select
the items that apply to your domestic reporting unit. If you mine products or have revenue from other sources not listed, you will report them in the next section.
Description
Select
Product Code
1001200000
1. Mining of gold ore
1001225000
2. Mining of silver ore
1001250000
3. Mining of lead ore and zinc ore
1001275000
4. Mining of copper ore and nickel ore
5. Mining of crude ferroalloy ores and concentrates, including manganese and manganiferous ores, chromium, molybdenum, tungsten,
etc.
1001325000
6. Mining of miscellaneous metal ores and concentrates, including antimony, bauxite, beryllium, mercury, rare-earth metals, tin, and
titanium
1001350000
7. Metal mining exploration work, excluding prospect services, test drilling, and geophysical surveying services
1002025000
1002050000
8. Open-pit metal ores mining not for your own account
1002075000
9. Metal mining prospect services and test drilling services
10. Sinking metal mine shafts and driving metal mine tunnels services
11. Other metal mining services, including overburden stripping and repair and maintenance services
1002100000
1002125000
All other sales, shipments, receipts, or revenue from this domestic reporting unit
12. Wholesale sales of ores, except coal, gemstones, and crude oil
4003575000
Add product/service not listed
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
37
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Report:
The value of the products shipped and services performed at the net selling value, free on board (FOB) quarry or plant to customer, after discounts or allowances.
Quantities in the unit of measure specified. Note: Short tons equal to 2,000 pounds.
Include:
All products mined, quarried, extracted, or leached from this domestic reporting unit
Material withdrawn from stockpiles, i.e. for leaching, sale, etc.
Products shipped on consignment
Prepared minerals from crude materials mined at this domestic reporting unit, purchased, or received from other domestic reporting units of your company
Concentrated ores, metals, and agglomerates from ores mined at this domestic reporting unit, or purchased or received from other domestic reporting units of your company
Estimated value of products treated on a custom or toll basis
Products transferred to other domestic reporting units of your company for treatment, preparation, milling, or other use
Bonuses or other credits for minerals contained, as well as royalties
Quantity of production of crude ore mined for treatment at this domestic reporting unit
Exclude:
Penalties for impurities
Wholesaling products (previously Resales), which include products that are bought from other domestic reporting units or transferred from other domestic reporting units of your
company and then sold without further treatment, processing, preparation, or milling by this domestic reporting unit. Report these products in the appropriate wholesaling
product line(s) you selected or else "Add product/service not listed" at the end of this item.
Freight charged
Excise taxes
Description
1. Mining of gold ore
2. Mining of silver ore
3. Mining of lead ore and zinc ore
4. Mining of copper ore and nickel ore
Quantity
Shipped
Unit of
Measure
Quantity
Produced
Unit of
Measure
Product
Code
Value
troy ounces
troy ounces
$
,000.00
1001200000
troy ounces
troy ounces
$
,000.00
1001225000
1000 lb
1000 lb
$
,000.00
1001250000
1000 lb
1000 lb
$
,000.00
1001275000
5. Mining of crude ferroalloy ores and
concentrates, including manganese and
manganiferous ores, chromium,
molybdenum, tungsten, etc.
$
,000.00
1001325000
6. Mining of miscellaneous metal ores and
concentrates, including antimony, bauxite,
beryllium, mercury, rare-earth metals, tin,
and titanium
$
,000.00
1001350000
7. Metal mining exploration work, excluding
prospect services, test drilling, and
geophysical surveying services
$
,000.00
1002025000
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
38
8. Open-pit metal ores mining not for your
own account
$
,000.00
1002050000
9. Metal mining prospect services and test
drilling services
$
,000.00
1002075000
10. Sinking metal mine shafts and driving
metal mine tunnels services
$
,000.00
1002100000
11. Other metal mining services, including
overburden stripping and repair and
maintenance services
$
,000.00
1002125000
$
,000.00
4003575000
All other sales, shipments, receipts, or revenue from this domestic reporting unit
12. Wholesale sales of ores, except coal,
gemstones, and crude oil
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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39
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this domestic reporting unit a cooperative?
Yes
No
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Item 28: Special Items - Metal Content
ITEM 28: SPECIAL ITEMS - METAL CONTENT
Report metal content of production where both production and shipments are reported. Quantities of metals contained based on an assay content of ores reported.
1. Gold
Quantities of metals contained based on an
assay content of ores reported in Item 22
Fine troy ounces
a. Gold
b. Silver
Fine troy ounces
c. Lead/Zinc
Thousand pounds
d. Copper/Nickel
Thousand pounds
2. Silver
Fine troy ounces
a. Silver
Thousand pounds
b. Copper/Nickel
Thousand pounds
c. Lead/Zinc
Fine troy ounces
d. Gold
3. Lead/Zinc
Thousand pounds
a. Lead/Zinc
Fine troy ounces
b. Silver
Fine troy ounces
c. Gold
Thousand pounds
d. Copper/Nickel
4. Copper/Nickel
a. Copper/Nickel
Thousand pounds
b. Silver
Fine troy ounces
c. Lead/Zinc
Thousand pounds
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
41
Fine troy ounces
d. Gold
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42
Item 28: Special Items - Water Use
ITEM 28: SPECIAL ITEMS - WATER USE
1. What was this domestic reporting unit’s water intake in 2022, that is, the quantity of new water introduced into the domestic reporting unit for the first time, regardless of source or
quality?
Include water used in the production process and auxiliary operations (such as cooling and condensing, boiler feed, sanitary and domestic use). Report to the nearest thousand.
,000 gallons
2. Did this domestic reporting unit recirculate or reuse any water during 2022?
Yes
No
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43
Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s gross water use in 2022, that is, the quantity of water that would have been required if no water had been recirculated or reused?
For example, if total water intake was 500 million gallons and, of these 500 million gallons, 100 million gallons were used twice for cooling purposes and once for washing products or
materials, the total water required would be 300 million gallons, plus the 400 million gallons not recirculated, for a total of 700 million gallons of gross water use (less consumption and
evaporation loss). Report to the nearest thousand.
,000 gallons
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44
Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s main source of new water in 2022? Select only ONE.
Public water system includes water supplied by a water utility (whether municipally- or privately-owned) whose primary purpose is the supply of water to the general public and/or
industrial users. Self-supplied water systems include water obtained by this domestic reporting unit through its own system of pumps, pipes, hoses, etc. Also include here water obtained
from another company that is not primarily a water utility.
Public water system (municipally- or privately-owned utility)
Self-supplied surface water system (rivers, streams, lakes)
Self-supplied ground water system (wells, deep springs)
Self-supplied tide water system (estuaries, bays, oceans)
Self-supplied mine water (underground mines, quarries, open pits, water produced with oil)
Other sources (e.g., rainwater, truck deliveries)
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Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
Which of the following types of water was mainly supplied by the public water system? Select only ONE.
Potable
Reclaimed wastewater
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46
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this domestic reporting unit sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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47
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this domestic reporting unit purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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48
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this domestic reporting unit use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as
registering for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this domestic reporting unit use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this domestic reporting unit use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this domestic reporting unit use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into standalone stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this domestic reporting unit use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
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49
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
Yes
No
Do not know
6. In 2022, did this domestic reporting unit use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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50
Item 29: Business Technologies - Touchscreens/Kiosks for customer interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this domestic reporting unit acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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51
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this domestic reporting unit acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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52
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this domestic reporting unit acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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53
Item 29: Business Technologies - Industrial Robots
ITEM 29 BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this domestic reporting unit acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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54
Item 29: Business Technologies - Service Robots
ITEM 29 BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this domestic reporting unit acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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55
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this domestic reporting unit acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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56
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
1000
characters remaining
57
Item 32: Number of Domestic Reporting Units - Domestic Reporting Unit Information
ITEM 32: NUMBER OF DOMESTIC REPORTING UNITS - DOMESTIC REPORTING UNIT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MI-21221_su.pdf Generated 2022-02-23 16:22:50
,000.00
58
Location Information
DEFINITION OF DOMESTIC REPORTING UNIT
The reporting unit for this questionnaire is a mineral domestic reporting unit which is a location where mineral operations are performed. It represents a working or group of workings at
a given locality in which operations are conducted as a unit or are unified by common management or joint handling of some parts of the mining or concentration process.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
LEGAL BOUNDARY AND MUNICIPALITY
Is this domestic reporting unit physically located inside the legal boundaries of the city, town, village, etc.?
Yes
No
No legal boundaries
Do not know
In what type of municipality is this domestic reporting unit physically located?
City, village, or borough
Town or township
Other
Do not know
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this domestic reporting unit's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this domestic reporting unit’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Domestic Reporting Units
ITEM 2F: NUMBER OF DOMESTIC REPORTING UNITS
2022
How many domestic reporting units operated under EIN at the end of 2022?
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this domestic reporting unit's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
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11
Item 3A: Operational Status - Ceased Operation Date
If this domestic reporting unit ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
If this domestic reporting unit was sold or leased to another operator, what is the name, address, and 9-digit Employer Identification Number (EIN) of this domestic reporting unit's new
owner or operator?
Name of new owner/operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4A: Primary Business or Activity
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this domestic reporting unit's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the domestic reporting unit's
primary business or activity.
Select only ONE.
Dimension stone mining and quarrying
212311 001
Crushed and broken limestone mining and quarrying
212312 001
Crushed and broken granite mining and quarrying
212313 001
Other crushed and broken stone mining and quarrying
212319 001
Construction sand and gravel mining
212321 001
Industrial sand mining
212322 001
Kaolin and ball clay mining
212324 001
Clay and ceramic and refractory minerals mining
212325 001
Potash, soda, and borate mineral mining
212391 001
Phosphate rock mining
212392 001
Other chemical and fertilizer mineral mining, including barite, rock salt, native sulfur, fluorspar, pyrites, spodumene, mineral pigments, etc.
212393 001
All other nonmetallic mineral mining
212399 001
Other primary business or activity
779000 001
Select Sector
Describe
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15
Item 4B: Type of Operation
ITEM 4B: TYPE OF OPERATION
What type(s) of operation occurred at this domestic reporting unit?
If mine is under development or exploration, or maintenance is being performed, indicate method most likely to be used when production is started or resumed.
Include:
Production, development, and exploration operations
A. What mining methods are used at this domestic reporting unit?
(Check ALL that apply.)
440
Surface (including open-pit, strip-pit, dredge, quarry, auger)
444
Underground
450
Other (including culm or silt bank, in-situ, well, brine well)
432
No mine or quarry or abandoned mine or quarry
B. What processing and/or treatment methods are used at this domestic reporting unit?
(Check ALL that apply.)
470
Agglomeration, concentration, or other treatment methods
474
Crushing, grinding, washing, evaporation, drying, calcining, flotation, air separation, expanding, sizing, screening, sawing,
turning, planing, etc.
468
No processing or treatment methods
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
2036
,000.00
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations (domestic reporting units) operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the domestic reporting unit listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each domestic reporting unit individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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18
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What was the total value of products shipped and other receipts for this domestic reporting unit?
(Report details in Item 22.)
Include:
All products physically shipped during 2022
Receipts for services
Value of resales
Interplant transfers
Exports
Other miscellaneous receipts
Exclude:
Non-operating income such as royalties, interest, dividends, or the sale of fixed assets
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
$
,000.00
B. What was the value of products shipped for export for this domestic reporting unit?
(This is a breakout of the $,000.00 reported in A.)
Include:
Shipments going directly for export including shipments to foreign subsidiaries or foreign divisions of your
company and their affiliates:
Shipments to customers in the Panama Canal Zone, the Commonwealth of Puerto Rico, and U.S.
possessions
Shipments of your products to export firms and to other customers who export these items
Sales to the U.S. government to be shipped to foreign nations under military and economic assistance
programs
Exclude:
Sales to the U.S. Government overseas
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
19
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941, Employer's Quarterly Federal
Tax Return, and filed under the Employer Identification Number (EIN)
Persons on paid sick leave, paid holidays, and paid vacations during the year
Officers, if a corporation
Persons at a general office serving two or more plants if located at or near this domestic reporting unit
Employees paid on a per ton, car, or yard basis
Exclude:
Members of the Armed Forces and pensioners carried on your active payrolls
Proprietor or partners, if an unincorporated concern
Workers at manufacturing plants (including petroleum refineries), company stores, boardinghouses, bunkhouses, recreational centers, and auxiliary offices
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report these values in Item 16, line C1.)
Temporary staffing obtained from a staffing service (Report these values in Item 16, line C1.)
Purchased professional and technical services (Report these values in Item 16, line C9.)
Contractors and subcontractors and their employees (Report the cost of contract work in Item 16,line A3.)
A. EMPLOYMENT
1. What was the number of mining, production, development, and exploration workers (direct labor including
first-line supervisors) at this domestic reporting unit for the pay period including March 12 (Q1)?
Include:
Workers engaged in services closely associated with production and development operations such as:
Manual work
Tool use and machine operation
Materials and products, loading and hauling
Mineral properties care
Exploration and development work
Storage, shipping, maintenances, repair, and guard services
Auxiliary production for own use (i.e. power plant) record keeping
Regular maintenance and repair
Drilling and maintaining wells
Seismic testing or cementing walls
Exclude:
Supervisory employees above the first-line level (Report these in A2.)
Employees of contractors or subcontractors
Check
if
None
2022 Number
2. What was the number of other employees at this domestic reporting unit for the pay period including March 12
(Q1)?
Include:
Force-account construction employees and your payroll engaged in construction of major additions or
alterations to your facilities that are utilized as a separate work force
Nonproduction personnel engaged in supervision above the working supervisor level and employees
engaged in activities such as:
Sales, advertising, purchasing, finance
Highway trucking and other transportation
Credit, collection, executive, legal, clerical, and routine office functions
Personnel including cafeteria, medical, etc.
Professional (engineers, geologists, etc.) and technical workers
Exclude:
Proprietors and partners
Temporary staff and leased employees
Employees of contractors or subcontractors
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
20
TOTAL (Add lines A1 and A2.)
B. HOURS WORKED
What was the annual number of hours worked by the mining, production, development, and exploration workers
(direct labor including first-line supervisors) at this domestic reporting unit reported in A1?
Include:
All hours worked or paid (except hours paid for vacations, holidays, or sick leave)
Overtime hours (Report actual hours worked, not straight-time equivalent hours.)
Actual hours worked by an employee who elects to work during a vacation period
All hours worked for the entire year by a full and part-time mining, production, development, and
exploration workers of the type reported in A1
Exclude:
Hours of proprietors or partners
Hours worked by temporary staff or leased employees
Hours worked by employees of contractors or subcontractors
Check
if
None
2022 Hours
,000
C. PAYROLL
Report the gross earnings paid in calendar year 2022 to employees prior to such deductions as employee’s Social Security contributions, withholding taxes, group insurance
premiums, union dues, and savings bonds.
Payroll should equal the taxable Medicare wages and tips reported on the Internal Revenue Services (IRS) Form 941, Employer’s Quarterly Tax Return and definitions as described in
Circular E, Employer’s Tax Guide.
Include:
Commissions, dismissal pay and paid bonuses
Employee contributions to pension plans such as a 401(k) plan
Vacation and sick-leave pay
Salaries of officers
Spread on stock options that are taxable to employee as wages
Cash equivalent of compensation paid in kind such as:
Board and housing
Payments in the form of shared profits and special stock purchases that are subject to withholding tax
Exclude:
Payroll for temporary staff and leased employees
Payments to proprietor or partners
Payments to members of Armed Forces and pensioners carried on your active payroll
Royalty payments to unions
Payments to contract or subcontractors who performed work for you
Employer-paid annual cost for fringe benefits (Report these costs in D1 through D3.)
Check
if
None
2022
1. What was the annual payroll before deductions for mining, production, development, and exploration workers
(direct labor including first-line supervisors) of the type reported in A1 at this domestic reporting unit?
$
,000.00
2. What was the annual payroll before deductions for all other employees of the type reported in A2 at this domestic
reporting unit?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $,000.00 reported above, what was the first quarter payroll at this domestic reporting unit before
deductions (January - March 2022)?
$
,000.00
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
21
Item 7: Employment and Payroll - Continued
ITEM 7: EMPLOYMENT AND PAYROLL
D. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS
This is the employer’s annual cost at this domestic reporting unit for legally required programs and programs not required by law.
1. What were the employer’s annual costs at this domestic reporting unit for health insurance? (insurance premiums on
hospitals, medical plans, and single service plans such as dental, vision, and prescription drug plans)
Include:
Premium equivalents for self-insured plans and fees paid to third-party administrators (TPAs)
Exclude:
Employee contributions
Disbursements from trusts or funds to satisfy health insurance claims
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Retirement plans:
a. What were the employer’s annual costs at this domestic reporting unit for defined benefit pension plans? (Costs
include both qualified and nonqualified defined pension plans, as well as plans that specify the benefit to be
paid to employee upon retirement, generally either as a specified amount or a percentage of compensation.
Employer contributions are based on actuarial computations that include the employee's compensation and years
of service and are not allocated to specific accounts maintained for employees.)
b. What were the employer’s annual costs at this domestic reporting unit for defined contribution plans? (These
are 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)
3. What were the employer’s annual costs at this domestic reporting unit for employer-paid payroll taxes, insurance
premiums, and all other employer-paid benefits?
Include:
Life insurance benefits
“Quality of life” benefits (e.g., childcare assistance, subsidized commuting, etc.)
Education assistance
Legally-required fringe benefits
Social Security
Workers' compensation insurance
Unemployment tax
State disability insurance programs (long- and short-term disability – LTD and STD)
Medicare
Exclude:
Disbursements from trusts or funds to satisfy health insurance claims
TOTAL (Add lines D1 through D3.)
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
22
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
23
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES
Report inventories at cost or market using generally accepted accounting practices. Report the value of all inventories that are attributable to the domestic reporting unit’s operations
regardless of where the inventories are held or stored.
What was the value of inventories for mined products and supplies owned by this domestic reporting unit as of December 31 before Last-In, First-Out (LIFO) adjustment (if any)
for:
A. Mined or quarried products?
Include:
Stocks of raw products awaiting treatment or
preparation
Stockpiles of products (raw, prepared minerals, or
quarried products) ready for shipment
Check
if
None
Check
if
None
2022
2021
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
B. Materials, parts, supplies, fuels, etc.?
Include:
Stockpiles of minerals received from other reporting
units for further processing
Cost of items to be used for extracting and
beneficiating
TOTAL (Add lines A and B.)
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
24
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this domestic reporting unit as of December 31, 2022 and the $,000.00 reported in Item 9 as the total
value of inventories owned by this domestic reporting unit as of December 31, 2021:
Check
if
None
Check
if
None
2022
2021
A. What was the amount subject to Last-In, First-Out (LIFO)
gross (gross LIFO amount)?
$
,000.00
$
,000.00
B. What was the amount not subject to LIFO valuation
method?
$
,000.00
$
,000.00
TOTAL (Sum of lines A and B should equal TOTAL in Item
9.)
$
,000.00
$
,000.00
C. What was the amount of LIFO reserve (if any)? [LIFO
reserve represents the excess of current period cost over
the LIFO carrying value. LIFO reserve is the difference
between the current cost (i.e., FIFO) of inventories (gross
value) and the LIFO carrying value (net value).]
$
,000.00
$
,000.00
Describe
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25
Item 13: Capital Expenditures
ITEM 13: CAPITAL EXPENDITURES
Report the actual outlays during 2022, not the final value of buildings or other structures completed or equipment put in place during the year. These expenditures are of the type for which
depreciation or amortization accounts are ordinarily maintained.
Capital expenditures during 2022 may be determined by the following computation:
(a) Cost of additions completed during the year, plus
(b) Work-in-progress at the end of the year, minus
(c) Work-in-progress at the beginning of the year.
Include labor and installation costs whether on contract or by your own forces
Exclude the cost of maintenance and repairs charged as current operating expense
A. What were the capital expenditures for new and used buildings, structures, machinery, and equipment for this domestic
reporting unit?
Include:
Buildings and structures directly related to mineral exploration, development, and production
Machinery, such as hoists, cranes, crushers, separators, and power plants
Exploration, development, production, and processing plant machinery
Value of the equipment produced and used
All mining loading, transportation, and similar equipment for use at mines
Equipment such as excavators, loaders, locomotives, tractors, hoists, drills, compressors, pumps
Transportation equipment, such as automobiles, trucks, and similar equipment
Office equipment, such as computers and peripheral data processing equipment, as well as furniture and fixtures
for offices, cafeterias, and change rooms
Replacements as well as additions to new capacity
Values from construction by your own employees, where capitalized
Value of improvements and capitalized repairs to machinery and equipment including those done to assets
transferred from other domestic reporting units of this company
Expenditures for old or existing plants and for second-hand equipment acquired from others (including U.S.
Government)
Gross book value of machinery or equipment transferred from other domestic reporting units of your company
Exclude:
Company houses and general recreational facilities
Value of land
Cost of maintenance and repairs charged as current operating expense
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. What were the capital expenditures for mineral exploration and development for this domestic reporting unit?
Include:
All intangible development and exploration outlays that were charged to a capital or Office of Minerals Exploration
account
Capitalized expenditures for entries, shafts, rail and other road construction, test boring, surveying, etc.
C. What were the capital expenditures for mineral land and rights for this domestic reporting unit?
Include:
All capital expenditures for acquiring either undeveloped or developed acreage
Capitalized lease bonuses and any other outlays necessary to acquire leases, mineral rights, and fee lands
incident to mineral exploration, development, or production
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
26
$
TOTAL (Add lines A through C.)
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
,000.00
27
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS
Report rental payments made to other companies for use of depreciable assets such as buildings, other structures, machinery, and equipment. Include rental payments for land.
Domestic reporting units involved with leasing arrangements for equipment and/or buildings, report lease equipment according to the type of lease negotiated with the producer or the
lessor.
Include:
Operating leases (Report the periodic payments made to the producer or lessor.)
Exclude:
Capital leases (leases with a contract to own at the end of the lease) (Report cost, at market value, of acquisitions of building and equipment during the year as a capital
expenditure, Item 13.)
At this domestic reporting unit, what were the payments for:
A. Rental or lease of buildings and other structures?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. Rental or lease of machinery and equipment?
Include:
Production machinery and equipment
Loading machinery and equipment
Transportation machinery and equipment
Construction equipment
Tools
Office equipment
Furniture
Vehicles
TOTAL (Add lines A and B.)
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
28
Item 15: Mineral Property Expenses
ITEM 15: MINERAL PROPERTY EXPENSES
Report mineral property expenses charged to current accounts.
Check
if
None
A. What were the lease rents for mineral properties for this domestic reporting unit?
2022
$
,000.00
B. Current Operation Expenses
Include:
Acquisition costs for mineral land and rights that were not capitalized
Cost of royalty payments related to mineral production
Labor costs whether on a contract basis or by your own forces associated with exploration and development or the acquisition of mineral properties
Intangible development and exploration outlays charged to a current account
Expenses for mineral properties charged to current accounts, such as:
all supplies, machinery, equipment, parts, fuel, power, etc., used for development or exploration (whether purchased or received from other domestic reporting units of
your company) and charged as current operating expenses
cost of maintenance and repairs associated with development or exploration activity that is charged to current accounts
Exclude:
Lease rents (Report separately in A.)
1. What were the current operating expenses for exploration, development, and mineral land and rights for this
domestic reporting unit?
$
,000.00
2. What were the current operating expenses for royalty payments for this domestic reporting unit?
$
,000.00
TOTAL (Add lines B1 and B2.)
$
,000.00
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29
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
SELECTED EXTRACTION/MINING/QUARRYING COSTS AND ELECTRICITY
Include costs incurred in mining processes such as supplies, resales, contract work, fuels, and electricity.
A. What were the extraction/mining/quarrying-related costs in 2022 for this domestic reporting unit for:
1. Materials, parts, and supplies used; and minerals received for preparation? (Report detail in Item 18.)
Include:
Cost of extraction/mining/quarrying-related materials purchased for other companies (contractors)
Cost of materials purchased or received from other domestic reporting units of your company
Exclude:
Non-extraction/mining/quarrying-related expenses that were paid to other companies (Report these
expense details in C.)
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Products bought and sold without further processing (products bought and resold in the same condition as when
purchased)? (Report these sales in Wholesaling Services product codes in Item 22.)
Exclude:
oil, gas or natural gas liquids (if applicable)
3. Work done for you by others on your materials (work contracted to others)? [Report in A1 the materials, parts, and
supplies purchased for other companies (contractors).]
4. Purchased fuels consumed for heat, power, or the generation of electricity? (Report detail in Item 19.)
Report the total amount actually paid or payable for all purchased fuels consumed.
Include:
Fuels or coal consumed at this domestic reporting unit, but produced at another domestic reporting unit of
your company (Assign commercial values to them.)
Fuel used to power on-site trucks, forklifts, or motor vehicles
Anthracite, lignite, bituminous, and subbituminous coal, coke, natural and manufactured gas, gasoline,
wood, purchased steam, and all other fuels
Exclude:
Gas purchased for gas lift
Crude petroleum, natural gas, and coal produced at the domestic reporting unit and used for heat, power,
or the generation of electricity
5. Purchased electricity? (Report comparable quantity in B1.)
Report total amount actually paid or payable for electric energy purchased during 2022 from other companies or
received from other domestic reporting units of your company.
Exclude value of electricity generated and used at this domestic reporting unit
TOTAL (Add lines A1 through A5.)
B. For this domestic reporting unit, what was the quantity of:
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
30
Check
if
None
1. Purchased electricity? (quantity comparable to cost reported in A5)
2022 Kilowatt Hours
,000
2. Generated electricity? (gross less generating station use)
When a figure is reported on this line, include data relating to the activity of the power stations in other sections of
this questionnaire. For example, include the number of employees assigned to the power station, their wages, and
hours worked in the figures reported in Item 7 and the cost of fuels used to generate electricity, in Item 16, line A4
and Item 18.
Include energy generated at the drilling site that was used for lighting or other purposes.
3. Electricity sold or transferred to other domestic reporting units? (Also include quantity in B1 and/or B2.)
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
,000
,000
31
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
OTHER OPERATING EXPENSES
C. What were the other operating expenses paid by this domestic reporting unit in 2022 for:
Include:
Costs for each of these services purchased from other companies that are paid directly by this domestic reporting unit
Expenses normally considered nonproduction related costs
Exclude:
Salaries paid to employees of this domestic reporting unit for any of the specified services (Report in Item 7.)
Cost of mining activities contracted or subcontracted to others (Report on A3.)
1. Temporary staff and leased employees? [total costs paid to Professional Employer Organizations (PEOs) and
staffing agencies for personnel]
Include:
All charges for payroll, benefits, and services
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report in 3.)
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
4. Purchased communication services?
Include:
Telephone, cellular, and fax services
Computer-related communications (e.g., Internet, connectivity, online)
Credit card transaction fees
Other wired and wireless communication services
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32
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
Exclude:
Services provided by other domestic reporting units of this company (such as a separate central data
processing unit)
Expensed integrated systems (Report in 4.)
Repair and maintenance of computer equipment (Report in 6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in 9 and credit card
transaction fees in 4.)
Expenses for telecommunication services, e.g., Internet, connectivity, telephone, etc. (Report in 4.)
$
,000.00
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof, replacing parts, over-hauling of equipment, and other repairs chargeable as
current operating costs
Cost of repair and maintenance of any leased property if the domestic reporting unit assumes the cost
Exclude:
Materials, parts, and supplies used for repairs and maintenance performed by this domestic reporting unit’s
employees (Report in A1.)
Extensive “repairs” or reconstruction that is capitalized (Report these as a capital expenditure in Item 13.)
Costs incurred directly by this domestic reporting unit in using its own work force to perform repairs and
maintenance work
Repairs and maintenance provided by the building or machinery owner as part of the rental contract
7. Water, sewer, refuse removal, and other non-electric utility payments? (Report electric utility payments on line
A5. If the cost of these utilities is included in a lease or rental payment, report in Item 14 line A.)
Include:
Cost of hazardous waste removal
8. Purchased advertising and promotional services?
Include:
Printed materials
Media coverage
Marketing and public relations services
Exclude:
All salaries paid to employees of the domestic reporting unit for advertising work
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33
9. Purchased professional and technical services?
Include:
Management consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll processing
Architectural
Engineering
Other professional services
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
$
,000.00
10. Governmental taxes and licensing fees? (payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
11. All other operating expenses not reported elsewhere?
Exclude:
Purchases of merchandise for resale (Report on line A2.)
Non-operating expenses
Describe
TOTAL (Add lines C1 through C11.)
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34
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
Report:
Delivered cost of individual items listed below. Delivered cost is the amount paid or payable after discounts and including freight and other direct charges incurred by the
domestic reporting unit in acquiring the materials. The figures reported should represent the total purchase cost of supplies, minerals received for preparation, etc., actually used
or processed during 2022. Include purchases, interplant transfers, and withdrawals from inventories. Do not combine material lines. If the information is not directly available
from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Estimated quantity and cost of minerals received for processing on a custom or toll basis, as if purchased.
Minerals mined and also processed at this domestic reporting unit.
Include:
Minerals received from other domestic reporting units for preparation which were used or processed during 2022
Cost of materials and supplies not covered in the pre-listed material codes (Report these in material code 00970098 - "All other supplies".)
Supplies purchased by this domestic reporting unit for use by companies performing contract work at this domestic reporting unit
Exclude:
Associated labor costs of the kind reported in Item 7 and Item 16, line A3
Payments made for contract services performed, including payments for supplies and equipment furnished by the contractor incidental to this work
Unit of
Measure
Description
Quantity
Census
Material
Code
Value
1. Parts and attachments for mining, mineral preparation, construction, and
conveying machinery and equipment
$
,000.00
33300009
2. Explosive materials, including ammonium nitrate, and blasting accessories
$
,000.00
32592000
3. Miscellaneous iron, steel, and ferroalloy ingot, shapes, and forms (excluding
castings, forgings, bars, structural shapes, wire, sheet, strip, and semifinished
shapes)
$
,000.00
33110090
4. All basic organic and inorganic chemicals, excluding petrochemicals
$
,000.00
32518000
$
,000.00
21239003
$
,000.00
00970098
short tons
(dry basis)
5. Crude minerals received for preparation
6. All other supplies
Describe
7. Crude minerals mined and prepared at same domestic reporting unit
short tons
(dry basis)
21239005
$
TOTAL
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
,000.00
77100000
35
Item 19: Fuels Used
ITEM 19: FUELS USED
Of the $,000.00 of purchased fuels in 2022, reported on Item 16, line A4, how much was for the following specified fuels?
Report:
Delivered cost of fuels received, not cost per unit. Delivered cost is the amount paid or payable after discounts, including freight and other direct charges incurred by the
domestic reporting unit in acquiring the fuels. Do not combine fuel lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Include:
Fuels purchased from other companies or transferred from other domestic reporting units of your company and used at this domestic reporting unit for the production of heat,
power, or generated electricity. The fuels transferred from other domestic reporting units of your company should be estimated at market value.
Cost of fuels not covered in the pre-listed fuel codes (Report these in fuel code 00960018 - "Other fuels".)
Unit of
Measure
Description
1. Diesel fuel
2. Gasoline used as a fuel
3. Gas (natural, manufactured, and mixed) used as a fuel
4. Other fuels (liquefied petroleum gas, coke, wood, etc.)
Quantity
Consumed
Cost, including delivery cost
(freight-in)
Census
Fuel Code
barrels
$
,000.00
32411021
1000 gal
$
,000.00
32411015
mil ft3
$
,000.00
21111015
$
,000.00
00960018
$
,000.00
00772000
Describe
TOTAL
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The mined products and services listed below are generally produced in your industry. They include products shipped and services performed by this domestic reporting unit. Select
the items that apply to your domestic reporting unit. If you mine products or have revenue from other sources not listed, you will report them in the next section.
Description
Select
Product Code
1000375000
1. Mining of potassium salts and boron compounds
1000400000
2. Mining of sodium carbonate and sulfate, natural
3. Mining of crude and prepared phosphate rock, including crude ore or matrix, washed, concentrated, dried, calcined, sintered or
nodulized
1000875000
1001150000
4. Mining of barite
1000900000
5. Mining of rock salt
6. Mining of other chemical and fertilizer materials (ores, fines, and concentrates, including fluorspar, pyrites, spodumene, mineral
pigments, native sulfur, etc.)
1001125000
1000925000
7. Mining and/or benefication of diatomite
1000950000
8. Mining and/or benefication of gypsum
9. Mining and/or benefication of talc, soapstone, and pyrophyllite
1000975000
1001000000
10. Mining and/or benefication of mica
1001025000
11. Mining and/or benefication of pumice and pumicite
1001375000
12. Mining and/or benefication of peat
1001050000
13. Mining and/or benefication of perlite
14. Mining and/or benefication of all other nonmetallic minerals, including natural abrasives, shell and native asphalt and bitumens
15. Open-pit or quarry nonmetallic minerals mining not for your own account
16. Nonmetallic mineral prospect services and test drilling services
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
1001075000
1002150000
1002175000
37
17. Other nonmetallic mineral services, including overburden stripping, drilling services, blasting, and repair and maintenance services
1002200000
All other sales, shipments, receipts, or revenue from this domestic reporting unit
18. Manufacturing of treated lightweight aggregate and crushed slag, minerals and earths
19. Manufacturing of other minerals or earths, treated, including exfoliated vermiculite, refractory magnesia, refined or blended
graphite, feldspar, mica, and roofing granules
20. Wholesale sales of nonmetallic minerals, except crude petroleum and minerals used in construction and fertilizer
2026225000
2026275000
4003525000
Add product/service not listed
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
38
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Report:
The value of the products shipped and services performed at the net selling value, free on board (FOB) quarry or plant to customer, after discounts or allowances.
Quantities in the unit of measure specified. Note: Short tons equal to 2,000 pounds.
Include:
All products mined, quarried, extracted, or leached from this domestic reporting unit
Material withdrawn from stockpiles, i.e. for leaching, sale, etc.
Products shipped on consignment
Prepared minerals from crude materials mined at this domestic reporting unit, purchased, or received from other domestic reporting units of your company
Concentrated ores, metals, and agglomerates from ores mined at this domestic reporting unit, or purchased or received from other domestic reporting units of your company
Estimated value of products treated on a custom or toll basis
Products transferred to other domestic reporting units of your company for treatment, preparation, milling, or other use
Bonuses or other credits for minerals contained, as well as royalties
Quantity of production of crude ore mined for treatment at this domestic reporting unit
Exclude:
Penalties for impurities
Wholesaling products (previously Resales), which include products that are bought from other domestic reporting units or transferred from other domestic reporting units of your
company and then sold without further treatment, processing, preparation, or milling by this domestic reporting unit. Report these products in the appropriate wholesaling
product line(s) you selected or else "Add product/service not listed" at the end of this item.
Freight charged
Excise taxes
Description
Quantity
Shipped
Unit of
Measure
Quantity
Produced
Unit of
Measure
Product
Code
Value
1. Mining of potassium salts and boron
compounds
short tons
2. Mining of sodium carbonate and sulfate,
natural
short tons
3. Mining of crude and prepared phosphate
rock, including crude ore or matrix,
washed, concentrated, dried, calcined,
sintered or nodulized
short tons
(dry basis)
short tons
(dry basis)
$
,000.00
1000875000
short tons
short tons
$
,000.00
1001150000
4. Mining of barite
5. Mining of rock salt
short tons
$
short tons
,000.00
$
short tons
short tons
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
,000.00
,000.00
$
6. Mining of other chemical and fertilizer
materials (ores, fines, and concentrates,
including fluorspar, pyrites, spodumene,
mineral pigments, native sulfur, etc.)
7. Mining and/or benefication of diatomite
$
,000.00
$
,000.00
1000375000
1000400000
1000900000
1001125000
1000925000
39
8. Mining and/or benefication of gypsum
9. Mining and/or benefication of talc,
soapstone, and pyrophyllite
10. Mining and/or benefication of mica
11. Mining and/or benefication of pumice
and pumicite
12. Mining and/or benefication of peat
13. Mining and/or benefication of perlite
14. Mining and/or benefication of all other
nonmetallic minerals, including natural
abrasives, shell and native asphalt and
bitumens
short tons
short tons
$
,000.00
1000950000
short tons
short tons
$
,000.00
1000975000
short tons
short tons
$
,000.00
1001000000
short tons
short tons
$
,000.00
1001025000
short tons
short tons
$
,000.00
1001375000
short tons
short tons
$
,000.00
1001050000
short tons
short tons
$
,000.00
1001075000
15. Open-pit or quarry nonmetallic minerals
mining not for your own account
$
,000.00
1002150000
16. Nonmetallic mineral prospect services
and test drilling services
$
,000.00
1002175000
$
,000.00
1002200000
18. Manufacturing of treated lightweight
aggregate and crushed slag, minerals
and earths
$
,000.00
2026225000
19. Manufacturing of other minerals or
earths, treated, including exfoliated
vermiculite, refractory magnesia, refined
or blended graphite, feldspar, mica, and
roofing granules
$
,000.00
2026275000
20. Wholesale sales of nonmetallic minerals,
except crude petroleum and minerals
used in construction and fertilizer
$
,000.00
4003525000
17. Other nonmetallic mineral services,
including overburden stripping, drilling
services, blasting, and repair and
maintenance services
All other sales, shipments, receipts, or revenue from this domestic reporting unit
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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40
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this domestic reporting unit a cooperative?
Yes
No
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41
Item 28: Special Items - Water Use
ITEM 28: SPECIAL ITEMS - WATER USE
1. What was this domestic reporting unit’s water intake in 2022, that is, the quantity of new water introduced into the domestic reporting unit for the first time, regardless of source or
quality?
Include water used in the production process and auxiliary operations (such as cooling and condensing, boiler feed, sanitary and domestic use). Report to the nearest thousand.
,000 gallons
2. Did this domestic reporting unit recirculate or reuse any water during 2022?
Yes
No
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42
Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s gross water use in 2022, that is, the quantity of water that would have been required if no water had been recirculated or reused?
For example, if total water intake was 500 million gallons and, of these 500 million gallons, 100 million gallons were used twice for cooling purposes and once for washing products or
materials, the total water required would be 300 million gallons, plus the 400 million gallons not recirculated, for a total of 700 million gallons of gross water use (less consumption and
evaporation loss). Report to the nearest thousand.
,000 gallons
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43
Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
What was this domestic reporting unit’s main source of new water in 2022? Select only ONE.
Public water system includes water supplied by a water utility (whether municipally- or privately-owned) whose primary purpose is the supply of water to the general public and/or
industrial users. Self-supplied water systems include water obtained by this domestic reporting unit through its own system of pumps, pipes, hoses, etc. Also include here water obtained
from another company that is not primarily a water utility.
Public water system (municipally- or privately-owned utility)
Self-supplied surface water system (rivers, streams, lakes)
Self-supplied ground water system (wells, deep springs)
Self-supplied tide water system (estuaries, bays, oceans)
Self-supplied mine water (underground mines, quarries, open pits, water produced with oil)
Other sources (e.g., rainwater, truck deliveries)
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44
Item 28: Special Items - Water Use - Continued
ITEM 28: SPECIAL ITEMS - WATER USE
Which of the following types of water was mainly supplied by the public water system? Select only ONE.
Potable
Reclaimed wastewater
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45
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this domestic reporting unit sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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46
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this domestic reporting unit purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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47
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this domestic reporting unit use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as
registering for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this domestic reporting unit use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this domestic reporting unit use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this domestic reporting unit use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into standalone stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this domestic reporting unit use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
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48
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
Yes
No
Do not know
6. In 2022, did this domestic reporting unit use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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49
Item 29: Business Technologies - Touchscreens/Kiosks for customer interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this domestic reporting unit acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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50
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this domestic reporting unit acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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51
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this domestic reporting unit acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
52
Item 29: Business Technologies - Industrial Robots
ITEM 29 BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this domestic reporting unit acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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53
Item 29: Business Technologies - Service Robots
ITEM 29 BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this domestic reporting unit acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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54
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this domestic reporting unit acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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55
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
1000
characters remaining
56
Item 32: Number of Domestic Reporting Units - Domestic Reporting Unit Information
ITEM 32: NUMBER OF DOMESTIC REPORTING UNITS - DOMESTIC REPORTING UNIT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MI-21238_su.pdf Generated 2022-02-23 16:26:28
,000.00
57
Location Information
DEFINITION OF DOMESTIC REPORTING UNIT
The reporting unit for this questionnaire is a mineral service domestic reporting unit. A mineral service domestic reporting unit represents all nationwide mineral support activities
performed for operators of mineral properties specified in the "Industry" field below on a fee or contract basis.
Mineral service activities include exploration and other mining and quarrying support services.
Please update the pre-identified locations for this industry in Item 33A, Pre-identified Locations of Operation.
Name 1
Name 2
NAICS
Industry
For Census Bureau Use Only
CFN
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1
Item 4A: Primary Business or Activity
CFN:
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this domestic reporting unit's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the domestic reporting unit's
primary business or activity.
Select only ONE.
Support activities for coal mining, e.g., sinking mine shafts and driving mine tunnels services, overburden stripping, recovering culm bank,
etc.
213113 001
Support activities for metal mining, e.g., sinking mine shafts and driving mine tunnels services, overburden stripping, etc.
213114 001
Support activities for nonmetallic minerals (excluding fuel) mining, e.g., sinking mine shafts and driving mine tunnels services, overburden
stripping, etc.
213115 001
Drilling oil and gas wells, on a contract basis
213111 001
Support activities for oil and gas operations on a contract basis (excluding drilling wells), e.g., cementing wells, exploration services,
hydraulic fracturing, gathering services, etc.
213112 001
Other primary business or activity
779000 001
Select Sector
Describe
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2
Item 4B: Type of Operation
ITEM 4B: TYPE OF OPERATION
For which ONE activity did this domestic reporting unit receive the largest receipts?
(Include production, development, and exploration operations.)
Principal mineral activity of domestic reporting units served
452
Metal mining
454
Coal mining
456
Mining of nonmetallic minerals, except fuels
458
Crude petroleum, natural gas, and natural gas liquids
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3
General Reporting Guidelines
CFN:
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
2036
,000.00
4
Item 5: Sales, Shipments, Receipts, or Revenue
CFN:
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What was the total value of products shipped and other receipts for this domestic reporting unit?
(Report details in Item 22.)
Include:
All products physically shipped during 2022
Receipts for services
Value of resales
Interplant transfers
Exports
Other miscellaneous receipts
Exclude:
Non-operating income such as royalties, interest, dividends, or the sale of fixed assets
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
$
,000.00
B. What was the value of products shipped for export for this domestic reporting unit?
(This is a breakout of the $,000.00 reported in A.)
Include:
Shipments going directly for export including shipments to foreign subsidiaries or foreign divisions of your
company and their affiliates:
Shipments to customers in the Panama Canal Zone, the Commonwealth of Puerto Rico, and U.S.
possessions
Shipments of your products to export firms and to other customers who export these items
Sales to the U.S. government to be shipped to foreign nations under military and economic assistance
programs
Exclude:
Sales to the U.S. Government overseas
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5
Item 7: Employment and Payroll
CFN:
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941, Employer's Quarterly Federal
Tax Return, and filed under the Employer Identification Number (EIN)
Persons on paid sick leave, paid holidays, and paid vacations during the year
Officers, if a corporation
Exclude:
Members of the Armed Forces and pensioners carried on your active payrolls
Proprietor or partners, if an unincorporated concern
Workers at manufacturing plants, company stores, boardinghouses, bunkhouses, recreational centers, and auxiliary offices
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report these values in Item 16, line D1.)
Temporary staffing obtained from a staffing service (Report these values in Item 16, line D1.)
Purchased professional and technical services (Report these values in Item 16, line D9.)
Contractors and subcontractors and their employees (Report the cost of contract work in Item 16, line A3.)
A. EMPLOYMENT
1. What was the number of mining, production, development, and exploration workers (direct labor including
first-line supervisors) at this domestic reporting unit for the pay period including March 12 (Q1)?
Include:
Workers engaged in services closely associated with production and development operations such as:
Manual work
Tool use and machine operation
Materials and products, loading and hauling
Mineral properties care
Exploration and development work
Storage, shipping, maintenances, repair, and guard services
Auxiliary production for own use (i.e. power plant) record keeping
Regular maintenance and repair
Drilling and maintaining wells
Seismic testing or cementing walls
Exclude:
Supervisory employees above the first-line level (Report these in A2.)
Employees of contractors or subcontractors
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
Check
if
None
2022 Number
6
2. What was the number of other employees at this domestic reporting unit for the pay period including March 12
(Q1)?
Include:
Force-account construction employees and your payroll engaged in construction of major additions or
alterations to your facilities that are utilized as a separate work force
Nonproduction personnel engaged in supervision above the working supervisor level and employees
engaged in activities such as:
Sales, advertising, purchasing, finance
Highway trucking and other transportation
Credit, collection, executive, legal, clerical, and routine office functions
Personnel including cafeteria, medical, etc.
Professional (engineers, geologists, etc.) and technical workers
Exclude:
Proprietors and partners
Temporary staff and leased employees
Employees of contractors or subcontractors
TOTAL (Add lines A1 and A2.)
B. HOURS WORKED
What was the annual number of hours worked by the mining, production, development, and exploration workers
(direct labor including first-line supervisors) at this domestic reporting unit reported in A1?
Include:
All hours worked or paid (except hours paid for vacations, holidays, or sick leave)
Overtime hours (Report actual hours worked, not straight-time equivalent hours.)
Actual hours worked by an employee who elects to work during a vacation period
All hours worked for the entire year by a full and part-time mining, production, development, and
exploration workers of the type reported in A1
Exclude:
Hours of proprietors or partners
Hours worked by temporary staff or leased employees
Hours worked by employees of contractors or subcontractors
Check
if
None
2022 Hours
,000
C. PAYROLL
Report the gross earnings paid in calendar year 2022 to employees prior to such deductions as employee’s Social Security contributions, withholding taxes, group insurance
premiums, union dues, and savings bonds.
Payroll should equal the taxable Medicare wages and tips reported on the Internal Revenue Services (IRS) Form 941, Employer’s Quarterly Tax Return and definitions as described in
Circular E, Employer’s Tax Guide.
Include:
Commissions, dismissal pay and paid bonuses
Employee contributions to pension plans such as a 401(k) plan
Vacation and sick-leave pay
Salaries of officers
Spread on stock options that are taxable to employee as wages
Cash equivalent of compensation paid in kind such as:
Board and housing
Payments in the form of shared profits and special stock purchases that are subject to withholding tax
Exclude:
Payroll for temporary staff and leased employees
Payments to proprietor or partners
Payments to members of Armed Forces and pensioners carried on your active payroll
Royalty payments to unions
Payments to contract or subcontractors who performed work for you
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7
Employer-paid annual cost for fringe benefits (Report these costs in D1 through D3.)
Check
if
None
2022
1. What was the annual payroll before deductions for mining, production, development, and exploration workers
(direct labor including first-line supervisors) of the type reported in A1 at this domestic reporting unit?
$
,000.00
2. What was the annual payroll before deductions for all other employees of the type reported in A2 at this domestic
reporting unit?
$
,000.00
$
,000.00
$
,000.00
TOTAL (Add lines C1 and C2.)
3. Of the $,000.00 reported above, what was the first quarter payroll at this domestic reporting unit before
deductions (January - March 2022)?
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8
Item 7: Employment and Payroll - Continued
CFN:
ITEM 7: EMPLOYMENT AND PAYROLL
D. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS
This is the employer’s annual cost at this domestic reporting unit for legally required programs and programs not required by law.
1. What were the employer’s annual costs at this domestic reporting unit for health insurance? (insurance premiums on
hospitals, medical plans, and single service plans such as dental, vision, and prescription drug plans)
Include:
Premium equivalents for self-insured plans and fees paid to third-party administrators (TPAs)
Exclude:
Employee contributions
Disbursements from trusts or funds to satisfy health insurance claims
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
2. Retirement plans:
a. What were the employer’s annual costs at this domestic reporting unit for defined benefit pension plans? (Costs
include both qualified and nonqualified defined pension plans, as well as plans that specify the benefit to be
paid to employee upon retirement, generally either as a specified amount or a percentage of compensation.
Employer contributions are based on actuarial computations that include the employee's compensation and years
of service and are not allocated to specific accounts maintained for employees.)
b. What were the employer’s annual costs at this domestic reporting unit for defined contribution plans? (These
are 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)
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9
3. What were the employer’s annual costs at this domestic reporting unit for employer-paid payroll taxes, insurance
premiums, and all other employer-paid benefits?
Include:
Life insurance benefits
“Quality of life” benefits (e.g., childcare assistance, subsidized commuting, etc.)
Education assistance
Legally-required fringe benefits
Social Security
Workers' compensation insurance
Unemployment tax
State disability insurance programs (long- and short-term disability – LTD and STD)
Medicare
Exclude:
Disbursements from trusts or funds to satisfy health insurance claims
TOTAL (Add lines D1 through D3.)
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
$
,000.00
$
,000.00
10
Item 9: Value of Inventories
CFN:
ITEM 9: VALUE OF INVENTORIES
Report inventories at cost or market using generally accepted accounting practices. Report the value of all inventories that are attributable to the domestic reporting unit’s operations
regardless of where the inventories are held or stored.
What was the value of inventories owned by this domestic reporting unit as of December 31 before Last-In, First-Out (LIFO) adjustment (if any)?
Include:
Stocks of items to be used for mineral service work
Stocks of materials, parts, supplies, fuels, etc.
Check
if
None
Check
if
None
2022
$
,000.00
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
2021
$
,000.00
11
Item 10: Inventories by Valuation Method
CFN:
ITEM 10: INVENTORIES BY VALUATION METHOD
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this domestic reporting unit as of December 31, 2022 and the $,000.00 reported in Item 9 as the total
value of inventories owned by this domestic reporting unit as of December 31, 2021:
Check
if
None
Check
if
None
2022
2021
A. What was the amount subject to Last-In, First-Out (LIFO)
gross (gross LIFO amount)?
$
,000.00
$
,000.00
B. What was the amount not subject to LIFO valuation
method?
$
,000.00
$
,000.00
TOTAL (Sum of lines A and B should equal TOTAL in Item
9.)
$
,000.00
$
,000.00
C. What was the amount of LIFO reserve (if any)? [LIFO
reserve represents the excess of current period cost over
the LIFO carrying value. LIFO reserve is the difference
between the current cost (i.e., FIFO) of inventories (gross
value) and the LIFO carrying value (net value).]
$
,000.00
$
,000.00
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
12
Item 13: Capital Expenditures
CFN:
ITEM 13: CAPITAL EXPENDITURES
Report the actual outlays during 2022, not the final value of buildings or other structures completed or equipment put in place during the year. These expenditures are of the type for which
depreciation or amortization accounts are ordinarily maintained.
Capital expenditures during 2022 may be determined by the following computation:
(a) Cost of additions completed during the year, plus
(b) Work-in-progress at the end of the year, minus
(c) Work-in-progress at the beginning of the year.
Include labor and installation costs whether on contract or by your own forces
Exclude the cost of maintenance and repairs charged as current operating expense
A. What were the capital expenditures for new and used buildings, structures, machinery, and equipment for this domestic
reporting unit?
Include:
Buildings and structures directly related to mineral exploration, development, and production
Machinery, such as hoists, cranes, crushers, separators, and power plants
Exploration, development, production, and processing plant machinery
Value of the equipment produced and used
Equipment such as excavators, loaders, locomotives, tractors, hoists, drills, compressors, pumps
Transportation equipment, such as automobiles, trucks, and similar equipment
Office equipment, such as computers and peripheral data processing equipment, as well as furniture and fixtures
for offices, cafeterias, and change rooms
Replacements as well as additions to new capacity
Values from construction by your own employees, where capitalized
Value of improvements and capitalized repairs to machinery and equipment including those done to assets
transferred from other domestic reporting units of this company
Expenditures for old or existing plants and for second-hand equipment acquired from others (including U.S.
Government)
Gross book value of machinery or equipment transferred from other domestic reporting units of your company
Exclude:
Company houses and general recreational facilities
Value of land
Cost of maintenance and repairs charged as current operating expense
Check
if
None
2022
$
,000.00
$
,000.00
B. What were the capital expenditures for mineral exploration and development for this domestic reporting unit?
Include:
All intangible development and exploration outlays that were charged to a capital or Office of Minerals Exploration
account
Capitalized expenditures for entries, shafts, rail and other road construction, test boring, surveying, etc.
Capitalized expenditures for oil and gas field exploration and for drilling oil, gas, dry, and service wells through
completion of the well
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
13
$
TOTAL (Add lines A and B.)
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
,000.00
14
Item 14: Rental Payments
CFN:
ITEM 14: RENTAL PAYMENTS
Report rental payments made to other companies for use of depreciable assets such as buildings, other structures, machinery, and equipment. Include rental payments for land.
Domestic reporting units involved with leasing arrangements for equipment and/or buildings, report lease equipment according to the type of lease negotiated with the producer or the
lessor.
Include:
Operating leases (Report the periodic payments made to the producer or lessor.)
Exclude:
Capital leases (leases with a contract to own at the end of the lease) (Report cost, at market value, of acquisitions of building and equipment during the year as a capital
expenditure, Item 13.)
At this domestic reporting unit, what were the payments for:
A. Rental or lease of buildings and other structures?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
B. Rental or lease of machinery and equipment?
Include:
Production machinery and equipment
Loading machinery and equipment
Transportation machinery and equipment
Construction equipment
Tools
Office equipment
Furniture
Vehicles
TOTAL (Add lines A and B.)
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
15
Item 15: Mineral Property Expenses
CFN:
ITEM 15: MINERAL PROPERTY EXPENSES
Report mineral property expenses charged to current accounts.
Check
if
None
A. What were the lease rents for mineral properties for this domestic reporting unit?
2022
$
,000.00
B. Current Operation Expenses
Include:
Acquisition costs for mineral land and rights that were not capitalized
Cost of royalty payments related to mineral production
Labor costs whether on a contract basis or by your own forces associated with exploration and development or the acquisition of mineral properties
Intangible development and exploration outlays charged to a current account
Expenses for mineral properties charged to current accounts, such as:
all supplies, machinery, equipment, parts, fuel, power, etc., used for development or exploration (whether purchased or received from other domestic reporting units of
your company) and charged as current operating expenses
cost of maintenance and repairs associated with development or exploration activity that is charged to current accounts
Exclude:
Lease rents (Report separately in A.)
1. What were the current operating expenses for exploration, development, and mineral land and rights for this
domestic reporting unit?
$
,000.00
2. What were the current operating expenses for royalty payments for this domestic reporting unit?
$
,000.00
TOTAL (Add lines B1 and B2.)
$
,000.00
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
16
Item 16: Selected Expenses Additional Information
CFN:
ITEM 16: SELECTED EXPENSES
SELECTED EXTRACTION/MINING/QUARRYING COSTS AND ELECTRICITY
Include costs incurred in mining processes such as supplies, resales, contract work, fuels, and electricity.
A. What were the extraction/mining/quarrying-related costs in 2022 for this domestic reporting unit for:
1. Materials, parts, and supplies used; and minerals received for preparation? (Report detail in Item 18.)
Include:
Cost of extraction/mining/quarrying-related materials purchased for other companies (contractors)
Cost of materials purchased or received from other domestic reporting units of your company
Exclude:
Non-extraction/mining/quarrying-related expenses that were paid to other companies (Report these
expense details in C.)
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
2. Products bought and sold without further processing (products bought and resold in the same condition as when
purchased)? (Report these sales in Wholesaling Services product codes in Item 22.)
Exclude:
oil, gas or natural gas liquids (if applicable)
3. Work done for you by others on your materials (work contracted to others)? [Report in A1 the materials, parts, and
supplies purchased for other companies (contractors).]
4. Purchased fuels consumed for heat, power, or the generation of electricity? (Report detail in Item 19.)
Report the total amount actually paid or payable for all purchased fuels consumed.
Include:
Fuels or coal consumed at this domestic reporting unit, but produced at another domestic reporting unit of
your company (Assign commercial values to them.)
Fuel used to power on-site trucks, forklifts, or motor vehicles
Anthracite, lignite, bituminous, and subbituminous coal, coke, natural and manufactured gas, gasoline,
wood, purchased steam, and all other fuels
Exclude:
Gas purchased for gas lift
Crude petroleum, natural gas, and coal produced at the domestic reporting unit and used for heat, power,
or the generation of electricity
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
17
5. Purchased electricity? (Report comparable quantity in B1.)
Report total amount actually paid or payable for electric energy purchased during 2022 from other companies or
received from other domestic reporting units of your company.
Exclude value of electricity generated and used at this domestic reporting unit
TOTAL (Add lines A1 through A5.)
$
,000.00
$
,000.00
B. For this domestic reporting unit, what was the quantity of:
Check
if
None
1. Purchased electricity? (quantity comparable to cost reported in A5)
2022 Kilowatt Hours
,000
2. Generated electricity? (gross less generating station use)
When a figure is reported on this line, include data relating to the activity of the power stations in other sections of
this questionnaire. For example, include the number of employees assigned to the power station, their wages, and
hours worked in the figures reported in Item 7 and the cost of fuels used to generate electricity, in Item 16, line A4
and Item 18.
Include energy generated at the drilling site that was used for lighting or other purposes.
3. Electricity sold or transferred to other domestic reporting units? (Also include quantity in B1 and/or B2.)
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
,000
,000
18
Item 16: Selected Expenses - Continued
CFN:
ITEM 16: SELECTED EXPENSES
OTHER OPERATING EXPENSES
C. What were the other operating expenses paid by this domestic reporting unit in 2022 for:
Include:
Costs for each of these services purchased from other companies that are paid directly by this domestic reporting unit
Expenses normally considered nonproduction related costs
Exclude:
Salaries paid to employees of this domestic reporting unit for any of the specified services (Report in Item 7.)
Cost of mining activities contracted or subcontracted to others (Report on A3.)
1. Temporary staff and leased employees? [total costs paid to Professional Employer Organizations (PEOs) and
staffing agencies for personnel]
Include:
All charges for payroll, benefits, and services
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report in 3.)
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
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
19
4. Purchased communication services?
Include:
Telephone, cellular, and fax services
Computer-related communications (e.g., Internet, connectivity, online)
Credit card transaction fees
Other wired and wireless communication services
$
,000.00
$
,000.00
$
,000.00
$
,000.00
$
,000.00
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
Exclude:
Services provided by other domestic reporting units of this company (such as a separate central data
processing unit)
Expensed integrated systems (Report in 4.)
Repair and maintenance of computer equipment (Report in 6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in 9 and credit card
transaction fees in 4.)
Expenses for telecommunication services, e.g., Internet, connectivity, telephone, etc. (Report in 4.)
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof, replacing parts, over-hauling of equipment, and other repairs chargeable as
current operating costs
Cost of repair and maintenance of any leased property if the domestic reporting unit assumes the cost
Exclude:
Materials, parts, and supplies used for repairs and maintenance performed by this domestic reporting unit’s
employees (Report in A1.)
Extensive “repairs” or reconstruction that is capitalized (Report these as a capital expenditure in Item 13.)
Costs incurred directly by this domestic reporting unit in using its own work force to perform repairs and
maintenance work
Repairs and maintenance provided by the building or machinery owner as part of the rental contract
7. Water, sewer, refuse removal, and other non-electric utility payments? (Report electric utility payments on line
A5. If the cost of these utilities is included in a lease or rental payment, report in Item 14 line A.)
Include:
Cost of hazardous waste removal
8. Purchased advertising and promotional services?
Include:
Printed materials
Media coverage
Marketing and public relations services
Exclude:
All salaries paid to employees of the domestic reporting unit for advertising work
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
20
9. Purchased professional and technical services?
Include:
Management consulting
Accounting
Auditing
Bookkeeping
Legal
Actuarial
Payroll processing
Architectural
Engineering
Other professional services
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
$
,000.00
10. Governmental taxes and licensing fees? (payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
11. All other operating expenses not reported elsewhere?
Exclude:
Purchases of merchandise for resale (Report on line A2.)
Non-operating expenses
Describe
TOTAL (Add lines C1 through C11.)
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
21
Item 18: Detailed Cost of Materials, Parts, and Supplies
CFN:
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
Report:
Delivered cost of individual items listed below. Delivered cost is the amount paid or payable after discounts and including freight and other direct charges incurred by the
domestic reporting unit in acquiring the materials. The figures reported should represent the total purchase cost of supplies, minerals received for preparation, etc., actually used
or processed during 2022. Include purchases, interplant transfers, and withdrawals from inventories. Do not combine material lines. If the information is not directly available
from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Estimated quantity and cost of minerals received for processing on a custom or toll basis, as if purchased.
Minerals mined and also processed at this domestic reporting unit.
Include:
Minerals received from other domestic reporting units for preparation which were used or processed during 2022
Cost of materials and supplies not covered in the pre-listed material codes (Report these in material code 00970098 - "All other supplies".)
Supplies purchased by this domestic reporting unit for use by companies performing contract work at this domestic reporting unit
Exclude:
Associated labor costs of the kind reported in Item 7 and Item 16, line A3
Payments made for contract services performed, including payments for supplies and equipment furnished by the contractor incidental to this work
Description
Census
Material
Code
Value
1. Parts and attachments for mining, mineral preparation, construction, and conveying machinery and equipment
$
,000.00
33300009
2. Explosive materials, including ammonium nitrate, and blasting accessories
$
,000.00
32592000
3. Miscellaneous iron, steel, and ferroalloy ingot, shapes, and forms (excluding castings, forgings, bars, structural
shapes, wire, sheet, strip, and semifinished shapes)
$
,000.00
33110090
4. All other supplies
$
,000.00
00970098
$
,000.00
77100000
Describe
TOTAL
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
22
Item 19: Fuels Used
CFN:
ITEM 19: FUELS USED
Of the $,000.00 of purchased fuels in 2022, reported on Item 16, line A4, how much was for the following specified fuels?
Report:
Delivered cost of fuels received, not cost per unit. Delivered cost is the amount paid or payable after discounts, including freight and other direct charges incurred by the
domestic reporting unit in acquiring the fuels. Do not combine fuel lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Quantities in the unit of measure specified.
Include:
Fuels purchased from other companies or transferred from other domestic reporting units of your company and used at this domestic reporting unit for the production of heat,
power, or generated electricity. The fuels transferred from other domestic reporting units of your company should be estimated at market value.
Cost of fuels not covered in the pre-listed fuel codes (Report these in fuel code 00960018 - "Other fuels".)
Unit of
Measure
Description
1. Diesel fuel
2. Gasoline used as a fuel
3. Gas (natural, manufactured, and mixed) used as a fuel
4. Other fuels (liquefied petroleum gas, coke, wood, etc.)
Quantity
Consumed
Cost, including delivery cost
(freight-in)
Census
Fuel Code
barrels
$
,000.00
32411021
1000 gal
$
,000.00
32411015
mil ft3
$
,000.00
21111015
$
,000.00
00960018
$
,000.00
00772000
Describe
TOTAL
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
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 products and services were included?
Select ALL that apply.
The mined products and services listed below are generally produced in your industry. They include products shipped and services performed by this domestic reporting unit. Select
the items that apply to your domestic reporting unit. If you mine products or have revenue from other sources not listed, you will report them in the next section.
Description
Select
Product Code
1001950000
1. Coal mining prospect and test drilling services
2. Sinking coal mine shafts and driving coal mine tunnels services
3. Other coal mining services, including strip, auger or underground mining, drilling, overburden stripping, recovering culm bank, and
repair and maintenance services not for your own account
4. Metal mining exploration work, excluding prospect services, test drilling, and geophysical surveying services
1001975000
1002000000
1002025000
1002050000
5. Open-pit metal ores mining not for your own account
1002075000
6. Metal mining prospect services and test drilling services
7. Sinking metal mine shafts and driving metal mine tunnels services
8. Other metal mining services, including overburden stripping and repair and maintenance services
9. Open-pit or quarry nonmetallic minerals mining not for your own account
10. Nonmetallic mineral prospect services and test drilling services
11. Other nonmetallic mineral services, including overburden stripping, drilling services, blasting, and repair and maintenance services
1002100000
1002125000
1002150000
1002175000
1002200000
All other sales, shipments, receipts, or revenue from this domestic reporting unit
12. Wholesale sales of construction, forestry, and mining machinery and equipment, including attachments
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
4002100000
24
6000625000
13. Site remediation cleanup services
6000750000
14. Decommissioning services
15. Integrated surveying and mapping services, except geophysical
16. Integrated geophysical services, excluding oil and gas well logging
17. Rental services for agricultural, construction, forestry, mining, and oil and gas field machinery and equipment
18. Maintenance and repair services for agricultural, construction, forestry, mining, and oil and gas field machinery and equipment
19. Transportation of dry bulks, except in intermodal containers, by road
7008100000
7012260000
7009025000
7009050000
7011325000
Add product/service not listed
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
25
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Report:
The value of the products shipped and services performed at the net selling value, free on board (FOB) quarry or plant to customer, after discounts or allowances.
Quantities in the unit of measure specified. Note: Short tons equal to 2,000 pounds.
Include:
All products mined, quarried, extracted, or leached from this domestic reporting unit
Material withdrawn from stockpiles, i.e. for leaching, sale, etc.
Products shipped on consignment
Prepared minerals from crude materials mined at this domestic reporting unit, purchased, or received from other domestic reporting units of your company
Concentrated ores, metals, and agglomerates from ores mined at this domestic reporting unit, or purchased or received from other domestic reporting units of your company
Estimated value of products treated on a custom or toll basis
Products transferred to other domestic reporting units of your company for treatment, preparation, milling, or other use
Bonuses or other credits for minerals contained, as well as royalties
Quantity of production of crude ore mined for treatment at this domestic reporting unit
Exclude:
Penalties for impurities
Wholesaling products (previously Resales), which include products that are bought from other domestic reporting units or transferred from other domestic reporting units of your
company and then sold without further treatment, processing, preparation, or milling by this domestic reporting unit. Report these products in the appropriate wholesaling
product line(s) you selected or else "Add product/service not listed" at the end of this item.
Freight charged
Excise taxes
Description
Value
Product Code
1. Coal mining prospect and test drilling services
$
,000.00
1001950000
2. Sinking coal mine shafts and driving coal mine tunnels services
$
,000.00
1001975000
3. Other coal mining services, including strip, auger or underground mining, drilling, overburden stripping, recovering
culm bank, and repair and maintenance services not for your own account
$
,000.00
1002000000
4. Metal mining exploration work, excluding prospect services, test drilling, and geophysical surveying services
$
,000.00
1002025000
5. Open-pit metal ores mining not for your own account
$
,000.00
1002050000
6. Metal mining prospect services and test drilling services
$
,000.00
1002075000
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
26
7. Sinking metal mine shafts and driving metal mine tunnels services
$
,000.00
1002100000
8. Other metal mining services, including overburden stripping and repair and maintenance services
$
,000.00
1002125000
9. Open-pit or quarry nonmetallic minerals mining not for your own account
$
,000.00
1002150000
10. Nonmetallic mineral prospect services and test drilling services
$
,000.00
1002175000
11. Other nonmetallic mineral services, including overburden stripping, drilling services, blasting, and repair and
maintenance services
$
,000.00
1002200000
$
,000.00
4002100000
13. Site remediation cleanup services
$
,000.00
6000625000
14. Decommissioning services
$
,000.00
6000750000
15. Integrated surveying and mapping services, except geophysical
$
,000.00
7008100000
16. Integrated geophysical services, excluding oil and gas well logging
$
,000.00
7012260000
17. Rental services for agricultural, construction, forestry, mining, and oil and gas field machinery and equipment
$
,000.00
7009025000
18. Maintenance and repair services for agricultural, construction, forestry, mining, and oil and gas field machinery and
equipment
$
,000.00
7009050000
19. Transportation of dry bulks, except in intermodal containers, by road
$
,000.00
7011325000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
All other sales, shipments, receipts, or revenue from this domestic reporting unit
12. Wholesale sales of construction, forestry, and mining machinery and equipment, including attachments
Add product/service not listed
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
27
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this domestic reporting unit use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as
registering for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this domestic reporting unit use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this domestic reporting unit use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this domestic reporting unit use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into standalone stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this domestic reporting unit use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
28
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
Yes
No
Do not know
6. In 2022, did this domestic reporting unit use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
29
Item 29: Business Technologies - Touchscreens/Kiosks for customer interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this domestic reporting unit acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this domestic reporting unit acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
31
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this domestic reporting unit acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
32
Item 29: Business Technologies - Industrial Robots
ITEM 29 BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this domestic reporting unit acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
33
Item 29: Business Technologies - Service Robots
ITEM 29 BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this domestic reporting unit acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
34
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this domestic reporting unit acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
35
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
1000
characters remaining
36
Item 33: Locations of Operation
CFN:
ITEM 33: LOCATIONS OF OPERATION
A. Complete Item 33A: Pre-Identified Locations of Operation (On the Location List that follows, Type will be 'Pre-listed (Item
33A)')
B. Complete Item 33B: Additional Locations of Operation (On the Location List that follows, Type will be 'Added (Item 33B)')
Number of locations
Include:
All locations in operation or temporarily inactive in Item 33A
All locations added in Item 33B
Exclude:
All locations that have ceased operation or were sold
Check
if
None
2022
What was the total number of locations in operation in 2022?
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
37
Item 33A: Pre-identified Locations of Operation
ITEM 33A: PRE-IDENTIFIED LOCATIONS OF OPERATION
LOCATION INFORMATION
We have listed domestic reporting units of your company based on Census records. Correct any errors or omissions below.
(P.O. Box and rural route addresses are not physical locations)
Line No.
EIN
NAICS
99-9999999
Major Activity
Name
Secondary Name
Store/Plant Number
Physical Location (Number and Street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
CFN
EMPLOYMENT, PAYROLL, AND RECEIPTS
Include the number of employees and payroll for full- and part-time employees working at this domestic reporting unit whose payroll was reported on Internal Revenue Service Form
941, Employer's Quarterly Federal Tax Return
Include part-year operations
Do not combine data for domestic reporting units
If book figures are not available for employment and payroll for each domestic reporting unit, please provide your best estimates.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January-March 2022)?
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
,000.00
38
2022
$
What were the sales, shipments, receipts, or revenue?
,000.00
OPERATIONAL STATUS
Which of the following best describes this domestic reporting unit's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
CEASED OPERATION OR SOLD OR LEASED INFORMATION
If this domestic reporting unit ceased operation or was sold or leased to another operator, what was the date?
MMDDYYYY
MMDDYYYY
If this domestic reporting unit was sold or leased to another operator, what is the name and address of this domestic reporting unit's new owner or operator?
Name of new owner/operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
99999-9999
39
Item 33B: Additional Locations of Operation
ITEM 33B: ADDITIONAL LOCATIONS OF OPERATION
LOCATION INFORMATION
What is this domestic reporting unit's physical location?
(P.O. Box and rural route addresses are not physical locations)
EIN
99-9999999
Name
Secondary Name
Store/Plant
Physical Location (Number and Street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Date domestic reporting unit
opened or is expected to open
MMDDYYYY
CFN
EMPLOYMENT AND PAYROLL
Include the number of employees and payroll for full- and part-time employees working at this domestic reporting unit whose payroll was reported on Internal Revenue Service Form
941, Employer's Quarterly Federal Tax Return
Include part-year operations
Do not combine data for domestic reporting units
If book figures are not available for employment and payroll for each domestic reporting unit, please provide your best estimates.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January-March 2022)?
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
,000.00
40
2022
$
What were the sales, shipments, receipts, or revenue?
,000.00
MAJOR ACTIVITY CODE
Select the ACTIVITY CODE that best describes the activity of this domestic reporting unit and what were the primary products or services?
Primary products or services
Activity Code
Describe
FORMER OWNER OR OPERATOR INFORMATION
If this domestic reporting unit was acquired, who was the former owner or operator, and when was this domestic reporting unit acquired?
Name of former owner or operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
Month
Acquired
99999-9999
Year
Acquired
2022_MI-2132A_mu.pdf Generated 2022-02-23 16:31:09
41
Attachment D-3
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 22
Attachment Sector
D-3
22
Instrument
Path
Instrument Path Title
2211A
22110
22120
22130
Hydroelectric Power Generation
Electric Power Generation, Transmission and Distribution
Natural Gas Distribution
Water, Sewage and Other Systems
Location Information
DEFINITION OF REPORTING UNIT
The reporting unit for this questionnaire is a consolidation of all your company's domestic establishments for the industry specified in the "Industry" field below. Establishments are
generally single physical locations. Please update the pre-identified establishments for this industry in Item 33A, Pre-identified Locations of Operation.
Name 1
Name 2
NAICS
Industry
For Census Bureau Use Only
CFN
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
1
Item 4: Primary Business or Activity
CFN:
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this consolidated reporting unit's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the consolidated reporting unit's
primary business or activity.
Select only ONE.
Electric services
Hydroelectric power generation
221111 001
Fossil fuel electric power generation
221112 001
Nuclear electric power generation
221113 001
Solar electric power generation
221114 001
Wind electric power generation
221115 001
Geothermal electric power generation
221116 001
Biomass electric power generation, except at landfill
221117 001
Other electric power generation (Excludes hydroelectric, fossil fuel, nuclear, solar, wind, geothermal, and biomass.) - Describe
221118 001
Describe
Electric bulk power transmission and control
221121 001
Electric power distribution
221122 001
Electric power marketers and brokers
221122 002
Natural gas distribution and/or natural gas marketing
221210 005
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2
General Reporting Guidelines
CFN:
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
%
3
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
CFN:
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue of this consolidated reporting unit?
For further clarification, click the "Additional Information" link above.
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2022
$
,000.00
4
Item 7: Employment and Payroll Additional Information
CFN:
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees for this consolidated reporting unit (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2022
$
,000.00
$
,000.00
5
Item 20: Class of Customer
CFN:
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this consolidated reporting unit's total operating revenue (reported in Item 5) by class of customer?
2022 Whole
percent of
revenue
%
1. Residential (Include apartment buildings.)
%
2. Commercial (Include farms.)
%
3. Industrial
%
4. Institutional
%
5. Government (Exclude utilities.)
%
6. Government-owned utilities
7. Private utilities (Include co-ops, etc.)
%
8. Other
%
Describe
9. TOTAL - Sum of lines 1 through 8 should equal 100%. (Exclude utilities.)
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
%
6
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
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 products and services were included?
Select ALL that apply.
Description
Select
Product Code
6000075000
1. Electricity generation
a. Electricity generation (except waste energy generation - incineration at landfill)
b. Non-hazardous waste energy generation services (by incineration at landfill)
6000075003
6000075006
6000075009
c. Hazardous waste energy generation services
2. Electricity distribution and support services (except marketing and brokering)
6000125000
6000150000
3. Electricity (power) marketing and brokering
4. Natural gas distribution and support services (except marketing and brokering)
6000030000
6000035000
5. Natural gas (power) marketing and brokering
6000100000
6. Electricity transmission services
Add product/service not listed
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
7
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Electricity generation
$
,000.00
6000075003
b. Non-hazardous waste energy generation services (by incineration at landfill)
$
,000.00
6000075006
c. Hazardous waste energy generation services
$
,000.00
6000075009
$
,000.00
6000075000
2. Electricity distribution and support services (except marketing and brokering)
$
,000.00
6000125000
3. Electricity (power) marketing and brokering
$
,000.00
6000150000
$
,000.00
6000030000
5. Natural gas (power) marketing and brokering
$
,000.00
6000035000
6. Electricity transmission services
$
,000.00
6000100000
$
,000.00
9900000000
a. Electricity generation (except waste energy generation - incineration at landfill)
Subtotal
4. Natural gas distribution and support services (except marketing and brokering)
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
8
Item 28: Special Items - Exported Energy
CFN:
ITEM 28: SPECIAL ITEMS - EXPORTED ENERGY
Check
if
None
What was the percentage of revenue (reported in Item 5) from exports to customers in Canada and Mexico?
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2022 Whole
percent of
revenue
%
9
Item 28: Special Items - Cost of Electricity
CFN:
ITEM 28: SPECIAL ITEMS - COST OF ELECTRICITY
Check
if
None
1. What was the cost of electricity purchased for resale?
2. What was the revenue from the sale of electricity purchased for resale?
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2022
$
,000.00
$
,000.00
10
Item 28: Special Items - Cost of Natural Gas
CFN:
ITEM 28: SPECIAL ITEMS - COST OF NATURAL GAS
Check
if
None
1. Cost of natural gas purchased for resale
2. Revenue from the sale of natural gas purchased for resale
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
2022
$
,000.00
$
,000.00
11
Item 28: Special Items - New Construction, Including Renovation
CFN:
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
Was this consolidated reporting unit involved in new construction or renovation of buildings, structures, or communication lines during 2022?
Yes
No
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
12
Item 28: Special Items - New Construction, Including Renovation - Continued
CFN:
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
2022
1. What were the capital expenditures for new construction, including renovation?
(Include labor and materials. Exclude land and the value of production machinery and equipment not an integral part of a structure.)
Check
if
None
2. What percentage of the capital expenditures reported above represented work done by your own employees as
opposed to work done by contractors or other hired labor?
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
$
,000.00
2022
%
13
Item 28: Special Items - Maintenance and Repair
CFN:
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
Was this consolidated reporting unit involved in maintenance and repair of buildings, structures, or communication lines owned by your enterprise during 2022?
(Report "No" if expenses were limited to activities such as janitorial services, cleaning, lawn maintenance, etc.)
Yes
No
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
14
Item 28: Special Items - Maintenance and Repair - Continued
CFN:
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
2022
1. What were your expenses for maintenance and repairs?
(Exclude expenses for such activities as janitorial services, cleaning, lawn maintenance, etc.)
$
Check
if
None
2. What percentage of the expenses for maintenance and repairs reported above represented work done by your own
employees as opposed to work done by contractors or other hired labor?
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
,000.00
2022
%
15
Item 29: Business Technologies
CFN:
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this consolidated reporting unit use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this consolidated reporting unit use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this consolidated reporting unit use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this consolidated reporting unit use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
16
5. In 2022, did this consolidated reporting unit use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
Yes
No
Do not know
6. In 2022, did this consolidated reporting unit use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
17
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this consolidated reporting unit acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
18
Item 29: Business Technologies - Additive Manufacturing
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this consolidated reporting unit acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
19
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this consolidated reporting unit acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
20
Item 29: Business Technologies - Industrial Robots
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this consolidated reporting unit acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
21
Item 29: Business Technologies - Service Robots
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this consolidated reporting unit acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
22
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
CFN:
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this consolidated reporting unit acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
23
Item 31: Remarks
CFN:
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
1000
characters remaining
24
Item 33: Locations of Operation Additional Information
CFN:
ITEM 33: LOCATIONS OF OPERATION
A. Complete Item 33A: Pre-Identified Locations of Operation (On the Location List that follows, Type will be 'Pre-listed (Item
33A)')
B. Complete Item 33B: Additional Locations of Operation (On the Location List that follows, Type will be 'Added (Item 33B)')
Number of locations
Include:
All locations in operation or temporarily inactive in Item 33A
All locations added in Item 33B
Exclude:
All locations that have ceased operation or were sold
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
What was the total number of locations in operation in 2022?
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
25
Item 33A: Pre-identified Locations of Operation Additional Information
ITEM 33A: PRE-IDENTIFIED LOCATIONS OF OPERATION
LOCATION INFORMATION
We have listed establishments of your company based on Census records. Correct any errors or omissions below.
(P.O. Box and rural route addresses are not physical locations)
Line No.
EIN
NAICS
99-9999999
Major Activity
Name
Secondary Name
Store/Plant Number
Physical Location (Number and Street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
CFN
EMPLOYMENT AND PAYROLL
Include the number of employees and payroll for 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
Include part-year operations
Do not combine data for establishments
If book figures are not available for employment and payroll for each establishment, please provide your best estimates.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January-March 2022)?
,000.00
OPERATIONAL STATUS
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
26
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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 and address 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.
ZIP Code
State
Select State or Territory
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
99999-9999
27
Item 33B: Additional Locations of Operation Additional Information
ITEM 33B: ADDITIONAL LOCATIONS OF OPERATION
LOCATION INFORMATION
What is this establishment's physical location?
(P.O. Box and rural route addresses are not physical locations)
EIN
99-9999999
Name
Secondary Name
Store/Plant
Physical Location (Number and Street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Date establishment opened or
is expected to open
MMDDYYYY
CFN
EMPLOYMENT AND PAYROLL
Include the number of employees and payroll for 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
Include part-year operations
Do not combine data for establishments
If book figures are not available for employment and payroll for each establishment, please provide your best estimates.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January-March 2022)?
,000.00
MAJOR ACTIVITY CODE
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
28
Select the ACTIVITY CODE that best describes the activity of this establishment and what were the primary products or services?
Activity
Code
Primary products or services
Describe
FORMER OWNER OR OPERATOR INFORMATION
If this establishment was acquired, who was the former owner or operator, and when was this establishment acquired?
Name of former owner or operator
Mailing Address (Number and Street, P.O. Box,
etc.)
City, town, village, etc.
ZIP Code
State
Select State or Territory
Month
Acquired
99999-9999
Year
Acquired
2022_UT-2211A_mu.pdf Generated 2022-02-23 17:13:27
29
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Electric services
Hydroelectric power generation
221111 001
Fossil fuel electric power generation
221112 001
Nuclear electric power generation
221113 001
Solar electric power generation
221114 001
Wind electric power generation
221115 001
Geothermal electric power generation
221116 001
Biomass electric power generation, except at landfill
221117 001
Other electric power generation (Excludes hydroelectric, fossil fuel, nuclear, solar, wind, geothermal, and biomass.) - Describe
221118 001
Describe
Nonhazardous solid waste combustors and incinerators producing electricity at landfill
562213 002
Hazardous solid waste combustors and incinerators producing electricity at landfill
562211 004
Electric bulk power transmission and control
221121 001
Electric power distribution
221122 001
Electric power marketers and brokers
221122 002
Natural gas distribution and/or natural gas marketing
221210 005
Finance services
523130 002
Commodity trading company
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue?
For further clarification, click the "Additional Information" link above.
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating revenue (reported in Item 5) by class of customer?
2022 Whole
percent of
revenue
%
1. Residential (Include apartment buildings.)
2. Commercial (Include farms.)
%
3. Industrial
%
4. Institutional
%
%
5. Government (Exclude utilities.)
6. Government-owned utilities
%
7. Private utilities (Include co-ops, etc.)
%
8. Other
%
Describe
9. TOTAL - Sum of lines 1 through 8 should equal 100%. (Exclude utilities.)
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%
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
6000075000
1. Electricity generation
a. Electricity generation (except waste energy generation - incineration at landfill)
b. Non-hazardous waste energy generation services (by incineration at landfill)
6000075003
6000075006
6000075009
c. Hazardous waste energy generation services
2. Electricity distribution and support services (except marketing and brokering)
6000125000
6000150000
3. Electricity (power) marketing and brokering
4. Natural gas distribution and support services (except marketing and brokering)
6000030000
6000035000
5. Natural gas (power) marketing and brokering
6000100000
6. Electricity transmission services
7. Transportation of natural gas by pipeline, excluding gas field gathering services
7011150000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Electricity generation
a. Electricity generation (except waste energy generation - incineration at landfill)
$
,000.00
6000075003
b. Non-hazardous waste energy generation services (by incineration at landfill)
$
,000.00
6000075006
c. Hazardous waste energy generation services
$
,000.00
6000075009
Subtotal
$
,000.00
6000075000
$
,000.00
6000125000
$
,000.00
6000150000
4. Natural gas distribution and support services (except marketing and brokering)
$
,000.00
6000030000
5. Natural gas (power) marketing and brokering
$
,000.00
6000035000
6. Electricity transmission services
$
,000.00
6000100000
7. Transportation of natural gas by pipeline, excluding gas field gathering services
$
,000.00
7011150000
$
,000.00
9900000000
2. Electricity distribution and support services (except marketing and brokering)
3. Electricity (power) marketing and brokering
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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22
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Energy
ITEM 28: SPECIAL ITEMS - EXPORTED ENERGY
Check
if
None
What was the percentage of revenue (reported in Item 5) from exports to customers in Canada and Mexico?
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
2022 Whole
percent of
revenue
%
24
Item 28: Special Items - Cost of Electricity
ITEM 28: SPECIAL ITEMS - COST OF ELECTRICITY
Check
if
None
1. What was the cost of electricity purchased for resale?
2. What was the revenue from the sale of electricity purchased for resale?
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
2022
$
,000.00
$
,000.00
25
Item 28: Special Items - Cost of Natural Gas
ITEM 28: SPECIAL ITEMS - COST OF NATURAL GAS
Check
if
None
1. Cost of natural gas purchased for resale
2. Revenue from the sale of natural gas purchased for resale
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
2022
$
,000.00
$
,000.00
26
Item 28: Special Items - New Construction, Including Renovation
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
Was this establishment involved in new construction or renovation of buildings, structures, or communication lines during 2022?
Yes
No
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Item 28: Special Items - New Construction, Including Renovation - Continued
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
2022
1. What were the capital expenditures for new construction, including renovation?
(Include labor and materials. Exclude land and the value of production machinery and equipment not an integral part of a structure.)
Check
if
None
2. What percentage of the capital expenditures reported above represented work done by your own employees as
opposed to work done by contractors or other hired labor?
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$
,000.00
2022
%
28
Item 28: Special Items - Maintenance and Repair
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
Was this establishment involved in maintenance and repair of buildings, structures, or communication lines owned by your enterprise during 2022?
(Report "No" if expenses were limited to activities such as janitorial services, cleaning, lawn maintenance, etc.)
Yes
No
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Item 28: Special Items - Maintenance and Repair - Continued
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
2022
1. What were your expenses for maintenance and repairs?
(Exclude expenses for such activities as janitorial services, cleaning, lawn maintenance, etc.)
$
Check
if
None
2. What percentage of the expenses for maintenance and repairs reported above represented work done by your own
employees as opposed to work done by contractors or other hired labor?
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,000.00
2022
%
30
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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33
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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39
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
41
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_UT-22110_su.pdf Generated 2022-02-23 17:08:29
,000.00
42
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Gas production and distribution
Natural gas distribution
221210 003
Natural gas power marketers and brokers
221210 004
Pipeline transportation of natural gas and storage of natural gas
486210 001
Mixed, manufactured, or liquefied petroleum gas production and distribution
221210 002
Electric power distribution and/or electric power marketing
221122 003
Finance services
523130 002
Commodity trading company
Other utility-related activities
Heating/fuel oil dealer
454310 101
Liquefied petroleum (LP) gas dealer
454310 401
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue?
For further clarification, click the "Additional Information" link above.
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating revenue (reported in Item 5) by class of customer?
2022 Whole
percent of
revenue
%
1. Residential (Include apartment buildings.)
2. Commercial (Include farms.)
%
3. Industrial
%
4. Institutional
%
%
5. Government (Exclude utilities.)
6. Government-owned utilities
%
7. Private utilities (Include co-ops, etc.)
%
8. Other
%
Describe
9. TOTAL - Sum of lines 1 through 8 should equal 100%. (Exclude utilities.)
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
%
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Natural gas distribution and support services (except marketing and brokering)
Product Code
6000030000
6000035000
2. Natural gas (power) marketing and brokering
6000075000
3. Electricity generation
a. Electricity generation (except waste energy generation - incineration at landfill)
b. Non-hazardous waste energy generation services (by incineration at landfill)
6000075003
6000075006
6000075009
c. Hazardous waste energy generation services
4. Electricity distribution and support services (except marketing and brokering)
6000125000
6000150000
5. Electricity (power) marketing and brokering
6000100000
6. Electricity transmission services
7. Transportation of natural gas by pipeline, excluding gas field gathering services
7011150000
Add product/service not listed
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21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Natural gas distribution and support services (except marketing and brokering)
$
,000.00
6000030000
2. Natural gas (power) marketing and brokering
$
,000.00
6000035000
a. Electricity generation (except waste energy generation - incineration at landfill)
$
,000.00
6000075003
b. Non-hazardous waste energy generation services (by incineration at landfill)
$
,000.00
6000075006
c. Hazardous waste energy generation services
$
,000.00
6000075009
$
,000.00
6000075000
4. Electricity distribution and support services (except marketing and brokering)
$
,000.00
6000125000
5. Electricity (power) marketing and brokering
$
,000.00
6000150000
6. Electricity transmission services
$
,000.00
6000100000
7. Transportation of natural gas by pipeline, excluding gas field gathering services
$
,000.00
7011150000
$
,000.00
9900000000
3. Electricity generation
Subtotal
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
22
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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23
Item 28: Special Items - Exported Energy
ITEM 28: SPECIAL ITEMS - EXPORTED ENERGY
Check
if
None
What was the percentage of revenue (reported in Item 5) from exports to customers in Canada and Mexico?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
2022 Whole
percent of
revenue
%
24
Item 28: Special Items - Cost of Electricity
ITEM 28: SPECIAL ITEMS - COST OF ELECTRICITY
Check
if
None
1. What was the cost of electricity purchased for resale?
2. What was the revenue from the sale of electricity purchased for resale?
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
2022
$
,000.00
$
,000.00
25
Item 28: Special Items - Cost of Natural Gas
ITEM 28: SPECIAL ITEMS - COST OF NATURAL GAS
Check
if
None
1. Cost of natural gas purchased for resale
2. Revenue from the sale of natural gas purchased for resale
(Revenue reported here should be less than or equal to the revenue reported in Item 5.)
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
2022
$
,000.00
$
,000.00
26
Item 28: Special Items - New Construction, Including Renovation
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
Was this establishment involved in new construction or renovation of buildings, structures, or communication lines during 2022?
Yes
No
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27
Item 28: Special Items - New Construction, Including Renovation - Continued
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
2022
1. What were the capital expenditures for new construction, including renovation?
(Include labor and materials. Exclude land and the value of production machinery and equipment not an integral part of a structure.)
Check
if
None
2. What percentage of the capital expenditures reported above represented work done by your own employees as
opposed to work done by contractors or other hired labor?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
$
,000.00
2022
%
28
Item 28: Special Items - Maintenance and Repair
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
Was this establishment involved in maintenance and repair of buildings, structures, or communication lines owned by your enterprise during 2022?
(Report "No" if expenses were limited to activities such as janitorial services, cleaning, lawn maintenance, etc.)
Yes
No
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29
Item 28: Special Items - Maintenance and Repair - Continued
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
2022
1. What were your expenses for maintenance and repairs?
(Exclude expenses for such activities as janitorial services, cleaning, lawn maintenance, etc.)
$
Check
if
None
2. What percentage of the expenses for maintenance and repairs reported above represented work done by your own
employees as opposed to work done by contractors or other hired labor?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
,000.00
2022
%
30
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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31
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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32
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
33
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
34
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
35
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
36
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
37
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
38
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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39
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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40
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
1000
characters remaining
41
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_UT-22120_su.pdf Generated 2022-02-23 17:10:04
,000.00
42
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Water, sewerage, and other systems
Water supply and water treatment, except irrigation
221310 003
Irrigation system
221310 001
Sewerage system, including sewage treatment plant
221320 001
Steam or air-conditioning supply, including geothermal
221330 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue?
For further clarification, click the "Additional Information" link above.
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating revenue (reported in Item 5) by class of customer?
2022 Whole
percent of
revenue
%
1. Residential (Include apartment buildings.)
2. Commercial (Include farms.)
%
3. Industrial
%
4. Institutional
%
%
5. Government (Exclude utilities.)
6. Government-owned utilities
%
7. Private utilities (Include co-ops, etc.)
%
8. Other
%
Describe
9. TOTAL - Sum of lines 1 through 8 should equal 100%. (Exclude utilities.)
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%
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Water supply and sewage treatment services (including waste water treatment)
a. Water supply, transmission, treatment, and distribution, including water supply through irrigation systems
Product Code
6000175000
6000175003
6000175006
b. Sewage treatment
6000050000
2. Steam distribution services, including air-conditioning
Add product/service not listed
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21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Water supply and sewage treatment services (including waste water treatment)
a. Water supply, transmission, treatment, and distribution, including water supply through irrigation systems
$
,000.00
6000175003
b. Sewage treatment
$
,000.00
6000175006
Subtotal
$
,000.00
6000175000
2. Steam distribution services, including air-conditioning
$
,000.00
6000050000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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22
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - New Construction, Including Renovation
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
Was this establishment involved in new construction or renovation of buildings, structures, or communication lines during 2022?
Yes
No
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24
Item 28: Special Items - New Construction, Including Renovation - Continued
ITEM 28: SPECIAL ITEMS - NEW CONSTRUCTION, INCLUDING RENOVATION
2022
1. What were the capital expenditures for new construction, including renovation?
(Include labor and materials. Exclude land and the value of production machinery and equipment not an integral part of a structure.)
Check
if
None
2. What percentage of the capital expenditures reported above represented work done by your own employees as
opposed to work done by contractors or other hired labor?
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$
,000.00
2022
%
25
Item 28: Special Items - Maintenance and Repair
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
Was this establishment involved in maintenance and repair of buildings, structures, or communication lines owned by your enterprise during 2022?
(Report "No" if expenses were limited to activities such as janitorial services, cleaning, lawn maintenance, etc.)
Yes
No
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26
Item 28: Special Items - Maintenance and Repair - Continued
ITEM 28: SPECIAL ITEMS - MAINTENANCE AND REPAIR
2022
1. What were your expenses for maintenance and repairs?
(Exclude expenses for such activities as janitorial services, cleaning, lawn maintenance, etc.)
$
Check
if
None
2. What percentage of the expenses for maintenance and repairs reported above represented work done by your own
employees as opposed to work done by contractors or other hired labor?
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,000.00
2022
%
27
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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30
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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31
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
38
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_UT-22130_su.pdf Generated 2022-02-23 17:11:49
,000.00
39
Attachment D-4
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 23
Attachment Sector
D-4
23
Instrument
Path
Instrument Path Title
23610
23810
23830
23890
Residential and Nonresidential Building Construction
Foundation, Structure, and Building Exterior Contractors
Building Finishing Contractors
Other Specialty Trade Contractors
Location Information
DEFINITION OF ESTABLISHMENT
The reporting unit for this questionnaire is a construction establishment which is generally a permanent office, payroll office, or other place where business activities related to
construction are conducted. A construction establishment manages one or more projects or jobs and is usually maintained on a continuing basis.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Temporary construction site
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
New single-family housing construction (excluding for-sale builders), including attached and detached housing
236115 001
New multifamily housing construction (excluding for-sale builders), including apartments and condominiums
236116 001
New housing for-sale builder of single-family housing and multifamily housing
236117 001
Residential remodeler for home improvement (e.g., adding on, renovating, maintenance, and repair), including remodeling homes for resale
236118 001
Industrial building construction (e.g., processing and assembly plants, factories, refineries, waste disposal facilities), excluding warehouses
and sewage disposal plants
236210 001
Commercial and institutional building construction (e.g., office and school buildings, hospitals, health and data facilities, stores, and
warehouses)
236220 001
Water and sewer line and related structures construction (e.g., mains, sewage disposal plants, pumping stations, and water well drilling)
237110 001
Oil and gas pipeline and related structures construction (e.g., mains, petrochemical plants, pumping stations, and oil refineries)
237120 001
Power and communication line and related structures construction (e.g., alternative energy structures, power plants, transformer stations,
high voltage transmission cable connections, and cellular phone towers)
237130 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Highway, street, and bridge construction, including curbs, airport runway construction, and line painting of streets and parking lots
237310 001
Other heavy and civil engineering construction (e.g., tunnels, railways, outside recreation areas, dams, flood and drainage control projects,
dredging, trenching, and marine facilities)
237990 001
Poured concrete foundation and structure contractor (e.g., shotcrete, mud-jacking, gunning, gunite, pumping, and placement footing)
238110 001
Structural steel and precast concrete contractor, including structural iron work
238120 001
Framing contractor, including wood and steel (excluding structural steel or precast concrete)
238130 001
Masonry contractor (e.g., brick, stone, slate, glass block, cement, cinder blocking, stucco setting and other stone work)
238140 001
Glass and glazing contractor (e.g., glass coating and tinting (excluding automotive), window pane, glass sheet, glass curtain wall, and mirror
installation)
238150 001
Roofing contractor, including treating roofs (i.e., spraying, painting or coating) and skylight installation
238160 001
Siding contractor (e.g., gutters, downspouts, fascia, soffit, eavestrough, flashing, and ice apron)
238170 001
Other foundation, structure, and building exterior contractor (e.g., awning, metal balcony and stairway, and falsework construction), including
decorative steel and wrought iron work; poured concrete form installation and dismantling; and welding at site
238190 001
Electrical and other wiring installation contractor (e.g., electronic and environmental controls, telecommunications and fiber optic equipment
(excluding transmission line), solar panel installation, traffic signals, and fire and security systems)
238210 001
Plumbing, heating, and air-conditioning (HVAC) contractor, including installation, maintenance, and repair of refrigeration systems, sprinkler
systems, water systems, gas and oil line individual hookups, and steam and pipe fittings
238220 001
Other building equipment contractor (e.g., millwrights, machine rigging), including installation, maintenance, and repair of ATM equipment,
elevators, escalators, service station gasoline pumps, commercial and industrial doors)
238290 001
Drywall and insulation contractor, including acoustical, plastering, and fireproofing contractors
238310 001
Painting and wall covering contractor, including on-site electrostatic painting, whitewashing, and rustproofing of buildings, ships, bridges,
tanks, and towers (excluding automotive)
238320 001
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15
Flooring contractor (e.g., laying carpet, linoleum, hardwood, laminate, and vinyl flooring), excluding fireproof, stone, concrete, and ceramic
tile flooring
238330 001
Tile and terrazzo contractor (e.g., marble, granite, slate, ceramic, stone, and mosaic work for floors, walls, and ceilings), excluding exterior
marble, granite, and slate work
238340 001
Finish carpentry contractor (e.g., door, window, cabinetry, countertop, stairway, deck, molding, trim, and paneling work, residential-type,
installation), excluding framing
238350 001
Other building finishing contractor (e.g., waterproofing, spectator seating, modular furniture system attachments, closet organizer systems,
concrete coating, window shades and blinds, and trade show exhibit installation and dismantling)
238390 001
Site preparation contractor, without land subdivision (e.g., land clearing, drilling, demolition, trenching, and earthmoving), and rental of
construction equipment with operators (excluding cranes))
238910 001
All other specialty trade contractor (e.g., driveway paving; constructions of residential and commercial parking lots, sidewalks, patios, and
outdoor swimming pools; installation of fences (excluding electric) and playground equipment; and crane rental with operator)
238990 001
Other primary business or activity
779000 001
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Receipts (or billings) derived from contract construction work done for others
Sales of houses and other buildings you built and sold
Construction management and design-build contracts
Site preparation receipts, such as land clearing, laying roads, installing utilities, and subdividing land into lots (Exclude purchase cost of land or estimated value of raw land for
construction projects.)
Architectural services, except the design portion of integrated design-build contracts
Engineering services
Rental or lease of properties
Real estate commissions and property management fees
Rental of construction machinery or equipment to others, without an operator
Manufacturing, mining, and transportation activities
Retail and wholesale trades
Other business activities
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building structure)
Purchased cost of land or estimated value of raw land for construction projects (Include site preparation receipts.)
Non-operating income such as interest, dividends, or the sale of fixed assets.
What were the receipts for all business activities done by this establishment, including receipts, billings, or sales for
construction work? (Construction work includes new construction and remodeling as well as maintenance and repair
work. The activities of prime and trade contractors are considered to be construction. Some trades not traditionally
thought of as construction are included such as land subdivision, excavation, building demolition, painting, carpet-laying,
water well drilling, plumbing and electrical work.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
Check
if
None
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Number of employees at this establishment
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
If the legal form of organization for this business is a corporation, the reporting of other employees and other payroll at this establishment is required. Enter "0" if the establishment
did not have payroll and employment for specific data for this EIN. If payroll and employment for this EIN are zero, please indicate if the EIN is a joint venture or reason why data
are zero in Item 31: Remarks at the end of the survey.
All persons on paid sick leave, paid holidays, and paid vacation during the year at this establishment
Spread on stock options that are taxable to employees at this establishment as wages
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.)
Contractors, subcontractors, or independent contractors
Purchased or managed services, such as janitorial, security, or landscape services (Report values in Item 16, line C9.)
Purchased professional and technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services (Report
values in Item 16, line C9.)
Members of the Armed Forces and pensioners carried on your active rolls
Proprietors and partners, if an unincorporated concern
Number of construction workers at this establishment include:
Apprentices
Working foremen
Equipment operators and mechanics
Journeymen
Job-site record keepers
Craftsmen
Laborers
Truck drivers and helpers
Others engaged directly in construction
Number of other employees at this establishment include:
Supervisors above working foremen
Office staff
Executives
Architects
Purchasing Agents
Personnel staff
Engineers
Accounting staff
Others engaged in non-construction activities
A. Number of employees at this establishment for the pay period including the 12th of the month.
March 2022
June 2022
September 2022
December 2022
1. What was the number of construction workers
(direct labor including first-line supervisors)?
2. What was the number of other employees?
TOTAL (Add lines A1 and A2.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
20
B. HOURS WORKED
Check
if
None
2022 Hours
What was the annual number of hours worked by the construction workers at this establishment (direct labor
including first-line supervisors) reported in line A?
,000
C. PAYROLL
Include:
Payroll for officers at this establishment
Exclude:
Income or costs not recorded as payroll for IRS by establishment.
Employer-paid annual cost for fringe benefits reported in lines 7D1 and 7D2
Check
if
None
2022
1. What was the annual payroll at this establishment before deductions for construction workers (direct labor
including first-line supervisors)?
$
,000.00
2. What was the annual payroll before deductions for other employees?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $0,000.00 reported above, what was the first quarter payroll at this establishment before deductions
(January-March 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
Check
if
None
2022
1. What were the legally required fringe benefits? (Include employer payments for Social Security, Medicare,
unemployment compensation, workmen's compensation, and State disability programs, if required.)
$
,000.00
2. What were the voluntarily provided fringe benefits? (Include such items as payments for life insurance, medical
insurance, pensions, welfare benefits, and union-negotiated benefits.)
$
,000.00
TOTAL (Add lines D1 and D2.)
$
,000.00
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
21
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Include:
Inventories, regardless of where held, for materials and supplies owned by this establishment as of December 31
Exclude:
Work-in-progress and finished units
Using current cost, what was the value of inventories owned
by this establishment as of December 31? (If using LIFO
method of evaluation, adjust to obtain FIFO or current cost.)
Check
if
None
2022
$
2021
,000.00
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
$
,000.00
22
Item 13: Assets, Capital Expenditures, and Retirements Additional Information
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS
Exclude
Land (Report cost of land acquired during the year in Item 16A, line 5.)
Check
if
None
2022
$
,000.00
B. What were the capital expenditures for new and used depreciable assets?
$
,000.00
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc.?
$
,000.00
D. What was the value of depreciable assets at the end of the year? (Add lines A and B minus line C.)
$
,000.00
A. What was the gross value of depreciable assets (usually original cost) at the beginning of the year?
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
23
Item 14: Rental Payments Additional Information
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,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.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
24
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
A. For this establishment, what were the cost of materials, subcontract work, fuels, electricity, and land acquired in 2022 for:
Include:
Current account expenses normally considered as cost of work performed or job-specific costs
1. Cost of materials, parts, and supplies?
Include:
All job-site, office, and construction materials and supplies
Cost of materials purchased by this establishment's subcontractors
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building
structure)
Non-construction-related expenses that were paid to subcontractors by this establishment (Report these
expense details on the next screen, Item 16: Selected Expenses - Continued, in line C.)
Check
if
None
2022
$
,000.00
$
,000.00
a. Natural gas and manufactured gas (propane)?
$
,000.00
b. Gasoline and diesel fuel - ON highway (not at site)?
$
,000.00
c. Gasoline and diesel fuel - OFF highway (at site)?
$
,000.00
$
,000.00
$
,000.00
2. Cost of construction-related work subcontracted out to others?
Exclude:
Cost of materials purchased by this establishment for subcontractors (These costs should be reported in line
A1.)
Check
if
None
3. Cost of fuels for heat, power, lubricants
Check
if
None
d. All other fuels and lubricants, including heating oils, lubricating oils, and greases?
Check
if
None
4. Cost of electricity?
5. When you answered Item 5, did you include the purchased cost of land or estimated value of raw land? Please check one, and answer the below question.
Yes
No
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
25
Check
if
None
6. What was the purchased cost of land or estimated value of raw land for reported construction projects during the
covered time?
$
,000.00
$
,000.00
Check
if
None
B. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
26
Item 16: Selected Expenses - Continued Additional Information
ITEM 16: SELECTED EXPENSES
C. What were the other operating expenses paid by this establishment in 2022 for:
1. Temporary staff and leased employees? (Professional Employer Organizations and staffing agencies for
personnel)
Include:
All charges for payroll, benefits, and services your establishment paid to the Professional Employer
Organizations for the temporary staff and leased employees
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report on line C3.)
Leased and rented equipment (Report on 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
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
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
27
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data Storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
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 in line C6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in line C9 and credit
card transaction fees in line C4.)
Expenses for telecommunication services (e.g., Internet, connectivity, telephone) (Report in line C4.)
$
,000.00
Exclude
Materials, parts, and supplies used for repairs and maintenance performed by this firm's employees
$
,000.00
7. Water, sewer, refuse removal, and other non-electric utility payments?
(Report electric utility payments in Item 16, line A4. If the cost of these utilities is included in a leased or rental
payment, report in Item 14, line A.)
Include:
Cost of hazardous waste removal
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
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. such as janitorial, security, or landscape services)
Exclude:
Salaries paid to your own employees for these services (Report in Item 7.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
28
10. Governmental taxes and licensing fees?(Payments to government agencies for taxes and licenses)
Include:
Business and property tax fees for establishment to remain active legal operable business
Permits and licensing fees
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Include:
Expenses for paid temporary day labors not on your payroll or hired as construction subcontractors
Exclude:
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included? Select ALL that apply.
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
The construction project types listed below are general to your industry. Select the project types that apply to your establishment. On the next screen, you will report the specific
construction products and services related to the construction projects you select. If you have revenue from other sources not listed, you will have the opportunity to report them later.
At-risk construction project management revenue should be reported with the specific construction project associated with those management services. For example, if at-risk
construction project management is for office buildings, then include the management revenue with the project for office buildings. However, at-fee project management services
should be reported in the specific project for construction project management services.
Description
Select
Amusement, social, and recreational building construction
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
Commercial warehouses, such as distribution buildings and mini-storage
Project Code
334
322
359
327
319
Dormitories and barracks
329
Educational building construction
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
323
333
Farm building construction, nonresidential
331
Health care and institutional building construction
324
Hotel, motel, and inn construction
321
Industrial warehouse construction
Nonresidential mobile building construction, office and other commercial
335
325
Office building construction
332
Public safety building construction
328
Religious building construction
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
30
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
326
336
338
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
318
314
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
317
316
Single detached residential building construction
346
Bridge and elevated highway
Conservation and development construction, including dams, drainage canals, and flood control projects
368
378
Fencing
373
Harbor and port facilities
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
341
357
Hydroelectric power plants
Oil and gas pipelines, pumping stations, storage tanks, and mains
353
364
Petrochemical plant and petroleum refinery construction
Power and cogeneration plant construction, except hydroelectric construction
Power and communication transmission line, cable, tower, and related facilities
Private driveway and parking area construction, except garages
356
354
343
361
Sewage and water treatment plants
Sewers, sewer lines, septic systems, and related facilities
351
375
Swimming pools
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
31
347
Tunnels
352
Water mains, storage wells, and related facilities
395
Other nonresidential constructions, except buildings
Other specialized cleaning services, not elsewhere classified
399
376
Residential decks
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
Project management services, except at-risk, for building and non-building projects
377
313
Add product/service not listed
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
32
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services associated with the construction projects you previously selected. If you have revenue from sources not listed, describe and report them in the
"All other sales, shipments, receipts, or revenue from this establishment" section at the end of this question.
At-risk construction project management revenue should be reported with the specific constructions or construction services associated with those management services. For
example, if at-risk construction project management is for entire office building constructions, then include the management revenue with the new constructions for office buildings.
However, at-fee project management services should be reported in the specific product lines for construction project management services.
New Constructions and Construction Services – Report only the main activities including the type of buildings, structures, or facilities contracted to construct or work on by this
establishment in the reporting year in which this establishment received receipts only. If you worked on more than one type of building or structure in a multipurpose complex, report
separately for each building or type of structure. However, if you worked on a building that had more than one purpose, i.e. office, residential, or commercial, classify this building by
its major purpose.
New constructions include all components of the entire original building or structure. Land development work on the site and demolition of existing structures are included with
new constructions.
Construction services for new building or structures include separate components of the original building or structure, such as electric work, painting, plumbing, etc.
Construction services for additions, renovations, and alterations to buildings or structures include construction work which adds to the value of useful life of an existing
building or structure, or which adapts a building or structure to a new or different use. Included are “major replacements” of building systems such as the installation of a new
roof or heating system, and the resurfacing of streets or highways. Exclude activities such as the repair of a hole in a roof or the routine patching of highways and streets, which
are classified as “maintenance and repair work”.
Construction services for maintenance and repair of buildings or structures include incidental construction work that keeps a property in ordinary working condition.
Exclude trash and snow removal, lawn maintenance, and janitorial services.
Description
Value
Product Code
Amusement, social, and recreational building construction
1. Amusement, social, and recreational building new constructions (by builders and at-risk project managers)
$
,000.00
3000875000
2. Construction services for new amusement, social, and recreational buildings
$
,000.00
3001350000
3. Construction services for additions, renovations, and alterations to amusement, social, and recreational buildings
$
,000.00
3001750000
4. Construction services for maintenance and repair of amusement, social, and recreational buildings
$
,000.00
3002150000
5. Apartment building (two or more units) new constructions, excluding condominiums (by builders and at-risk project
managers)
$
,000.00
3000625000
6. Construction services for new apartment buildings (two or more units), excluding condominiums
$
,000.00
3001050000
7. Construction services for additions, renovations, and alterations to apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001075000
8. Construction services for maintenance and repair of apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001100000
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
33
9. Chemical (except petrochemical) complex/plant, blast furnace, and mining appurtenance new constructions (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002600000
10. Construction services for new chemical (except petrochemical) complexes/plants, blast furnaces, and mining
appurtenances
$
,000.00
3003250000
11. Construction services for additions, renovations, and alterations to chemical (except petrochemical)
complexes/plants, blast furnaces, and mining appurtenances
$
,000.00
3003900000
12. Construction services for maintenance and repair of chemical (except petrochemical) complexes/plants, blast
furnaces, and mining appurtenances
$
,000.00
3004550000
13. Commercial warehouse new constructions, such as distribution buildings and mini-storage (by builders and at-risk
project managers)
$
,000.00
3000750000
14. Construction services for new commercial warehouses, such as distribution buildings and mini-storage
$
,000.00
3001225000
15. Construction services for additions, renovations, and alterations to commercial warehouses, such as distribution
buildings and mini-storage
$
,000.00
3001625000
16. Construction services for maintenance and repair of commercial warehouses, such as distribution buildings and
mini-storage
$
,000.00
3002025000
17. Educational institution dormitories new constructions (by builders and at-risk project mangers)
$
,000.00
3001005000
18. Military and other public safety dormitories and barracks new constructions (by builders and at-risk project
managers)
$
,000.00
3001010000
$
,000.00
3001480000
20. Construction services for new military and other public safety dormitories and barracks
$
,000.00
3001485000
21. Construction services for additions, renovations, and alterations to educational institution dormitories
$
,000.00
3001880000
22. Construction services for additions, renovations, and alterations to military and other public safety dormitories and
barracks
$
,000.00
3001885000
$
,000.00
3002280000
$
,000.00
3002285000
25. Educational building new constructions (by builders and at-risk project managers)
$
,000.00
3000825000
26. Construction services for new educational buildings
$
,000.00
3001300000
Commercial warehouses, such as distribution buildings and mini-storage
Dormitories and barracks
19. Construction services for new educational institution dormitories
23. Construction services for maintenance and repair of educational institution dormitories
24. Construction services for maintenance and repair of military and other public safety dormitories and barracks
Educational building construction
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
34
27. Construction services for additions, renovations, and alterations to educational buildings
$
,000.00
3001700000
28. Construction services for maintenance and repair of educational buildings
$
,000.00
3002100000
29. Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building new
constructions (by builders and at-risk project managers)
$
,000.00
3000700000
30. Construction services for new factories, assembly plants, industrial research laboratories, and other new
manufacturing and industrial buildings
$
,000.00
3001175000
31. Construction services for additions, renovations, and alterations to factories, assembly plants, industrial research
laboratories, and other manufacturing and industrial buildings
$
,000.00
3001575000
32. Construction services for maintenance and repair of factories, assembly plants, industrial research laboratories, and
other manufacturing and industrial buildings
$
,000.00
3001975000
$
,000.00
3000975000
$
,000.00
3001450000
35. Construction services for additions, renovations, and alterations to farm buildings, nonresidential
$
,000.00
3001850000
36. Construction services for maintenance and repair of farm buildings, nonresidential
$
,000.00
3002250000
$
,000.00
3000850000
$
,000.00
3001325000
39. Construction services for additions, renovations, and alterations to health care and institutional buildings
$
,000.00
3001725000
40. Construction services for maintenance and repair of health care and institutional buildings
$
,000.00
3002125000
41. Hotel, motel, and inn new constructions (by builders and at-risk project managers)
$
,000.00
3000650000
42. Construction services for new hotels, motels, and inns
$
,000.00
3001125000
43. Construction services for additions, renovations, and alterations to hotels, motels, and inns
$
,000.00
3001525000
44. Construction services for maintenance and repair of hotels, motels, and inns
$
,000.00
3001925000
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
Farm building construction, nonresidential
33. Farm building new constructions, nonresidential (by builders and at-risk project managers)
34. Construction services for new farm buildings, nonresidential
Health care and institutional building construction
37. Health care and institutional buildings new constructions (by builders and at-risk project managers)
38. Construction services for new health care and institutional buildings
Hotel, motel, and inn construction
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
35
Industrial warehouse construction
45. Industrial warehouse new constructions at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000680000
46. Industrial warehouse new constructions not at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000685000
47. Construction services for new industrial warehouses at manufacturing sites
$
,000.00
3001155000
48. Construction services for new industrial warehouses not at manufacturing sites
$
,000.00
3001160000
49. Construction services for additions, renovations, and alterations to industrial warehouses at manufacturing sites
$
,000.00
3001555000
50. Construction services for additions, renovations, and alterations to industrial warehouses not at manufacturing sites
$
,000.00
3001560000
51. Construction services for maintenance and repair of industrial warehouses at manufacturing sites
$
,000.00
3001955000
$
,000.00
3001960000
53. Nonresidential mobile building new constructions, office (by builders and at-risk project managers)
$
,000.00
3000930000
54. Nonresidential mobile building new constructions, other commercial (by builders and at-risk project managers)
$
,000.00
3000935000
55. Construction services for new nonresidential mobile building constructions, office
$
,000.00
3001405000
56. Construction services for new nonresidential mobile building constructions, other commercial
$
,000.00
3001410000
57. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
office
$
,000.00
3001805000
58. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
other commercial
$
,000.00
3001810000
59. Construction services for maintenance and repair of nonresidential mobile building constructions, office
$
,000.00
3002205000
60. Construction services for maintenance and repair of nonresidential mobile building constructions, other commercial
$
,000.00
3002210000
61. Office building and data center new constructions (by builders and at-risk project managers)
$
,000.00
3000725000
62. Construction services for new office buildings and data centers
$
,000.00
3001200000
63. Construction services for additions, renovations, and alterations to office buildings and data centers
$
,000.00
3001600000
52. Construction services for maintenance and repair of industrial warehouses not at manufacturing sites
Nonresidential mobile building construction, office and other commercial
Office building construction
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
36
64. Construction services for maintenance and repair of office buildings and data centers
$
,000.00
3002000000
65. Public safety building new constructions (by builders and at-risk project managers)
$
,000.00
3000900000
66. Construction services for new public safety buildings
$
,000.00
3001375000
67. Construction services for additions, renovations, and alterations to public safety buildings
$
,000.00
3001775000
68. Construction services for maintenance and repair of public safety buildings
$
,000.00
3002175000
$
,000.00
3000800000
70. Construction services for new religious buildings
$
,000.00
3001275000
71. Construction services for additions, renovations, and alterations to religious buildings
$
,000.00
3001675000
72. Construction services for maintenance and repair of religious buildings
$
,000.00
3002075000
73. Store, restaurant, automobile service station, parking garage, and other commercial building new constructions
(excluding mobile buildings)(by builders and at-risk project managers)
$
,000.00
3000775000
74. Construction services for new stores, restaurants, automobile service stations, parking garages, and other
commercial buildings (excluding mobile buildings)
$
,000.00
3001250000
75. Construction services for additions, renovations, and alterations to stores, restaurants, automobile service stations,
parking garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3001650000
76. Construction services for maintenance and repair of stores, restaurants, automobile service stations, parking
garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3002050000
77. Nonresidential mobile building new constructions, classroom (by builders and at-risk project managers)
$
,000.00
3000955000
78. Nonresidential mobile building new constructions, industrial (by builders and at-risk project managers)
$
,000.00
3000960000
79. Construction services for new nonresidential mobile building constructions, classroom
$
,000.00
3001430000
80. Construction services for new nonresidential mobile building constructions, industrial
$
,000.00
3001435000
81. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, classrooms
$
,000.00
3001830000
Public safety building construction
Religious building construction
69. Religious building new constructions (by builders and at-risk project managers)
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
37
82. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, industrial
$
,000.00
3001835000
83. Construction services for maintenance and repair of other nonresidential mobile building constructions, classrooms
$
,000.00
3002230000
84. Construction services for maintenance and repair of other nonresidential mobile building constructions, industrial
$
,000.00
3002235000
85. All other nonresidential building new constructions (by builders and at-risk project managers)
$
,000.00
3001025000
86. Construction services for all other new nonresidential buildings
$
,000.00
3001500000
87. Construction services for additions, renovations, and alterations to all other nonresidential buildings
$
,000.00
3001900000
88. Construction services for maintenance and repair of all other nonresidential buildings
$
,000.00
3002300000
89. Constructions of new apartment type condominiums, excluding single family condominiums (by builders and at-risk
project managers)
$
,000.00
3000100000
90. Construction services for new apartment type condominiums, excluding single family condominiums
$
,000.00
3000200000
91. Construction services for additions, renovations, and alterations to apartment type condominiums, excluding single
family condominiums
$
,000.00
3000300000
92. Construction services for maintenance and repair of apartment type condominiums, excluding single family
condominiums
$
,000.00
3000400000
93. Constructions of new manufactured (mobile) homes, all width sizes (including multisection) (by builders and at-risk
project managers)
$
,000.00
3000075000
94. Construction services for new manufactured homes (mobile homes), all width sizes (including multisection)
$
,000.00
3000175000
95. Construction services for additions, renovations, and alterations to manufactured homes (mobile homes), all width
sizes (including multisection)
$
,000.00
3000275000
96. Construction services for maintenance and repair of manufactured homes (mobile homes), all width sizes (including
multisection)
$
,000.00
3000375000
97. Constructions of new single attached residential buildings, including row houses and town houses (by builders and
at-risk project managers)
$
,000.00
3000050000
98. Construction services for new single attached residential buildings, including row houses and town houses
$
,000.00
3000150000
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
38
99. Construction services for additions, renovations, and alterations to single attached residential buildings, including
row houses and town houses
$
,000.00
3000250000
100. Construction services for maintenance and repair of single attached residential buildings, including row houses and
town houses
$
,000.00
3000350000
101. Constructions of new single detached residential buildings (by builders and at-risk project managers)
$
,000.00
3000025000
102. Construction services for new single detached residential buildings
$
,000.00
3000125000
103. Construction services for additions, renovations, and alterations to single detached residential buildings
$
,000.00
3000225000
104. Construction services for maintenance and repair of single detached residential buildings
$
,000.00
3000325000
105. Bridge and elevated highway new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002375000
106. Construction services for new bridges and elevated highways
$
,000.00
3003025000
107. Construction services for additions, renovations, and alterations to bridges and elevated highways
$
,000.00
3003675000
108. Construction services for maintenance and repair of bridges and elevated highways
$
,000.00
3004325000
109. Conservation and development new constructions, including dams, drainage canals, and flood control projects (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002650000
110. Construction services for new conservation and development constructions, including dams, drainage canals, and
flood control projects
$
,000.00
3003300000
111. Construction services for additions, renovations, and alterations to conservation and development constructions,
including dams, drainage canals, and flood control projects
$
,000.00
3003950000
112. Construction services for maintenance and repair of conservation and development constructions, including dams,
drainage canals, and flood control projects
$
,000.00
3004600000
$
,000.00
3002825000
$
,000.00
3003475000
115. Construction services for additions, renovations, and alterations to fencing constructions
$
,000.00
3004125000
116. Construction services for maintenance and repair of fencing constructions
$
,000.00
3004750000
Single detached residential building construction
Bridge and elevated highway
Conservation and development construction, including dams, drainage canals, and flood control projects
Fencing
113. Fencing new constructions (by heavy construction contractors and at-risk project managers)
114. Construction services for new fencing constructions
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
39
Harbor and port facilities
117. Harbor and port facilities new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002725000
118. Construction services for new harbor and port facilities
$
,000.00
3003375000
119. Construction services for additions, renovations, and alterations to harbor and port facilities
$
,000.00
3004025000
120. Construction services for maintenance and repair of harbor and port facilities
$
,000.00
3004675000
121. Highway, street, and related work new constructions, including public sidewalks, curbs, guardrails and signs (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002325000
122. Construction services for new highways, streets, and related work, including public sidewalks, curbs, guardrails
and signs
$
,000.00
3002975000
123. Construction services for additions, renovations, and alterations to highways, streets, and related works, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3003625000
124. Construction services for maintenance and repair of highways, streets, and related work constructions, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3004275000
$
,000.00
3002575000
$
,000.00
3003225000
$
,000.00
3003875000
$
,000.00
3004525000
$
,000.00
3002500000
$
,000.00
3003150000
131. Construction services for additions, renovations, and alterations to oil and gas pipelines, pumping stations, storage
tanks, and mains
$
,000.00
3003800000
132. Construction services for maintenance and repair of oil and gas pipelines, pumping stations, storage tanks, and
mains
$
,000.00
3004450000
$
,000.00
3002625000
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
Hydroelectric power plants
125. Power plant new constructions, hydroelectric (by heavy construction contractors and at-risk project managers)
126. Construction services for new power plants, hydroelectric
127. Construction services for additions, renovations, and alterations to power plants, hydroelectric
128. Construction services for maintenance and repair of power plants, hydroelectric
Oil and gas pipelines, pumping stations, storage tanks, and mains
129. Oil and gas pipeline, pumping station, storage tank, and main new constructions (by heavy construction
contractors and at-risk project managers)
130. Construction services for new oil and gas pipelines, pumping stations, storage tanks, and mains
Petrochemical plant and petroleum refinery construction
133. Petrochemical plant and petroleum refinery new constructions (by heavy construction contractors and at-risk
project managers)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
40
134. Construction services for new petrochemical plants and petroleum refineries
$
,000.00
3003275000
$
,000.00
3003925000
$
,000.00
3004575000
$
,000.00
3002550000
$
,000.00
3003200000
$
,000.00
3003850000
$
,000.00
3004500000
141. Power and communication transmission line, cable, tower, and related facilities new constructions (by heavy
construction contractors and at-risk project managers)
$
,000.00
3002525000
142. Construction services for new power and communication transmission lines, cables, towers, and related facilities
$
,000.00
3003175000
143. Construction services for additions, renovations, and alterations to power and communication transmission lines,
cables, towers, and related facilities
$
,000.00
3003825000
144. Construction services for maintenance and repair of power and communication transmission lines, cables, towers,
and related facilities
$
,000.00
3004475000
145. Private driveway and parking area new constructions, except garages (by heavy construction contractors and atrisk project managers)
$
,000.00
3002350000
146. Construction services for new private driveways and parking areas, excluding garages
$
,000.00
3003000000
147. Construction services for additions, renovations, and alterations to private driveways and parking areas, excluding
garages
$
,000.00
3003650000
148. Construction services for maintenance and repair of private driveways and parking areas, excluding garages
$
,000.00
3004300000
149. Sewage and water treatment plant new constructions(by heavy construction contractors and at-risk project
managers)
$
,000.00
3002475000
150. Construction services for new sewage and water treatment plants
$
,000.00
3003125000
135. Construction services for additions, renovations, and alterations to petrochemical plants and petroleum refineries
136. Construction services for maintenance and repair of petrochemical plants and petroleum refineries
Power and cogeneration plant construction, except hydroelectric construction
137. Power and cogeneration plant new constructions, except hydroelectric (by heavy construction contractors and atrisk project managers)
138. Construction services for new power and cogeneration plants, except hydroelectric
139. Construction services for additions, renovations, and alterations to power and cogeneration plants, except
hydroelectric
140. Construction services for maintenance and repair of power and cogeneration plants, except hydroelectric
Power and communication transmission line, cable, tower, and related facilities
Private driveway and parking area construction, except garages
Sewage and water treatment plants
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
41
151. Construction services for additions, renovations, and alterations to sewage and water treatment plants
$
,000.00
3003775000
152. Construction services for maintenance and repair of sewage and water treatment plants
$
,000.00
3004425000
153. Sewer, sewer line, septic system, and related facilities new constructions (by heavy construction contractors and
at-risk project managers)
$
,000.00
3002425000
154. Construction services for new sewers, sewer lines, septic systems, and related facilities
$
,000.00
3003075000
155. Construction services for additions, renovations, and alterations to sewers, sewer lines, septic systems, and
related facilities
$
,000.00
3003725000
156. Construction services for maintenance and repair of sewers, sewer lines, septic systems, and related facilities
$
,000.00
3004375000
$
,000.00
3002775000
$
,000.00
3003425000
$
,000.00
3004075000
$
,000.00
3002400000
$
,000.00
3003050000
$
,000.00
3003700000
$
,000.00
3004350000
$
,000.00
3002450000
$
,000.00
3003100000
$
,000.00
3003750000
$
,000.00
3004400000
Sewers, sewer lines, septic systems, and related facilities
Swimming pools
157. Swimming pool new constructions (by builders and at-risk project managers)
158. Construction services for new swimming pools
159. Construction services for additions, renovations, and alterations to swimming pools
Tunnels
160. Tunnel new constructions (by heavy construction contractors and at-risk project managers)
161. Construction services for new tunnels
162. Construction services for additions, renovations, and alterations to tunnels
163. Construction services for maintenance and repair of tunnels
Water mains, storage wells, and related facilities
164. Water main, storage, well, and related facilities new constructions (by heavy construction contractors and at-risk
project managers)
165. Construction services for new water mains, storage, wells, and related facilities
166. Construction services for additions, renovations, and alterations to water mains, storage, wells, and related
facilities
167. Construction services for maintenance and repair of water mains, storage, wells, and related facilities
Other nonresidential constructions, except buildings
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
42
168. Other nonresidential new constructions, except buildings (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002950000
169. Construction services for other new nonresidential constructions, excluding buildings
$
,000.00
3003600000
170. Construction services for additions, renovations, and alterations to other nonresidential constructions, excluding
buildings
$
,000.00
3004250000
171. Construction services for maintenance and repair of all other nonresidential constructions, excluding buildings
$
,000.00
3004775000
$
,000.00
7008725003
$
,000.00
7008725006
$
,000.00
7008725009
$
,000.00
7008725012
$
,000.00
7008725000
$
,000.00
3000425000
$
,000.00
3000450000
$
,000.00
3000475000
$
,000.00
3000500000
$
,000.00
3000525003
$
,000.00
3000525006
$
,000.00
3000525000
Other specialized cleaning services, not elsewhere classified
172. Other specialized cleaning services, not elsewhere classified
a. Drain and gutter cleaning services
b. Parking lot sweeping services
c. Swimming pool cleaning and maintenance services
d. All other specialized cleaning services, not elsewhere classified
Subtotal
Residential decks
173. Residential deck new constructions (by builders and at-risk project managers)
174. Construction services for new residential deck constructions
175. Construction services for additions, renovations, and alterations to residential deck constructions
176. Construction services for maintenance and repair of residential deck constructions
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
177. Residential landscape new constructions, excluding decks (by builders and at-risk project managers)
a. Residential irrigation and sprinkler system new constructions (by builders and at-risk project managers)
b. Other residential landscape new constructions, excluding decks (by builders and at-risk project managers)
Subtotal
178. Construction services for new residential landscape constructions, excluding decks (by builders and at-risk project
managers)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
43
a. Construction services for new residential irrigation and sprinkler system constructions
$
,000.00
3000550003
$
,000.00
3000550006
$
,000.00
3000550000
a. Construction services for additions, renovations, and alterations to residential irrigation and sprinkler system
constructions
$
,000.00
3000575003
b. Construction services for additions, renovations, and alterations to other residential landscape constructions,
excluding decks
$
,000.00
3000575006
Subtotal
$
,000.00
3000575000
$
,000.00
3000600003
$
,000.00
3000600006
$
,000.00
3000600000
$
,000.00
3004800003
$
,000.00
3004800006
c. Construction project management services for new constructions of apartment type condominiums, excluding
single family condominiums
$
,000.00
3004800009
d. Construction project management services for new constructions of apartment buildings (two or more units),
excluding condominiums
$
,000.00
3004800012
e. Construction project management services for additions, renovations, alterations, maintenance, and repair of
residential single family buildings and apartment buildings (two or more units), including condominiums
$
,000.00
3004800015
f. Construction project management services for constructions of industrial buildings
$
,000.00
3004800018
g. Construction project management services for constructions of commercial and institutional buildings
$
,000.00
3004800021
$
,000.00
3004800024
b. Construction services for other new residential landscape constructions, excluding decks
Subtotal
179. Construction services for additions, renovations, and alterations to residential landscape constructions, excluding
decks
180. Construction services for maintenance and repair of residential landscape constructions, excluding decks
a. Construction services for maintenance and repair of residential irrigation and sprinkler system constructions
b. Construction services for maintenance and repair of other residential landscape constructions, excluding decks
Subtotal
Project management services, except at-risk, for building and non-building projects
181. Construction project management services, excluding at-risk
a. Construction project management services for new constructions of single detached residential buildings
b. Construction project management services for new constructions of single attached residential buildings
h. Construction project management services for constructions of water and sewer line and related structures
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
44
i. Construction project management services for constructions of oil and gas pipeline and related structures
$
,000.00
3004800027
j. Construction project management services for constructions of power and communication line and related
structures
$
,000.00
3004800033
k. Construction project management services for land subdivision
$
,000.00
3004800036
l. Construction project management services for highway, street, and bridge constructions
$
,000.00
3004800039
$
,000.00
3004800042
$
,000.00
3004800000
$
,000.00
9900000000
m. Construction project management services for other heavy and civil engineering constructions
Subtotal
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
45
Item 23: Kind of Business Activities Additional Information
ITEM 23: KIND OF BUSINESS ACTIVITIES
For the $,000.00 of sales, shipments, receipts, or revenue in 2022, please report the percent of the total represented by the following construction and non-construction business
activities. The sum of these percentages should equal 100%.
CONSTRUCTION WORK ACTIVITIES
Report only the main activities for which you were contracted. Work which was incidental to the primary activities of jobs should not be reported separately. If the construction activity is
not listed below, please enter a description of the construction activity in the “Other construction activities” write-in box, along with a percentage of the value of total business for that
specified construction activity.
OTHER BUSINESS ACTIVITIES
Report any non-construction activities. If the activity is not listed below, please enter a description of the non-construction activity in the “Other business activities” write-in box, along
with a percentage of the value of total business for that specified activity.
Description
Code
Value
Construction work activities
1. Building construction on land you own or control, for sale
2. Building construction on land customer owns
3. Remodeling contractor (except those performing specialized work such as carpentry,
flooring, doors, or windows)
4. Construction management, at risk
5. Construction management, agency or fee only
6. Subdividing and servicing of raw land into lots, for sale by you to builders
7. Heavy construction contractor, such as bridges, tunnels, pipelines, utility lines, and anchored
earth retention
8. Concrete contractor (except paving or precast)
9. Framing contractor
10. Finish carpentry contractor
11. Excavation work, earthmoving, or land clearing contractor
12. Other kinds of construction
6001
%
6002
%
6003
%
6701
%
6702
%
7210
%
7001
%
8110
%
8130
%
8350
%
8911
%
9000
%
Describe
Other business activity
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
46
13. Architectural services
14. Engineering services
15. Real estate commissions and property management fees
16. Rental or lease of properties
17. Building construction on land owned by you, for rent or lease (investment builder)
18. Retail trade
19. Other business activities
9911
%
9914
%
9917
%
9918
%
9923
%
9925
%
9929
%
8005
%
Describe
TOTAL
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
47
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
48
Item 28: Special Items - Ownership of Projects Additional Information
ITEM 28: SPECIAL ITEMS - OWNERSHIP OF PROJECTS
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue) on projects owned by the following:
2022
%
1. Private businesses and individuals
%
2. State and local governments
%
3. Federal Government
TOTAL
(Percentages reported in lines 1 through 3 should equal 100%.)
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
%
49
Item 28: Special Items - Construction Subcontractors
ITEM 28: SPECIAL ITEMS - CONSTRUCTION SUBCONTRACTORS
What percent of the amount you reported in Item 5 (Sales, Shipments, Receipts, or Revenue) represents work you did for other contractors or builders?
(Enter "0" if you did not subcontract work from other contractors or builders.)
2022
%
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
50
Item 28: Special Items - Construction by State
ITEM 28: SPECIAL ITEMS - CONSTRUCTION BY STATE
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue), which occurred in each state
(The sum of the percentages reported should equal 100%.)
2022
2022
%
Montana
%
%
Nebraska
%
%
Nevada
%
%
New Hampshire
%
%
New Jersey
%
%
New Mexico
%
%
New York
%
Delaware
%
North Carolina
%
District of Columbia
%
North Dakota
%
Florida
%
Ohio
%
Georgia
%
Oklahoma
%
Hawaii
%
Oregon
%
Idaho
%
Pennsylvania
%
%
Rhode Island
%
%
South Carolina
%
%
South Dakota
%
%
Tennessee
%
%
Texas
%
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Illinois
Indiana
Iowa
Kansas
Kentucky
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
51
Louisiana
%
Utah
%
Maine
%
Vermont
%
%
Virginia
%
%
Washington
%
%
West Virginia
%
%
Wisconsin
%
%
Wyoming
%
%
United States
%
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
52
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
53
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_CC-23610_su.pdf Generated 2022-02-23 15:53:16
54
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
63
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
64
Location Information
DEFINITION OF ESTABLISHMENT
The reporting unit for this questionnaire is a construction establishment which is generally a permanent office, payroll office, or other place where business activities related to
construction are conducted. A construction establishment manages one or more projects or jobs and is usually maintained on a continuing basis.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Temporary construction site
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
New single-family housing construction (excluding for-sale builders), including attached and detached housing
236115 001
New multifamily housing construction (excluding for-sale builders), including apartments and condominiums
236116 001
New housing for-sale builder of single-family housing and multifamily housing
236117 001
Residential remodeler for home improvement (e.g., adding on, renovating, maintenance, and repair), including remodeling homes for resale
236118 001
Industrial building construction (e.g., processing and assembly plants, factories, refineries, waste disposal facilities), excluding warehouses
and sewage disposal plants
236210 001
Commercial and institutional building construction (e.g., office and school buildings, hospitals, health and data facilities, stores, and
warehouses)
236220 001
Water and sewer line and related structures construction (e.g., mains, sewage disposal plants, pumping stations, and water well drilling)
237110 001
Oil and gas pipeline and related structures construction (e.g., mains, petrochemical plants, pumping stations, and oil refineries)
237120 001
Power and communication line and related structures construction (e.g., alternative energy structures, power plants, transformer stations,
high voltage transmission cable connections, and cellular phone towers)
237130 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Highway, street, and bridge construction, including curbs, airport runway construction, and line painting of streets and parking lots
237310 001
Other heavy and civil engineering construction (e.g., tunnels, railways, outside recreation areas, dams, flood and drainage control projects,
dredging, trenching, and marine facilities)
237990 001
Poured concrete foundation and structure contractor (e.g., shotcrete, mud-jacking, gunning, gunite, pumping, and placement footing)
238110 001
Structural steel and precast concrete contractor, including structural iron work
238120 001
Framing contractor, including wood and steel (excluding structural steel or precast concrete)
238130 001
Masonry contractor (e.g., brick, stone, slate, glass block, cement, cinder blocking, stucco setting and other stone work)
238140 001
Glass and glazing contractor (e.g., glass coating and tinting (excluding automotive), window pane, glass sheet, glass curtain wall, and mirror
installation)
238150 001
Roofing contractor, including treating roofs (i.e., spraying, painting or coating) and skylight installation
238160 001
Siding contractor (e.g., gutters, downspouts, fascia, soffit, eavestrough, flashing, and ice apron)
238170 001
Other foundation, structure, and building exterior contractor (e.g., awning, metal balcony and stairway, and falsework construction), including
decorative steel and wrought iron work; poured concrete form installation and dismantling; and welding at site
238190 001
Electrical and other wiring installation contractor (e.g., electronic and environmental controls, telecommunications and fiber optic equipment
(excluding transmission line), solar panel installation, traffic signals, and fire and security systems)
238210 001
Plumbing, heating, and air-conditioning (HVAC) contractor, including installation, maintenance, and repair of refrigeration systems, sprinkler
systems, water systems, gas and oil line individual hookups, and steam and pipe fittings
238220 001
Other building equipment contractor (e.g., millwrights, machine rigging), including installation, maintenance, and repair of ATM equipment,
elevators, escalators, service station gasoline pumps, commercial and industrial doors)
238290 001
Drywall and insulation contractor, including acoustical, plastering, and fireproofing contractors
238310 001
Painting and wall covering contractor, including on-site electrostatic painting, whitewashing, and rustproofing of buildings, ships, bridges,
tanks, and towers (excluding automotive)
238320 001
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Flooring contractor (e.g., laying carpet, linoleum, hardwood, laminate, and vinyl flooring), excluding fireproof, stone, concrete, and ceramic
tile flooring
238330 001
Tile and terrazzo contractor (e.g., marble, granite, slate, ceramic, stone, and mosaic work for floors, walls, and ceilings), excluding exterior
marble, granite, and slate work
238340 001
Finish carpentry contractor (e.g., door, window, cabinetry, countertop, stairway, deck, molding, trim, and paneling work, residential-type,
installation), excluding framing
238350 001
Other building finishing contractor (e.g., waterproofing, spectator seating, modular furniture system attachments, closet organizer systems,
concrete coating, window shades and blinds, and trade show exhibit installation and dismantling)
238390 001
Site preparation contractor, without land subdivision (e.g., land clearing, drilling, demolition, trenching, and earthmoving), and rental of
construction equipment with operators (excluding cranes))
238910 001
All other specialty trade contractor (e.g., driveway paving; constructions of residential and commercial parking lots, sidewalks, patios, and
outdoor swimming pools; installation of fences (excluding electric) and playground equipment; and crane rental with operator)
238990 001
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Receipts (or billings) derived from contract construction work done for others
Sales of houses and other buildings you built and sold
Construction management and design-build contracts
Site preparation receipts, such as land clearing, laying roads, installing utilities, and subdividing land into lots (Exclude purchase cost of land or estimated value of raw land for
construction projects.)
Architectural services, except the design portion of integrated design-build contracts
Engineering services
Rental or lease of properties
Real estate commissions and property management fees
Rental of construction machinery or equipment to others, without an operator
Manufacturing, mining, and transportation activities
Retail and wholesale trades
Other business activities
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building structure)
Purchased cost of land or estimated value of raw land for construction projects (Include site preparation receipts.)
Non-operating income such as interest, dividends, or the sale of fixed assets.
What were the receipts for all business activities done by this establishment, including receipts, billings, or sales for
construction work? (Construction work includes new construction and remodeling as well as maintenance and repair
work. The activities of prime and trade contractors are considered to be construction. Some trades not traditionally
thought of as construction are included such as land subdivision, excavation, building demolition, painting, carpet-laying,
water well drilling, plumbing and electrical work.)
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Check
if
None
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Number of employees at this establishment
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
If the legal form of organization for this business is a corporation, the reporting of other employees and other payroll at this establishment is required. Enter "0" if the establishment
did not have payroll and employment for specific data for this EIN. If payroll and employment for this EIN are zero, please indicate if the EIN is a joint venture or reason why data
are zero in Item 31: Remarks at the end of the survey.
All persons on paid sick leave, paid holidays, and paid vacation during the year at this establishment
Spread on stock options that are taxable to employees at this establishment as wages
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.)
Contractors, subcontractors, or independent contractors
Purchased or managed services, such as janitorial, security, or landscape services (Report values in Item 16, line C9.)
Purchased professional and technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services (Report
values in Item 16, line C9.)
Members of the Armed Forces and pensioners carried on your active rolls
Proprietors and partners, if an unincorporated concern
Number of construction workers at this establishment include:
Apprentices
Working foremen
Equipment operators and mechanics
Journeymen
Job-site record keepers
Craftsmen
Laborers
Truck drivers and helpers
Others engaged directly in construction
Number of other employees at this establishment include:
Supervisors above working foremen
Office staff
Executives
Architects
Purchasing Agents
Personnel staff
Engineers
Accounting staff
Others engaged in non-construction activities
A. Number of employees at this establishment for the pay period including the 12th of the month.
March 2022
June 2022
September 2022
December 2022
1. What was the number of construction workers
(direct labor including first-line supervisors)?
2. What was the number of other employees?
TOTAL (Add lines A1 and A2.)
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B. HOURS WORKED
Check
if
None
2022 Hours
What was the annual number of hours worked by the construction workers at this establishment (direct labor
including first-line supervisors) reported in line A?
,000
C. PAYROLL
Include:
Payroll for officers at this establishment
Exclude:
Income or costs not recorded as payroll for IRS by establishment.
Employer-paid annual cost for fringe benefits reported in lines 7D1 and 7D2
Check
if
None
2022
1. What was the annual payroll at this establishment before deductions for construction workers (direct labor
including first-line supervisors)?
$
,000.00
2. What was the annual payroll before deductions for other employees?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $0,000.00 reported above, what was the first quarter payroll at this establishment before deductions
(January-March 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
Check
if
None
2022
1. What were the legally required fringe benefits? (Include employer payments for Social Security, Medicare,
unemployment compensation, workmen's compensation, and State disability programs, if required.)
$
,000.00
2. What were the voluntarily provided fringe benefits? (Include such items as payments for life insurance, medical
insurance, pensions, welfare benefits, and union-negotiated benefits.)
$
,000.00
TOTAL (Add lines D1 and D2.)
$
,000.00
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Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Include:
Inventories, regardless of where held, for materials and supplies owned by this establishment as of December 31
Exclude:
Work-in-progress and finished units
Using current cost, what was the value of inventories owned
by this establishment as of December 31? (If using LIFO
method of evaluation, adjust to obtain FIFO or current cost.)
Check
if
None
2022
$
2021
,000.00
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$
,000.00
22
Item 13: Assets, Capital Expenditures, and Retirements Additional Information
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS
Exclude
Land (Report cost of land acquired during the year in Item 16A, line 5.)
Check
if
None
2022
$
,000.00
B. What were the capital expenditures for new and used depreciable assets?
$
,000.00
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc.?
$
,000.00
D. What was the value of depreciable assets at the end of the year? (Add lines A and B minus line C.)
$
,000.00
A. What was the gross value of depreciable assets (usually original cost) at the beginning of the year?
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Item 14: Rental Payments Additional Information
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,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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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
A. For this establishment, what were the cost of materials, subcontract work, fuels, electricity, and land acquired in 2022 for:
Include:
Current account expenses normally considered as cost of work performed or job-specific costs
1. Cost of materials, parts, and supplies?
Include:
All job-site, office, and construction materials and supplies
Cost of materials purchased by this establishment's subcontractors
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building
structure)
Non-construction-related expenses that were paid to subcontractors by this establishment (Report these
expense details on the next screen, Item 16: Selected Expenses - Continued, in line C.)
Check
if
None
2022
$
,000.00
$
,000.00
a. Natural gas and manufactured gas (propane)?
$
,000.00
b. Gasoline and diesel fuel - ON highway (not at site)?
$
,000.00
c. Gasoline and diesel fuel - OFF highway (at site)?
$
,000.00
$
,000.00
$
,000.00
2. Cost of construction-related work subcontracted out to others?
Exclude:
Cost of materials purchased by this establishment for subcontractors (These costs should be reported in line
A1.)
Check
if
None
3. Cost of fuels for heat, power, lubricants
Check
if
None
d. All other fuels and lubricants, including heating oils, lubricating oils, and greases?
Check
if
None
4. Cost of electricity?
5. When you answered Item 5, did you include the purchased cost of land or estimated value of raw land? Please check one, and answer the below question.
Yes
No
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25
Check
if
None
6. What was the purchased cost of land or estimated value of raw land for reported construction projects during the
covered time?
$
,000.00
$
,000.00
Check
if
None
B. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
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Item 16: Selected Expenses - Continued Additional Information
ITEM 16: SELECTED EXPENSES
C. What were the other operating expenses paid by this establishment in 2022 for:
1. Temporary staff and leased employees? (Professional Employer Organizations and staffing agencies for
personnel)
Include:
All charges for payroll, benefits, and services your establishment paid to the Professional Employer
Organizations for the temporary staff and leased employees
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report on line C3.)
Leased and rented equipment (Report on 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
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
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
27
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data Storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
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 in line C6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in line C9 and credit
card transaction fees in line C4.)
Expenses for telecommunication services (e.g., Internet, connectivity, telephone) (Report in line C4.)
$
,000.00
Exclude
Materials, parts, and supplies used for repairs and maintenance performed by this firm's employees
$
,000.00
7. Water, sewer, refuse removal, and other non-electric utility payments?
(Report electric utility payments in Item 16, line A4. If the cost of these utilities is included in a leased or rental
payment, report in Item 14, line A.)
Include:
Cost of hazardous waste removal
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
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. such as janitorial, security, or landscape services)
Exclude:
Salaries paid to your own employees for these services (Report in Item 7.)
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
28
10. Governmental taxes and licensing fees?(Payments to government agencies for taxes and licenses)
Include:
Business and property tax fees for establishment to remain active legal operable business
Permits and licensing fees
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Include:
Expenses for paid temporary day labors not on your payroll or hired as construction subcontractors
Exclude:
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
The construction project types listed below are general to your industry. Select the project types that apply to your establishment. On the next screen, you will report the specific
construction products and services related to the construction projects you select. If you have revenue from other sources not listed, you will have the opportunity to report them later.
At-risk construction project management revenue should be reported with the specific construction project associated with those management services. For example, if at-risk
construction project management is for office buildings, then include the management revenue with the project for office buildings. However, at-fee project management services
should be reported in the specific project for construction project management services.
Description
Select
Amusement, social, and recreational building construction
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
Commercial warehouses, such as distribution buildings and mini-storage
Project Code
334
322
359
327
319
Dormitories and barracks
329
Educational building construction
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
323
333
Farm building construction, nonresidential
331
Health care and institutional building construction
324
Hotel, motel, and inn construction
321
Industrial warehouse construction
Nonresidential mobile building construction, office and other commercial
335
325
Office building construction
332
Public safety building construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
30
328
Religious building construction
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
326
336
338
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
318
314
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
317
316
Single detached residential building construction
342
Airport runways and landing fields
346
Bridge and elevated highway
Conservation and development construction, including dams, drainage canals, and flood control projects
368
378
Fencing
373
Harbor and port facilities
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
341
357
Hydroelectric power plants
Marine construction, such as dredging, navigational channels, and locks
374
366
Mass transit, including railroads
Oil and gas pipelines, pumping stations, storage tanks, and mains
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
353
381
364
Petrochemical plant and petroleum refinery construction
Power and cogeneration plant construction, except hydroelectric construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
356
31
Power and communication transmission line, cable, tower, and related facilities
Private driveway and parking area construction, except garages
354
343
361
Sewage and water treatment plants
Sewers, sewer lines, septic systems, and related facilities
351
384
Ship maintenance and repair services
375
Swimming pools
347
Tunnels
352
Water mains, storage wells, and related facilities
395
Other nonresidential constructions, except buildings
Other specialized cleaning services, not elsewhere classified
399
376
Residential decks
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
377
Add product/service not listed
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
32
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services associated with the construction projects you previously selected. If you have revenue from sources not listed, describe and report them in the
"All other sales, shipments, receipts, or revenue from this establishment" section at the end of this question.
At-risk construction project management revenue should be reported with the specific constructions or construction services associated with those management services. For
example, if at-risk construction project management is for entire office building constructions, then include the management revenue with the new constructions for office buildings.
However, at-fee project management services should be reported in the specific product lines for construction project management services.
New Constructions and Construction Services – Report only the main activities including the type of buildings, structures, or facilities contracted to construct or work on by this
establishment in the reporting year in which this establishment received receipts only. If you worked on more than one type of building or structure in a multipurpose complex, report
separately for each building or type of structure. However, if you worked on a building that had more than one purpose, i.e. office, residential, or commercial, classify this building by
its major purpose.
New constructions include all components of the entire original building or structure. Land development work on the site and demolition of existing structures are included with
new constructions.
Construction services for new building or structures include separate components of the original building or structure, such as electric work, painting, plumbing, etc.
Construction services for additions, renovations, and alterations to buildings or structures include construction work which adds to the value of useful life of an existing
building or structure, or which adapts a building or structure to a new or different use. Included are “major replacements” of building systems such as the installation of a new
roof or heating system, and the resurfacing of streets or highways. Exclude activities such as the repair of a hole in a roof or the routine patching of highways and streets, which
are classified as “maintenance and repair work”.
Construction services for maintenance and repair of buildings or structures include incidental construction work that keeps a property in ordinary working condition.
Exclude trash and snow removal, lawn maintenance, and janitorial services.
Description
Value
Product Code
Amusement, social, and recreational building construction
1. Amusement, social, and recreational building new constructions (by builders and at-risk project managers)
$
,000.00
3000875000
2. Construction services for new amusement, social, and recreational buildings
$
,000.00
3001350000
3. Construction services for additions, renovations, and alterations to amusement, social, and recreational buildings
$
,000.00
3001750000
4. Construction services for maintenance and repair of amusement, social, and recreational buildings
$
,000.00
3002150000
5. Apartment building (two or more units) new constructions, excluding condominiums (by builders and at-risk project
managers)
$
,000.00
3000625000
6. Construction services for new apartment buildings (two or more units), excluding condominiums
$
,000.00
3001050000
7. Construction services for additions, renovations, and alterations to apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001075000
8. Construction services for maintenance and repair of apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001100000
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
33
9. Chemical (except petrochemical) complex/plant, blast furnace, and mining appurtenance new constructions (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002600000
10. Construction services for new chemical (except petrochemical) complexes/plants, blast furnaces, and mining
appurtenances
$
,000.00
3003250000
11. Construction services for additions, renovations, and alterations to chemical (except petrochemical)
complexes/plants, blast furnaces, and mining appurtenances
$
,000.00
3003900000
12. Construction services for maintenance and repair of chemical (except petrochemical) complexes/plants, blast
furnaces, and mining appurtenances
$
,000.00
3004550000
13. Commercial warehouse new constructions, such as distribution buildings and mini-storage (by builders and at-risk
project managers)
$
,000.00
3000750000
14. Construction services for new commercial warehouses, such as distribution buildings and mini-storage
$
,000.00
3001225000
15. Construction services for additions, renovations, and alterations to commercial warehouses, such as distribution
buildings and mini-storage
$
,000.00
3001625000
16. Construction services for maintenance and repair of commercial warehouses, such as distribution buildings and
mini-storage
$
,000.00
3002025000
17. Educational institution dormitories new constructions (by builders and at-risk project mangers)
$
,000.00
3001005000
18. Military and other public safety dormitories and barracks new constructions (by builders and at-risk project
managers)
$
,000.00
3001010000
$
,000.00
3001480000
20. Construction services for new military and other public safety dormitories and barracks
$
,000.00
3001485000
21. Construction services for additions, renovations, and alterations to educational institution dormitories
$
,000.00
3001880000
22. Construction services for additions, renovations, and alterations to military and other public safety dormitories and
barracks
$
,000.00
3001885000
$
,000.00
3002280000
$
,000.00
3002285000
25. Educational building new constructions (by builders and at-risk project managers)
$
,000.00
3000825000
26. Construction services for new educational buildings
$
,000.00
3001300000
Commercial warehouses, such as distribution buildings and mini-storage
Dormitories and barracks
19. Construction services for new educational institution dormitories
23. Construction services for maintenance and repair of educational institution dormitories
24. Construction services for maintenance and repair of military and other public safety dormitories and barracks
Educational building construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
34
27. Construction services for additions, renovations, and alterations to educational buildings
$
,000.00
3001700000
28. Construction services for maintenance and repair of educational buildings
$
,000.00
3002100000
29. Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building new
constructions (by builders and at-risk project managers)
$
,000.00
3000700000
30. Construction services for new factories, assembly plants, industrial research laboratories, and other new
manufacturing and industrial buildings
$
,000.00
3001175000
31. Construction services for additions, renovations, and alterations to factories, assembly plants, industrial research
laboratories, and other manufacturing and industrial buildings
$
,000.00
3001575000
32. Construction services for maintenance and repair of factories, assembly plants, industrial research laboratories, and
other manufacturing and industrial buildings
$
,000.00
3001975000
$
,000.00
3000975000
$
,000.00
3001450000
35. Construction services for additions, renovations, and alterations to farm buildings, nonresidential
$
,000.00
3001850000
36. Construction services for maintenance and repair of farm buildings, nonresidential
$
,000.00
3002250000
$
,000.00
3000850000
$
,000.00
3001325000
39. Construction services for additions, renovations, and alterations to health care and institutional buildings
$
,000.00
3001725000
40. Construction services for maintenance and repair of health care and institutional buildings
$
,000.00
3002125000
41. Hotel, motel, and inn new constructions (by builders and at-risk project managers)
$
,000.00
3000650000
42. Construction services for new hotels, motels, and inns
$
,000.00
3001125000
43. Construction services for additions, renovations, and alterations to hotels, motels, and inns
$
,000.00
3001525000
44. Construction services for maintenance and repair of hotels, motels, and inns
$
,000.00
3001925000
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
Farm building construction, nonresidential
33. Farm building new constructions, nonresidential (by builders and at-risk project managers)
34. Construction services for new farm buildings, nonresidential
Health care and institutional building construction
37. Health care and institutional buildings new constructions (by builders and at-risk project managers)
38. Construction services for new health care and institutional buildings
Hotel, motel, and inn construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
35
Industrial warehouse construction
45. Industrial warehouse new constructions at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000680000
46. Industrial warehouse new constructions not at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000685000
47. Construction services for new industrial warehouses at manufacturing sites
$
,000.00
3001155000
48. Construction services for new industrial warehouses not at manufacturing sites
$
,000.00
3001160000
49. Construction services for additions, renovations, and alterations to industrial warehouses at manufacturing sites
$
,000.00
3001555000
50. Construction services for additions, renovations, and alterations to industrial warehouses not at manufacturing sites
$
,000.00
3001560000
51. Construction services for maintenance and repair of industrial warehouses at manufacturing sites
$
,000.00
3001955000
$
,000.00
3001960000
53. Nonresidential mobile building new constructions, office (by builders and at-risk project managers)
$
,000.00
3000930000
54. Nonresidential mobile building new constructions, other commercial (by builders and at-risk project managers)
$
,000.00
3000935000
55. Construction services for new nonresidential mobile building constructions, office
$
,000.00
3001405000
56. Construction services for new nonresidential mobile building constructions, other commercial
$
,000.00
3001410000
57. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
office
$
,000.00
3001805000
58. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
other commercial
$
,000.00
3001810000
59. Construction services for maintenance and repair of nonresidential mobile building constructions, office
$
,000.00
3002205000
60. Construction services for maintenance and repair of nonresidential mobile building constructions, other commercial
$
,000.00
3002210000
61. Office building and data center new constructions (by builders and at-risk project managers)
$
,000.00
3000725000
62. Construction services for new office buildings and data centers
$
,000.00
3001200000
63. Construction services for additions, renovations, and alterations to office buildings and data centers
$
,000.00
3001600000
52. Construction services for maintenance and repair of industrial warehouses not at manufacturing sites
Nonresidential mobile building construction, office and other commercial
Office building construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
36
64. Construction services for maintenance and repair of office buildings and data centers
$
,000.00
3002000000
65. Public safety building new constructions (by builders and at-risk project managers)
$
,000.00
3000900000
66. Construction services for new public safety buildings
$
,000.00
3001375000
67. Construction services for additions, renovations, and alterations to public safety buildings
$
,000.00
3001775000
68. Construction services for maintenance and repair of public safety buildings
$
,000.00
3002175000
$
,000.00
3000800000
70. Construction services for new religious buildings
$
,000.00
3001275000
71. Construction services for additions, renovations, and alterations to religious buildings
$
,000.00
3001675000
72. Construction services for maintenance and repair of religious buildings
$
,000.00
3002075000
73. Store, restaurant, automobile service station, parking garage, and other commercial building new constructions
(excluding mobile buildings)(by builders and at-risk project managers)
$
,000.00
3000775000
74. Construction services for new stores, restaurants, automobile service stations, parking garages, and other
commercial buildings (excluding mobile buildings)
$
,000.00
3001250000
75. Construction services for additions, renovations, and alterations to stores, restaurants, automobile service stations,
parking garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3001650000
76. Construction services for maintenance and repair of stores, restaurants, automobile service stations, parking
garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3002050000
77. Nonresidential mobile building new constructions, classroom (by builders and at-risk project managers)
$
,000.00
3000955000
78. Nonresidential mobile building new constructions, industrial (by builders and at-risk project managers)
$
,000.00
3000960000
79. Construction services for new nonresidential mobile building constructions, classroom
$
,000.00
3001430000
80. Construction services for new nonresidential mobile building constructions, industrial
$
,000.00
3001435000
81. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, classrooms
$
,000.00
3001830000
Public safety building construction
Religious building construction
69. Religious building new constructions (by builders and at-risk project managers)
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
37
82. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, industrial
$
,000.00
3001835000
83. Construction services for maintenance and repair of other nonresidential mobile building constructions, classrooms
$
,000.00
3002230000
84. Construction services for maintenance and repair of other nonresidential mobile building constructions, industrial
$
,000.00
3002235000
85. All other nonresidential building new constructions (by builders and at-risk project managers)
$
,000.00
3001025000
86. Construction services for all other new nonresidential buildings
$
,000.00
3001500000
87. Construction services for additions, renovations, and alterations to all other nonresidential buildings
$
,000.00
3001900000
88. Construction services for maintenance and repair of all other nonresidential buildings
$
,000.00
3002300000
89. Constructions of new apartment type condominiums, excluding single family condominiums (by builders and at-risk
project managers)
$
,000.00
3000100000
90. Construction services for new apartment type condominiums, excluding single family condominiums
$
,000.00
3000200000
91. Construction services for additions, renovations, and alterations to apartment type condominiums, excluding single
family condominiums
$
,000.00
3000300000
92. Construction services for maintenance and repair of apartment type condominiums, excluding single family
condominiums
$
,000.00
3000400000
93. Constructions of new manufactured (mobile) homes, all width sizes (including multisection) (by builders and at-risk
project managers)
$
,000.00
3000075000
94. Construction services for new manufactured homes (mobile homes), all width sizes (including multisection)
$
,000.00
3000175000
95. Construction services for additions, renovations, and alterations to manufactured homes (mobile homes), all width
sizes (including multisection)
$
,000.00
3000275000
96. Construction services for maintenance and repair of manufactured homes (mobile homes), all width sizes (including
multisection)
$
,000.00
3000375000
97. Constructions of new single attached residential buildings, including row houses and town houses (by builders and
at-risk project managers)
$
,000.00
3000050000
98. Construction services for new single attached residential buildings, including row houses and town houses
$
,000.00
3000150000
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
38
99. Construction services for additions, renovations, and alterations to single attached residential buildings, including
row houses and town houses
$
,000.00
3000250000
100. Construction services for maintenance and repair of single attached residential buildings, including row houses and
town houses
$
,000.00
3000350000
101. Constructions of new single detached residential buildings (by builders and at-risk project managers)
$
,000.00
3000025000
102. Construction services for new single detached residential buildings
$
,000.00
3000125000
103. Construction services for additions, renovations, and alterations to single detached residential buildings
$
,000.00
3000225000
104. Construction services for maintenance and repair of single detached residential buildings
$
,000.00
3000325000
105. Airport runway and landing field new constructions (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002675000
106. Construction services for new airport runways and landing fields
$
,000.00
3003325000
107. Construction services for additions, renovations, and alterations to airport runways and landing fields
$
,000.00
3003975000
108. Construction services for maintenance and repair of airport runways and landing fields
$
,000.00
3004625000
$
,000.00
3002375000
$
,000.00
3003025000
111. Construction services for additions, renovations, and alterations to bridges and elevated highways
$
,000.00
3003675000
112. Construction services for maintenance and repair of bridges and elevated highways
$
,000.00
3004325000
113. Conservation and development new constructions, including dams, drainage canals, and flood control projects (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002650000
114. Construction services for new conservation and development constructions, including dams, drainage canals, and
flood control projects
$
,000.00
3003300000
115. Construction services for additions, renovations, and alterations to conservation and development constructions,
including dams, drainage canals, and flood control projects
$
,000.00
3003950000
116. Construction services for maintenance and repair of conservation and development constructions, including dams,
drainage canals, and flood control projects
$
,000.00
3004600000
Single detached residential building construction
Airport runways and landing fields
Bridge and elevated highway
109. Bridge and elevated highway new constructions (by heavy construction contractors and at-risk project managers)
110. Construction services for new bridges and elevated highways
Conservation and development construction, including dams, drainage canals, and flood control projects
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
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Fencing
117. Fencing new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002825000
118. Construction services for new fencing constructions
$
,000.00
3003475000
119. Construction services for additions, renovations, and alterations to fencing constructions
$
,000.00
3004125000
120. Construction services for maintenance and repair of fencing constructions
$
,000.00
3004750000
121. Harbor and port facilities new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002725000
122. Construction services for new harbor and port facilities
$
,000.00
3003375000
123. Construction services for additions, renovations, and alterations to harbor and port facilities
$
,000.00
3004025000
$
,000.00
3004675000
125. Highway, street, and related work new constructions, including public sidewalks, curbs, guardrails and signs (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002325000
126. Construction services for new highways, streets, and related work, including public sidewalks, curbs, guardrails
and signs
$
,000.00
3002975000
127. Construction services for additions, renovations, and alterations to highways, streets, and related works, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3003625000
128. Construction services for maintenance and repair of highways, streets, and related work constructions, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3004275000
$
,000.00
3002575000
$
,000.00
3003225000
$
,000.00
3003875000
$
,000.00
3004525000
$
,000.00
3002750000
Harbor and port facilities
124. Construction services for maintenance and repair of harbor and port facilities
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
Hydroelectric power plants
129. Power plant new constructions, hydroelectric (by heavy construction contractors and at-risk project managers)
130. Construction services for new power plants, hydroelectric
131. Construction services for additions, renovations, and alterations to power plants, hydroelectric
132. Construction services for maintenance and repair of power plants, hydroelectric
Marine construction, such as dredging, navigational channels, and locks
133. Marine new constructions, including dredging, navigational channels, and locks (by heavy construction contractors
and at-risk project managers)
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
40
134. Construction services for new marine constructions, including dredging, navigational channels, and locks
$
,000.00
3003400000
135. Construction services for additions, renovations, and alterations to marine constructions, including dredging,
navigational channels, and locks
$
,000.00
3004050000
136. Construction services for maintenance and repair of marine constructions, including dredging, navigational
channels, and locks
$
,000.00
3004700000
137. Mass transit new constructions, including railroads (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002700000
138. Construction services for new mass transit constructions, including railroads
$
,000.00
3003350000
139. Construction services contractors for additions, renovations, and alterations to mass transit constructions, including
railroads
$
,000.00
3004000000
140. Construction services for maintenance and repair of mass transit constructions, including railroads
$
,000.00
3004650000
141. Oil and gas pipeline, pumping station, storage tank, and main new constructions (by heavy construction
contractors and at-risk project managers)
$
,000.00
3002500000
142. Construction services for new oil and gas pipelines, pumping stations, storage tanks, and mains
$
,000.00
3003150000
143. Construction services for additions, renovations, and alterations to oil and gas pipelines, pumping stations, storage
tanks, and mains
$
,000.00
3003800000
144. Construction services for maintenance and repair of oil and gas pipelines, pumping stations, storage tanks, and
mains
$
,000.00
3004450000
145. Outdoor recreational area new constructions, including athletic fields, courts, golf courses, and campgrounds (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002800000
146. Construction services for new outdoor recreational areas, including athletic fields, courts, golf courses, and
campgrounds
$
,000.00
3003450000
147. Construction services for additions, renovations, and alterations to outdoor recreational area constructions,
including athletic fields, courts, golf courses, and campgrounds
$
,000.00
3004100000
148. Construction services for maintenance and repair of outdoor recreational area constructions, including athletic
fields, courts, golf courses, and campgrounds
$
,000.00
3004725000
149. Petrochemical plant and petroleum refinery new constructions (by heavy construction contractors and at-risk
project managers)
$
,000.00
3002625000
150. Construction services for new petrochemical plants and petroleum refineries
$
,000.00
3003275000
Mass transit, including railroads
Oil and gas pipelines, pumping stations, storage tanks, and mains
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
Petrochemical plant and petroleum refinery construction
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
41
151. Construction services for additions, renovations, and alterations to petrochemical plants and petroleum refineries
$
,000.00
3003925000
152. Construction services for maintenance and repair of petrochemical plants and petroleum refineries
$
,000.00
3004575000
153. Power and cogeneration plant new constructions, except hydroelectric (by heavy construction contractors and atrisk project managers)
$
,000.00
3002550000
154. Construction services for new power and cogeneration plants, except hydroelectric
$
,000.00
3003200000
155. Construction services for additions, renovations, and alterations to power and cogeneration plants, except
hydroelectric
$
,000.00
3003850000
156. Construction services for maintenance and repair of power and cogeneration plants, except hydroelectric
$
,000.00
3004500000
$
,000.00
3002525000
$
,000.00
3003175000
159. Construction services for additions, renovations, and alterations to power and communication transmission lines,
cables, towers, and related facilities
$
,000.00
3003825000
160. Construction services for maintenance and repair of power and communication transmission lines, cables, towers,
and related facilities
$
,000.00
3004475000
$
,000.00
3002350000
$
,000.00
3003000000
$
,000.00
3003650000
$
,000.00
3004300000
$
,000.00
3002475000
$
,000.00
3003125000
$
,000.00
3003775000
Power and cogeneration plant construction, except hydroelectric construction
Power and communication transmission line, cable, tower, and related facilities
157. Power and communication transmission line, cable, tower, and related facilities new constructions (by heavy
construction contractors and at-risk project managers)
158. Construction services for new power and communication transmission lines, cables, towers, and related facilities
Private driveway and parking area construction, except garages
161. Private driveway and parking area new constructions, except garages (by heavy construction contractors and atrisk project managers)
162. Construction services for new private driveways and parking areas, excluding garages
163. Construction services for additions, renovations, and alterations to private driveways and parking areas, excluding
garages
164. Construction services for maintenance and repair of private driveways and parking areas, excluding garages
Sewage and water treatment plants
165. Sewage and water treatment plant new constructions(by heavy construction contractors and at-risk project
managers)
166. Construction services for new sewage and water treatment plants
167. Construction services for additions, renovations, and alterations to sewage and water treatment plants
2022_CC-23810_su.pdf Generated 2022-02-23 15:44:50
42
168. Construction services for maintenance and repair of sewage and water treatment plants
$
,000.00
3004425000
$
,000.00
3002425000
$
,000.00
3003075000
171. Construction services for additions, renovations, and alterations to sewers, sewer lines, septic systems, and
related facilities
$
,000.00
3003725000
172. Construction services for maintenance and repair of sewers, sewer lines, septic systems, and related facilities
$
,000.00
3004375000
$
,000.00
2053950000
$
,000.00
2053975000
175. Swimming pool new constructions (by builders and at-risk project managers)
$
,000.00
3002775000
176. Construction services for new swimming pools
$
,000.00
3003425000
$
,000.00
3004075000
$
,000.00
3002400000
179. Construction services for new tunnels
$
,000.00
3003050000
180. Construction services for additions, renovations, and alterations to tunnels
$
,000.00
3003700000
$
,000.00
3004350000
182. Water main, storage, well, and related facilities new constructions (by heavy construction contractors and at-risk
project managers)
$
,000.00
3002450000
183. Construction services for new water mains, storage, wells, and related facilities
$
,000.00
3003100000
184. Construction services for additions, renovations, and alterations to water mains, storage, wells, and related
facilities
$
,000.00
3003750000
Sewers, sewer lines, septic systems, and related facilities
169. Sewer, sewer line, septic system, and related facilities new constructions (by heavy construction contractors and
at-risk project managers)
170. Construction services for new sewers, sewer lines, septic systems, and related facilities
Ship maintenance and repair services
173. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, military
174. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, nonmilitary
Swimming pools
177. Construction services for additions, renovations, and alterations to swimming pools
Tunnels
178. Tunnel new constructions (by heavy construction contractors and at-risk project managers)
181. Construction services for maintenance and repair of tunnels
Water mains, storage wells, and related facilities
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43
185. Construction services for maintenance and repair of water mains, storage, wells, and related facilities
$
,000.00
3004400000
186. Other nonresidential new constructions, except buildings (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002950000
187. Construction services for other new nonresidential constructions, excluding buildings
$
,000.00
3003600000
188. Construction services for additions, renovations, and alterations to other nonresidential constructions, excluding
buildings
$
,000.00
3004250000
189. Construction services for maintenance and repair of all other nonresidential constructions, excluding buildings
$
,000.00
3004775000
$
,000.00
7008725003
$
,000.00
7008725006
c. Swimming pool cleaning and maintenance services
$
,000.00
7008725009
d. All other specialized cleaning services, not elsewhere classified
$
,000.00
7008725012
$
,000.00
7008725000
$
,000.00
3000425000
192. Construction services for new residential deck constructions
$
,000.00
3000450000
193. Construction services for additions, renovations, and alterations to residential deck constructions
$
,000.00
3000475000
$
,000.00
3000500000
a. Residential irrigation and sprinkler system new constructions (by builders and at-risk project managers)
$
,000.00
3000525003
b. Other residential landscape new constructions, excluding decks (by builders and at-risk project managers)
$
,000.00
3000525006
$
,000.00
3000525000
Other nonresidential constructions, except buildings
Other specialized cleaning services, not elsewhere classified
190. Other specialized cleaning services, not elsewhere classified
a. Drain and gutter cleaning services
b. Parking lot sweeping services
Subtotal
Residential decks
191. Residential deck new constructions (by builders and at-risk project managers)
194. Construction services for maintenance and repair of residential deck constructions
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
195. Residential landscape new constructions, excluding decks (by builders and at-risk project managers)
Subtotal
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44
196. Construction services for new residential landscape constructions, excluding decks (by builders and at-risk project
managers)
a. Construction services for new residential irrigation and sprinkler system constructions
$
,000.00
3000550003
b. Construction services for other new residential landscape constructions, excluding decks
$
,000.00
3000550006
Subtotal
$
,000.00
3000550000
a. Construction services for additions, renovations, and alterations to residential irrigation and sprinkler system
constructions
$
,000.00
3000575003
b. Construction services for additions, renovations, and alterations to other residential landscape constructions,
excluding decks
$
,000.00
3000575006
$
,000.00
3000575000
$
,000.00
3000600003
$
,000.00
3000600006
$
,000.00
3000600000
$
,000.00
9900000000
197. Construction services for additions, renovations, and alterations to residential landscape constructions, excluding
decks
Subtotal
198. Construction services for maintenance and repair of residential landscape constructions, excluding decks
a. Construction services for maintenance and repair of residential irrigation and sprinkler system constructions
b. Construction services for maintenance and repair of other residential landscape constructions, excluding decks
Subtotal
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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45
Item 23: Kind of Business Activities Additional Information
ITEM 23: KIND OF BUSINESS ACTIVITIES
For the $,000.00 of sales, shipments, receipts, or revenue in 2022, please report the percent of the total represented by the following construction and non-construction business
activities. The sum of these percentages should equal 100%.
CONSTRUCTION WORK ACTIVITIES
Report only the main activities for which you were contracted. Work which was incidental to the primary activities of jobs should not be reported separately. If the construction activity is
not listed below, please enter a description of the construction activity in the “Other construction activities” write-in box, along with a percentage of the value of total business for that
specified construction activity.
OTHER BUSINESS ACTIVITIES
Report any non-construction activities. If the activity is not listed below, please enter a description of the non-construction activity in the “Other business activities” write-in box, along
with a percentage of the value of total business for that specified activity.
Description
Code
Value
Construction work activities
1. Concrete contractor (except paving or precast)
2. Reinforcing steel contractor
3. Structural steel erection contractor
4. Precast concrete installation contractor
5. Framing contractor
6. Marble, granite, or slate contractor, exterior
7. Masonry contractor: brick, block, or stone (except brick paving)
8. Masonry: pointing, cleaning, or caulking contractor
9. Stucco contractor
10. Glass, glazing, and tinting contractor
11. Roofing contractor
12. Gutter, gutter guard, and downspout installation contractor
13. Siding contractor, including fascia and soffit
8110
%
8120
%
8121
%
8122
%
8130
%
8140
%
8141
%
8142
%
8143
%
8150
%
8160
%
8170
%
8171
%
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14. Metal curtain wall installation contractor
15. Ornamental metal contractor, including metal stairway, balcony, and wrought iron
installation
16. Wrecking, demolition, or blasting contractor
17. Welding contractor, operating at the site of construction
18. Paving contractor -- asphalt/concrete for highways, streets, bridges, airport runways
19. Plastering, lathing, or fresco contractor
20. Marble, granite, or slate contractor, interior
21. Finish carpentry contractor
22. Waterproofing and weather stripping contractor
23. Fireproofing for other foundation, structure, and building exterior contractor
24. Fireproof flooring contractor
25. Rental of construction machinery or equipment (except cranes) with operator
26. Rental of cranes with operator
27. Asphalt, concrete, and brick paving contractor, residential or commercial driveways and
parking areas
28. Excavation work, earthmoving, or land clearing contractor
29. Other kinds of construction
8190
%
8191
%
8914
%
8192
%
7311
%
8313
%
8340
%
8350
%
8391
%
8314
%
8315
%
8916
%
8991
%
8990
%
8911
%
9000
%
9915
%
9919
%
9921
%
9922
%
Describe
Other business activity
30. Manufacturing -- products manufactured and sold to others
31. Rental of construction machinery or equipment to others, without an operator
32. Transportation of goods for others
33. Wholesale trade
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34. Retail trade
35. Other business activities
9925
%
9929
%
8005
%
Describe
TOTAL
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Ownership of Projects Additional Information
ITEM 28: SPECIAL ITEMS - OWNERSHIP OF PROJECTS
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue) on projects owned by the following:
2022
%
1. Private businesses and individuals
2. State and local governments
%
3. Federal Government
%
TOTAL
(Percentages reported in lines 1 through 3 should equal 100%.)
%
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Item 28: Special Items - Construction Subcontractors
ITEM 28: SPECIAL ITEMS - CONSTRUCTION SUBCONTRACTORS
What percent of the amount you reported in Item 5 (Sales, Shipments, Receipts, or Revenue) represents work you did for other contractors or builders?
(Enter "0" if you did not subcontract work from other contractors or builders.)
2022
%
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Item 28: Special Items - Construction by State
ITEM 28: SPECIAL ITEMS - CONSTRUCTION BY STATE
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue), which occurred in each state
(The sum of the percentages reported should equal 100%.)
2022
2022
%
Montana
%
Alaska
%
Nebraska
%
Arizona
%
Nevada
%
Arkansas
%
New Hampshire
%
California
%
New Jersey
%
Colorado
%
New Mexico
%
Connecticut
%
New York
%
Delaware
%
North Carolina
%
%
North Dakota
%
%
Ohio
%
%
Oklahoma
%
%
Oregon
%
%
Pennsylvania
%
%
Rhode Island
%
%
South Carolina
%
Iowa
%
South Dakota
%
Kansas
%
Tennessee
%
Kentucky
%
Texas
%
Alabama
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
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%
Utah
%
%
Vermont
%
%
Virginia
%
%
Washington
%
Michigan
%
West Virginia
%
Minnesota
%
Wisconsin
%
Mississippi
%
Wyoming
%
Missouri
%
United States
%
Louisiana
Maine
Maryland
Massachusetts
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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57
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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59
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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60
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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62
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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64
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
65
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
66
Location Information
DEFINITION OF ESTABLISHMENT
The reporting unit for this questionnaire is a construction establishment which is generally a permanent office, payroll office, or other place where business activities related to
construction are conducted. A construction establishment manages one or more projects or jobs and is usually maintained on a continuing basis.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Temporary construction site
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
New single-family housing construction (excluding for-sale builders), including attached and detached housing
236115 001
New multifamily housing construction (excluding for-sale builders), including apartments and condominiums
236116 001
New housing for-sale builder of single-family housing and multifamily housing
236117 001
Residential remodeler for home improvement (e.g., adding on, renovating, maintenance, and repair), including remodeling homes for resale
236118 001
Industrial building construction (e.g., processing and assembly plants, factories, refineries, waste disposal facilities), excluding warehouses
and sewage disposal plants
236210 001
Commercial and institutional building construction (e.g., office and school buildings, hospitals, health and data facilities, stores, and
warehouses)
236220 001
Water and sewer line and related structures construction (e.g., mains, sewage disposal plants, pumping stations, and water well drilling)
237110 001
Oil and gas pipeline and related structures construction (e.g., mains, petrochemical plants, pumping stations, and oil refineries)
237120 001
Power and communication line and related structures construction (e.g., alternative energy structures, power plants, transformer stations,
high voltage transmission cable connections, and cellular phone towers)
237130 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Highway, street, and bridge construction, including curbs, airport runway construction, and line painting of streets and parking lots
237310 001
Other heavy and civil engineering construction (e.g., tunnels, railways, outside recreation areas, dams, flood and drainage control projects,
dredging, trenching, and marine facilities)
237990 001
Poured concrete foundation and structure contractor (e.g., shotcrete, mud-jacking, gunning, gunite, pumping, and placement footing)
238110 001
Structural steel and precast concrete contractor, including structural iron work
238120 001
Framing contractor, including wood and steel (excluding structural steel or precast concrete)
238130 001
Masonry contractor (e.g., brick, stone, slate, glass block, cement, cinder blocking, stucco setting and other stone work)
238140 001
Glass and glazing contractor (e.g., glass coating and tinting (excluding automotive), window pane, glass sheet, glass curtain wall, and mirror
installation)
238150 001
Roofing contractor, including treating roofs (i.e., spraying, painting or coating) and skylight installation
238160 001
Siding contractor (e.g., gutters, downspouts, fascia, soffit, eavestrough, flashing, and ice apron)
238170 001
Other foundation, structure, and building exterior contractor (e.g., awning, metal balcony and stairway, and falsework construction), including
decorative steel and wrought iron work; poured concrete form installation and dismantling; and welding at site
238190 001
Electrical and other wiring installation contractor (e.g., electronic and environmental controls, telecommunications and fiber optic equipment
(excluding transmission line), solar panel installation, traffic signals, and fire and security systems)
238210 001
Plumbing, heating, and air-conditioning (HVAC) contractor, including installation, maintenance, and repair of refrigeration systems, sprinkler
systems, water systems, gas and oil line individual hookups, and steam and pipe fittings
238220 001
Other building equipment contractor (e.g., millwrights, machine rigging), including installation, maintenance, and repair of ATM equipment,
elevators, escalators, service station gasoline pumps, commercial and industrial doors)
238290 001
Drywall and insulation contractor, including acoustical, plastering, and fireproofing contractors
238310 001
Painting and wall covering contractor, including on-site electrostatic painting, whitewashing, and rustproofing of buildings, ships, bridges,
tanks, and towers (excluding automotive)
238320 001
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
15
Flooring contractor (e.g., laying carpet, linoleum, hardwood, laminate, and vinyl flooring), excluding fireproof, stone, concrete, and ceramic
tile flooring
238330 001
Tile and terrazzo contractor (e.g., marble, granite, slate, ceramic, stone, and mosaic work for floors, walls, and ceilings), excluding exterior
marble, granite, and slate work
238340 001
Finish carpentry contractor (e.g., door, window, cabinetry, countertop, stairway, deck, molding, trim, and paneling work, residential-type,
installation), excluding framing
238350 001
Other building finishing contractor (e.g., waterproofing, spectator seating, modular furniture system attachments, closet organizer systems,
concrete coating, window shades and blinds, and trade show exhibit installation and dismantling)
238390 001
Site preparation contractor, without land subdivision (e.g., land clearing, drilling, demolition, trenching, and earthmoving), and rental of
construction equipment with operators (excluding cranes))
238910 001
All other specialty trade contractor (e.g., driveway paving; constructions of residential and commercial parking lots, sidewalks, patios, and
outdoor swimming pools; installation of fences (excluding electric) and playground equipment; and crane rental with operator)
238990 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Receipts (or billings) derived from contract construction work done for others
Sales of houses and other buildings you built and sold
Construction management and design-build contracts
Site preparation receipts, such as land clearing, laying roads, installing utilities, and subdividing land into lots (Exclude purchase cost of land or estimated value of raw land for
construction projects.)
Architectural services, except the design portion of integrated design-build contracts
Engineering services
Rental or lease of properties
Real estate commissions and property management fees
Rental of construction machinery or equipment to others, without an operator
Manufacturing, mining, and transportation activities
Retail and wholesale trades
Other business activities
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building structure)
Purchased cost of land or estimated value of raw land for construction projects (Include site preparation receipts.)
Non-operating income such as interest, dividends, or the sale of fixed assets.
What were the receipts for all business activities done by this establishment, including receipts, billings, or sales for
construction work? (Construction work includes new construction and remodeling as well as maintenance and repair
work. The activities of prime and trade contractors are considered to be construction. Some trades not traditionally
thought of as construction are included such as land subdivision, excavation, building demolition, painting, carpet-laying,
water well drilling, plumbing and electrical work.)
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
Check
if
None
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Number of employees at this establishment
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
If the legal form of organization for this business is a corporation, the reporting of other employees and other payroll at this establishment is required. Enter "0" if the establishment
did not have payroll and employment for specific data for this EIN. If payroll and employment for this EIN are zero, please indicate if the EIN is a joint venture or reason why data
are zero in Item 31: Remarks at the end of the survey.
All persons on paid sick leave, paid holidays, and paid vacation during the year at this establishment
Spread on stock options that are taxable to employees at this establishment as wages
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.)
Contractors, subcontractors, or independent contractors
Purchased or managed services, such as janitorial, security, or landscape services (Report values in Item 16, line C9.)
Purchased professional and technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services (Report
values in Item 16, line C9.)
Members of the Armed Forces and pensioners carried on your active rolls
Proprietors and partners, if an unincorporated concern
Number of construction workers at this establishment include:
Apprentices
Working foremen
Equipment operators and mechanics
Journeymen
Job-site record keepers
Craftsmen
Laborers
Truck drivers and helpers
Others engaged directly in construction
Number of other employees at this establishment include:
Supervisors above working foremen
Office staff
Executives
Architects
Purchasing Agents
Personnel staff
Engineers
Accounting staff
Others engaged in non-construction activities
A. Number of employees at this establishment for the pay period including the 12th of the month.
March 2022
June 2022
September 2022
December 2022
1. What was the number of construction workers
(direct labor including first-line supervisors)?
2. What was the number of other employees?
TOTAL (Add lines A1 and A2.)
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20
B. HOURS WORKED
Check
if
None
2022 Hours
What was the annual number of hours worked by the construction workers at this establishment (direct labor
including first-line supervisors) reported in line A?
,000
C. PAYROLL
Include:
Payroll for officers at this establishment
Exclude:
Income or costs not recorded as payroll for IRS by establishment.
Employer-paid annual cost for fringe benefits reported in lines 7D1 and 7D2
Check
if
None
2022
1. What was the annual payroll at this establishment before deductions for construction workers (direct labor
including first-line supervisors)?
$
,000.00
2. What was the annual payroll before deductions for other employees?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $0,000.00 reported above, what was the first quarter payroll at this establishment before deductions
(January-March 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
Check
if
None
2022
1. What were the legally required fringe benefits? (Include employer payments for Social Security, Medicare,
unemployment compensation, workmen's compensation, and State disability programs, if required.)
$
,000.00
2. What were the voluntarily provided fringe benefits? (Include such items as payments for life insurance, medical
insurance, pensions, welfare benefits, and union-negotiated benefits.)
$
,000.00
TOTAL (Add lines D1 and D2.)
$
,000.00
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21
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Include:
Inventories, regardless of where held, for materials and supplies owned by this establishment as of December 31
Exclude:
Work-in-progress and finished units
Using current cost, what was the value of inventories owned
by this establishment as of December 31? (If using LIFO
method of evaluation, adjust to obtain FIFO or current cost.)
Check
if
None
2022
$
2021
,000.00
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
$
,000.00
22
Item 13: Assets, Capital Expenditures, and Retirements Additional Information
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS
Exclude
Land (Report cost of land acquired during the year in Item 16A, line 5.)
Check
if
None
2022
$
,000.00
B. What were the capital expenditures for new and used depreciable assets?
$
,000.00
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc.?
$
,000.00
D. What was the value of depreciable assets at the end of the year? (Add lines A and B minus line C.)
$
,000.00
A. What was the gross value of depreciable assets (usually original cost) at the beginning of the year?
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Item 14: Rental Payments Additional Information
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,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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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
A. For this establishment, what were the cost of materials, subcontract work, fuels, electricity, and land acquired in 2022 for:
Include:
Current account expenses normally considered as cost of work performed or job-specific costs
1. Cost of materials, parts, and supplies?
Include:
All job-site, office, and construction materials and supplies
Cost of materials purchased by this establishment's subcontractors
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building
structure)
Non-construction-related expenses that were paid to subcontractors by this establishment (Report these
expense details on the next screen, Item 16: Selected Expenses - Continued, in line C.)
Check
if
None
2022
$
,000.00
$
,000.00
a. Natural gas and manufactured gas (propane)?
$
,000.00
b. Gasoline and diesel fuel - ON highway (not at site)?
$
,000.00
c. Gasoline and diesel fuel - OFF highway (at site)?
$
,000.00
$
,000.00
$
,000.00
2. Cost of construction-related work subcontracted out to others?
Exclude:
Cost of materials purchased by this establishment for subcontractors (These costs should be reported in line
A1.)
Check
if
None
3. Cost of fuels for heat, power, lubricants
Check
if
None
d. All other fuels and lubricants, including heating oils, lubricating oils, and greases?
Check
if
None
4. Cost of electricity?
5. When you answered Item 5, did you include the purchased cost of land or estimated value of raw land? Please check one, and answer the below question.
Yes
No
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
25
Check
if
None
6. What was the purchased cost of land or estimated value of raw land for reported construction projects during the
covered time?
$
,000.00
$
,000.00
Check
if
None
B. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
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Item 16: Selected Expenses - Continued Additional Information
ITEM 16: SELECTED EXPENSES
C. What were the other operating expenses paid by this establishment in 2022 for:
1. Temporary staff and leased employees? (Professional Employer Organizations and staffing agencies for
personnel)
Include:
All charges for payroll, benefits, and services your establishment paid to the Professional Employer
Organizations for the temporary staff and leased employees
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report on line C3.)
Leased and rented equipment (Report on 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
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
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27
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data Storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
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 in line C6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in line C9 and credit
card transaction fees in line C4.)
Expenses for telecommunication services (e.g., Internet, connectivity, telephone) (Report in line C4.)
$
,000.00
Exclude
Materials, parts, and supplies used for repairs and maintenance performed by this firm's employees
$
,000.00
7. Water, sewer, refuse removal, and other non-electric utility payments?
(Report electric utility payments in Item 16, line A4. If the cost of these utilities is included in a leased or rental
payment, report in Item 14, line A.)
Include:
Cost of hazardous waste removal
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
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. such as janitorial, security, or landscape services)
Exclude:
Salaries paid to your own employees for these services (Report in Item 7.)
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28
10. Governmental taxes and licensing fees?(Payments to government agencies for taxes and licenses)
Include:
Business and property tax fees for establishment to remain active legal operable business
Permits and licensing fees
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Include:
Expenses for paid temporary day labors not on your payroll or hired as construction subcontractors
Exclude:
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
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29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
The construction project types listed below are general to your industry. Select the project types that apply to your establishment. On the next screen, you will report the specific
construction products and services related to the construction projects you select. If you have revenue from other sources not listed, you will have the opportunity to report them later.
At-risk construction project management revenue should be reported with the specific construction project associated with those management services. For example, if at-risk
construction project management is for office buildings, then include the management revenue with the project for office buildings. However, at-fee project management services
should be reported in the specific project for construction project management services.
Description
Select
Amusement, social, and recreational building construction
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
Commercial warehouses, such as distribution buildings and mini-storage
Project Code
334
322
359
327
319
Dormitories and barracks
329
Educational building construction
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
323
333
Farm building construction, nonresidential
331
Health care and institutional building construction
324
Hotel, motel, and inn construction
321
Industrial warehouse construction
Nonresidential mobile building construction, office and other commercial
335
325
Office building construction
332
Public safety building construction
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
30
328
Religious building construction
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
326
336
338
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
318
314
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
317
316
Single detached residential building construction
346
Bridge and elevated highway
Conservation and development construction, including dams, drainage canals, and flood control projects
368
378
Fencing
373
Harbor and port facilities
357
Hydroelectric power plants
Marine construction, such as dredging, navigational channels, and locks
374
366
Mass transit, including railroads
Oil and gas pipelines, pumping stations, storage tanks, and mains
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
353
381
364
Petrochemical plant and petroleum refinery construction
Power and cogeneration plant construction, except hydroelectric construction
Power and communication transmission line, cable, tower, and related facilities
356
354
361
Sewage and water treatment plants
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
31
Sewers, sewer lines, septic systems, and related facilities
351
384
Ship maintenance and repair services
375
Swimming pools
347
Tunnels
352
Water mains, storage wells, and related facilities
395
Other nonresidential constructions, except buildings
Other specialized cleaning services, not elsewhere classified
399
376
Residential decks
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
377
Add product/service not listed
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
32
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services associated with the construction projects you previously selected. If you have revenue from sources not listed, describe and report them in the
"All other sales, shipments, receipts, or revenue from this establishment" section at the end of this question.
At-risk construction project management revenue should be reported with the specific constructions or construction services associated with those management services. For
example, if at-risk construction project management is for entire office building constructions, then include the management revenue with the new constructions for office buildings.
However, at-fee project management services should be reported in the specific product lines for construction project management services.
New Constructions and Construction Services – Report only the main activities including the type of buildings, structures, or facilities contracted to construct or work on by this
establishment in the reporting year in which this establishment received receipts only. If you worked on more than one type of building or structure in a multipurpose complex, report
separately for each building or type of structure. However, if you worked on a building that had more than one purpose, i.e. office, residential, or commercial, classify this building by
its major purpose.
New constructions include all components of the entire original building or structure. Land development work on the site and demolition of existing structures are included with
new constructions.
Construction services for new building or structures include separate components of the original building or structure, such as electric work, painting, plumbing, etc.
Construction services for additions, renovations, and alterations to buildings or structures include construction work which adds to the value of useful life of an existing
building or structure, or which adapts a building or structure to a new or different use. Included are “major replacements” of building systems such as the installation of a new
roof or heating system, and the resurfacing of streets or highways. Exclude activities such as the repair of a hole in a roof or the routine patching of highways and streets, which
are classified as “maintenance and repair work”.
Construction services for maintenance and repair of buildings or structures include incidental construction work that keeps a property in ordinary working condition.
Exclude trash and snow removal, lawn maintenance, and janitorial services.
Description
Value
Product Code
Amusement, social, and recreational building construction
1. Amusement, social, and recreational building new constructions (by builders and at-risk project managers)
$
,000.00
3000875000
2. Construction services for new amusement, social, and recreational buildings
$
,000.00
3001350000
3. Construction services for additions, renovations, and alterations to amusement, social, and recreational buildings
$
,000.00
3001750000
4. Construction services for maintenance and repair of amusement, social, and recreational buildings
$
,000.00
3002150000
5. Apartment building (two or more units) new constructions, excluding condominiums (by builders and at-risk project
managers)
$
,000.00
3000625000
6. Construction services for new apartment buildings (two or more units), excluding condominiums
$
,000.00
3001050000
7. Construction services for additions, renovations, and alterations to apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001075000
8. Construction services for maintenance and repair of apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001100000
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
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9. Chemical (except petrochemical) complex/plant, blast furnace, and mining appurtenance new constructions (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002600000
10. Construction services for new chemical (except petrochemical) complexes/plants, blast furnaces, and mining
appurtenances
$
,000.00
3003250000
11. Construction services for additions, renovations, and alterations to chemical (except petrochemical)
complexes/plants, blast furnaces, and mining appurtenances
$
,000.00
3003900000
12. Construction services for maintenance and repair of chemical (except petrochemical) complexes/plants, blast
furnaces, and mining appurtenances
$
,000.00
3004550000
13. Commercial warehouse new constructions, such as distribution buildings and mini-storage (by builders and at-risk
project managers)
$
,000.00
3000750000
14. Construction services for new commercial warehouses, such as distribution buildings and mini-storage
$
,000.00
3001225000
15. Construction services for additions, renovations, and alterations to commercial warehouses, such as distribution
buildings and mini-storage
$
,000.00
3001625000
16. Construction services for maintenance and repair of commercial warehouses, such as distribution buildings and
mini-storage
$
,000.00
3002025000
17. Educational institution dormitories new constructions (by builders and at-risk project mangers)
$
,000.00
3001005000
18. Military and other public safety dormitories and barracks new constructions (by builders and at-risk project
managers)
$
,000.00
3001010000
$
,000.00
3001480000
20. Construction services for new military and other public safety dormitories and barracks
$
,000.00
3001485000
21. Construction services for additions, renovations, and alterations to educational institution dormitories
$
,000.00
3001880000
22. Construction services for additions, renovations, and alterations to military and other public safety dormitories and
barracks
$
,000.00
3001885000
$
,000.00
3002280000
$
,000.00
3002285000
25. Educational building new constructions (by builders and at-risk project managers)
$
,000.00
3000825000
26. Construction services for new educational buildings
$
,000.00
3001300000
Commercial warehouses, such as distribution buildings and mini-storage
Dormitories and barracks
19. Construction services for new educational institution dormitories
23. Construction services for maintenance and repair of educational institution dormitories
24. Construction services for maintenance and repair of military and other public safety dormitories and barracks
Educational building construction
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
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27. Construction services for additions, renovations, and alterations to educational buildings
$
,000.00
3001700000
28. Construction services for maintenance and repair of educational buildings
$
,000.00
3002100000
29. Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building new
constructions (by builders and at-risk project managers)
$
,000.00
3000700000
30. Construction services for new factories, assembly plants, industrial research laboratories, and other new
manufacturing and industrial buildings
$
,000.00
3001175000
31. Construction services for additions, renovations, and alterations to factories, assembly plants, industrial research
laboratories, and other manufacturing and industrial buildings
$
,000.00
3001575000
32. Construction services for maintenance and repair of factories, assembly plants, industrial research laboratories, and
other manufacturing and industrial buildings
$
,000.00
3001975000
$
,000.00
3000975000
$
,000.00
3001450000
35. Construction services for additions, renovations, and alterations to farm buildings, nonresidential
$
,000.00
3001850000
36. Construction services for maintenance and repair of farm buildings, nonresidential
$
,000.00
3002250000
$
,000.00
3000850000
$
,000.00
3001325000
39. Construction services for additions, renovations, and alterations to health care and institutional buildings
$
,000.00
3001725000
40. Construction services for maintenance and repair of health care and institutional buildings
$
,000.00
3002125000
41. Hotel, motel, and inn new constructions (by builders and at-risk project managers)
$
,000.00
3000650000
42. Construction services for new hotels, motels, and inns
$
,000.00
3001125000
43. Construction services for additions, renovations, and alterations to hotels, motels, and inns
$
,000.00
3001525000
44. Construction services for maintenance and repair of hotels, motels, and inns
$
,000.00
3001925000
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
Farm building construction, nonresidential
33. Farm building new constructions, nonresidential (by builders and at-risk project managers)
34. Construction services for new farm buildings, nonresidential
Health care and institutional building construction
37. Health care and institutional buildings new constructions (by builders and at-risk project managers)
38. Construction services for new health care and institutional buildings
Hotel, motel, and inn construction
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
35
Industrial warehouse construction
45. Industrial warehouse new constructions at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000680000
46. Industrial warehouse new constructions not at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000685000
47. Construction services for new industrial warehouses at manufacturing sites
$
,000.00
3001155000
48. Construction services for new industrial warehouses not at manufacturing sites
$
,000.00
3001160000
49. Construction services for additions, renovations, and alterations to industrial warehouses at manufacturing sites
$
,000.00
3001555000
50. Construction services for additions, renovations, and alterations to industrial warehouses not at manufacturing sites
$
,000.00
3001560000
51. Construction services for maintenance and repair of industrial warehouses at manufacturing sites
$
,000.00
3001955000
$
,000.00
3001960000
53. Nonresidential mobile building new constructions, office (by builders and at-risk project managers)
$
,000.00
3000930000
54. Nonresidential mobile building new constructions, other commercial (by builders and at-risk project managers)
$
,000.00
3000935000
55. Construction services for new nonresidential mobile building constructions, office
$
,000.00
3001405000
56. Construction services for new nonresidential mobile building constructions, other commercial
$
,000.00
3001410000
57. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
office
$
,000.00
3001805000
58. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
other commercial
$
,000.00
3001810000
59. Construction services for maintenance and repair of nonresidential mobile building constructions, office
$
,000.00
3002205000
60. Construction services for maintenance and repair of nonresidential mobile building constructions, other commercial
$
,000.00
3002210000
61. Office building and data center new constructions (by builders and at-risk project managers)
$
,000.00
3000725000
62. Construction services for new office buildings and data centers
$
,000.00
3001200000
63. Construction services for additions, renovations, and alterations to office buildings and data centers
$
,000.00
3001600000
52. Construction services for maintenance and repair of industrial warehouses not at manufacturing sites
Nonresidential mobile building construction, office and other commercial
Office building construction
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
36
64. Construction services for maintenance and repair of office buildings and data centers
$
,000.00
3002000000
65. Public safety building new constructions (by builders and at-risk project managers)
$
,000.00
3000900000
66. Construction services for new public safety buildings
$
,000.00
3001375000
67. Construction services for additions, renovations, and alterations to public safety buildings
$
,000.00
3001775000
68. Construction services for maintenance and repair of public safety buildings
$
,000.00
3002175000
$
,000.00
3000800000
70. Construction services for new religious buildings
$
,000.00
3001275000
71. Construction services for additions, renovations, and alterations to religious buildings
$
,000.00
3001675000
72. Construction services for maintenance and repair of religious buildings
$
,000.00
3002075000
73. Store, restaurant, automobile service station, parking garage, and other commercial building new constructions
(excluding mobile buildings)(by builders and at-risk project managers)
$
,000.00
3000775000
74. Construction services for new stores, restaurants, automobile service stations, parking garages, and other
commercial buildings (excluding mobile buildings)
$
,000.00
3001250000
75. Construction services for additions, renovations, and alterations to stores, restaurants, automobile service stations,
parking garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3001650000
76. Construction services for maintenance and repair of stores, restaurants, automobile service stations, parking
garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3002050000
77. Nonresidential mobile building new constructions, classroom (by builders and at-risk project managers)
$
,000.00
3000955000
78. Nonresidential mobile building new constructions, industrial (by builders and at-risk project managers)
$
,000.00
3000960000
79. Construction services for new nonresidential mobile building constructions, classroom
$
,000.00
3001430000
80. Construction services for new nonresidential mobile building constructions, industrial
$
,000.00
3001435000
81. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, classrooms
$
,000.00
3001830000
Public safety building construction
Religious building construction
69. Religious building new constructions (by builders and at-risk project managers)
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
37
82. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, industrial
$
,000.00
3001835000
83. Construction services for maintenance and repair of other nonresidential mobile building constructions, classrooms
$
,000.00
3002230000
84. Construction services for maintenance and repair of other nonresidential mobile building constructions, industrial
$
,000.00
3002235000
85. All other nonresidential building new constructions (by builders and at-risk project managers)
$
,000.00
3001025000
86. Construction services for all other new nonresidential buildings
$
,000.00
3001500000
87. Construction services for additions, renovations, and alterations to all other nonresidential buildings
$
,000.00
3001900000
88. Construction services for maintenance and repair of all other nonresidential buildings
$
,000.00
3002300000
89. Constructions of new apartment type condominiums, excluding single family condominiums (by builders and at-risk
project managers)
$
,000.00
3000100000
90. Construction services for new apartment type condominiums, excluding single family condominiums
$
,000.00
3000200000
91. Construction services for additions, renovations, and alterations to apartment type condominiums, excluding single
family condominiums
$
,000.00
3000300000
92. Construction services for maintenance and repair of apartment type condominiums, excluding single family
condominiums
$
,000.00
3000400000
93. Constructions of new manufactured (mobile) homes, all width sizes (including multisection) (by builders and at-risk
project managers)
$
,000.00
3000075000
94. Construction services for new manufactured homes (mobile homes), all width sizes (including multisection)
$
,000.00
3000175000
95. Construction services for additions, renovations, and alterations to manufactured homes (mobile homes), all width
sizes (including multisection)
$
,000.00
3000275000
96. Construction services for maintenance and repair of manufactured homes (mobile homes), all width sizes (including
multisection)
$
,000.00
3000375000
97. Constructions of new single attached residential buildings, including row houses and town houses (by builders and
at-risk project managers)
$
,000.00
3000050000
98. Construction services for new single attached residential buildings, including row houses and town houses
$
,000.00
3000150000
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
38
99. Construction services for additions, renovations, and alterations to single attached residential buildings, including
row houses and town houses
$
,000.00
3000250000
100. Construction services for maintenance and repair of single attached residential buildings, including row houses and
town houses
$
,000.00
3000350000
101. Constructions of new single detached residential buildings (by builders and at-risk project managers)
$
,000.00
3000025000
102. Construction services for new single detached residential buildings
$
,000.00
3000125000
103. Construction services for additions, renovations, and alterations to single detached residential buildings
$
,000.00
3000225000
104. Construction services for maintenance and repair of single detached residential buildings
$
,000.00
3000325000
105. Bridge and elevated highway new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002375000
106. Construction services for new bridges and elevated highways
$
,000.00
3003025000
107. Construction services for additions, renovations, and alterations to bridges and elevated highways
$
,000.00
3003675000
108. Construction services for maintenance and repair of bridges and elevated highways
$
,000.00
3004325000
109. Conservation and development new constructions, including dams, drainage canals, and flood control projects (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002650000
110. Construction services for new conservation and development constructions, including dams, drainage canals, and
flood control projects
$
,000.00
3003300000
111. Construction services for additions, renovations, and alterations to conservation and development constructions,
including dams, drainage canals, and flood control projects
$
,000.00
3003950000
112. Construction services for maintenance and repair of conservation and development constructions, including dams,
drainage canals, and flood control projects
$
,000.00
3004600000
$
,000.00
3002825000
$
,000.00
3003475000
115. Construction services for additions, renovations, and alterations to fencing constructions
$
,000.00
3004125000
116. Construction services for maintenance and repair of fencing constructions
$
,000.00
3004750000
Single detached residential building construction
Bridge and elevated highway
Conservation and development construction, including dams, drainage canals, and flood control projects
Fencing
113. Fencing new constructions (by heavy construction contractors and at-risk project managers)
114. Construction services for new fencing constructions
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
39
Harbor and port facilities
117. Harbor and port facilities new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002725000
118. Construction services for new harbor and port facilities
$
,000.00
3003375000
119. Construction services for additions, renovations, and alterations to harbor and port facilities
$
,000.00
3004025000
120. Construction services for maintenance and repair of harbor and port facilities
$
,000.00
3004675000
121. Power plant new constructions, hydroelectric (by heavy construction contractors and at-risk project managers)
$
,000.00
3002575000
122. Construction services for new power plants, hydroelectric
$
,000.00
3003225000
123. Construction services for additions, renovations, and alterations to power plants, hydroelectric
$
,000.00
3003875000
124. Construction services for maintenance and repair of power plants, hydroelectric
$
,000.00
3004525000
125. Marine new constructions, including dredging, navigational channels, and locks (by heavy construction contractors
and at-risk project managers)
$
,000.00
3002750000
126. Construction services for new marine constructions, including dredging, navigational channels, and locks
$
,000.00
3003400000
127. Construction services for additions, renovations, and alterations to marine constructions, including dredging,
navigational channels, and locks
$
,000.00
3004050000
128. Construction services for maintenance and repair of marine constructions, including dredging, navigational
channels, and locks
$
,000.00
3004700000
129. Mass transit new constructions, including railroads (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002700000
130. Construction services for new mass transit constructions, including railroads
$
,000.00
3003350000
131. Construction services contractors for additions, renovations, and alterations to mass transit constructions, including
railroads
$
,000.00
3004000000
132. Construction services for maintenance and repair of mass transit constructions, including railroads
$
,000.00
3004650000
$
,000.00
3002500000
Hydroelectric power plants
Marine construction, such as dredging, navigational channels, and locks
Mass transit, including railroads
Oil and gas pipelines, pumping stations, storage tanks, and mains
133. Oil and gas pipeline, pumping station, storage tank, and main new constructions (by heavy construction
contractors and at-risk project managers)
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
40
134. Construction services for new oil and gas pipelines, pumping stations, storage tanks, and mains
$
,000.00
3003150000
135. Construction services for additions, renovations, and alterations to oil and gas pipelines, pumping stations, storage
tanks, and mains
$
,000.00
3003800000
136. Construction services for maintenance and repair of oil and gas pipelines, pumping stations, storage tanks, and
mains
$
,000.00
3004450000
137. Outdoor recreational area new constructions, including athletic fields, courts, golf courses, and campgrounds (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002800000
138. Construction services for new outdoor recreational areas, including athletic fields, courts, golf courses, and
campgrounds
$
,000.00
3003450000
139. Construction services for additions, renovations, and alterations to outdoor recreational area constructions,
including athletic fields, courts, golf courses, and campgrounds
$
,000.00
3004100000
140. Construction services for maintenance and repair of outdoor recreational area constructions, including athletic
fields, courts, golf courses, and campgrounds
$
,000.00
3004725000
$
,000.00
3002625000
$
,000.00
3003275000
$
,000.00
3003925000
$
,000.00
3004575000
145. Power and cogeneration plant new constructions, except hydroelectric (by heavy construction contractors and atrisk project managers)
$
,000.00
3002550000
146. Construction services for new power and cogeneration plants, except hydroelectric
$
,000.00
3003200000
147. Construction services for additions, renovations, and alterations to power and cogeneration plants, except
hydroelectric
$
,000.00
3003850000
$
,000.00
3004500000
$
,000.00
3002525000
$
,000.00
3003175000
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
Petrochemical plant and petroleum refinery construction
141. Petrochemical plant and petroleum refinery new constructions (by heavy construction contractors and at-risk
project managers)
142. Construction services for new petrochemical plants and petroleum refineries
143. Construction services for additions, renovations, and alterations to petrochemical plants and petroleum refineries
144. Construction services for maintenance and repair of petrochemical plants and petroleum refineries
Power and cogeneration plant construction, except hydroelectric construction
148. Construction services for maintenance and repair of power and cogeneration plants, except hydroelectric
Power and communication transmission line, cable, tower, and related facilities
149. Power and communication transmission line, cable, tower, and related facilities new constructions (by heavy
construction contractors and at-risk project managers)
150. Construction services for new power and communication transmission lines, cables, towers, and related facilities
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
41
151. Construction services for additions, renovations, and alterations to power and communication transmission lines,
cables, towers, and related facilities
$
,000.00
3003825000
152. Construction services for maintenance and repair of power and communication transmission lines, cables, towers,
and related facilities
$
,000.00
3004475000
$
,000.00
3002475000
$
,000.00
3003125000
155. Construction services for additions, renovations, and alterations to sewage and water treatment plants
$
,000.00
3003775000
156. Construction services for maintenance and repair of sewage and water treatment plants
$
,000.00
3004425000
157. Sewer, sewer line, septic system, and related facilities new constructions (by heavy construction contractors and
at-risk project managers)
$
,000.00
3002425000
158. Construction services for new sewers, sewer lines, septic systems, and related facilities
$
,000.00
3003075000
159. Construction services for additions, renovations, and alterations to sewers, sewer lines, septic systems, and
related facilities
$
,000.00
3003725000
160. Construction services for maintenance and repair of sewers, sewer lines, septic systems, and related facilities
$
,000.00
3004375000
$
,000.00
2053950000
$
,000.00
2053975000
$
,000.00
3002775000
$
,000.00
3003425000
$
,000.00
3004075000
$
,000.00
3002400000
$
,000.00
3003050000
Sewage and water treatment plants
153. Sewage and water treatment plant new constructions(by heavy construction contractors and at-risk project
managers)
154. Construction services for new sewage and water treatment plants
Sewers, sewer lines, septic systems, and related facilities
Ship maintenance and repair services
161. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, military
162. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, nonmilitary
Swimming pools
163. Swimming pool new constructions (by builders and at-risk project managers)
164. Construction services for new swimming pools
165. Construction services for additions, renovations, and alterations to swimming pools
Tunnels
166. Tunnel new constructions (by heavy construction contractors and at-risk project managers)
167. Construction services for new tunnels
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
42
168. Construction services for additions, renovations, and alterations to tunnels
$
,000.00
3003700000
$
,000.00
3004350000
$
,000.00
3002450000
$
,000.00
3003100000
$
,000.00
3003750000
$
,000.00
3004400000
$
,000.00
3002950000
$
,000.00
3003600000
176. Construction services for additions, renovations, and alterations to other nonresidential constructions, excluding
buildings
$
,000.00
3004250000
177. Construction services for maintenance and repair of all other nonresidential constructions, excluding buildings
$
,000.00
3004775000
$
,000.00
7008725003
b. Parking lot sweeping services
$
,000.00
7008725006
c. Swimming pool cleaning and maintenance services
$
,000.00
7008725009
$
,000.00
7008725012
$
,000.00
7008725000
179. Residential deck new constructions (by builders and at-risk project managers)
$
,000.00
3000425000
180. Construction services for new residential deck constructions
$
,000.00
3000450000
169. Construction services for maintenance and repair of tunnels
Water mains, storage wells, and related facilities
170. Water main, storage, well, and related facilities new constructions (by heavy construction contractors and at-risk
project managers)
171. Construction services for new water mains, storage, wells, and related facilities
172. Construction services for additions, renovations, and alterations to water mains, storage, wells, and related
facilities
173. Construction services for maintenance and repair of water mains, storage, wells, and related facilities
Other nonresidential constructions, except buildings
174. Other nonresidential new constructions, except buildings (by heavy construction contractors and at-risk project
managers)
175. Construction services for other new nonresidential constructions, excluding buildings
Other specialized cleaning services, not elsewhere classified
178. Other specialized cleaning services, not elsewhere classified
a. Drain and gutter cleaning services
d. All other specialized cleaning services, not elsewhere classified
Subtotal
Residential decks
2022_CC-23830_su.pdf Generated 2022-02-23 15:46:52
43
181. Construction services for additions, renovations, and alterations to residential deck constructions
$
,000.00
3000475000
$
,000.00
3000500000
a. Residential irrigation and sprinkler system new constructions (by builders and at-risk project managers)
$
,000.00
3000525003
b. Other residential landscape new constructions, excluding decks (by builders and at-risk project managers)
$
,000.00
3000525006
$
,000.00
3000525000
$
,000.00
3000550003
$
,000.00
3000550006
$
,000.00
3000550000
a. Construction services for additions, renovations, and alterations to residential irrigation and sprinkler system
constructions
$
,000.00
3000575003
b. Construction services for additions, renovations, and alterations to other residential landscape constructions,
excluding decks
$
,000.00
3000575006
Subtotal
$
,000.00
3000575000
$
,000.00
3000600003
b. Construction services for maintenance and repair of other residential landscape constructions, excluding decks
$
,000.00
3000600006
Subtotal
$
,000.00
3000600000
$
,000.00
9900000000
182. Construction services for maintenance and repair of residential deck constructions
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
183. Residential landscape new constructions, excluding decks (by builders and at-risk project managers)
Subtotal
184. Construction services for new residential landscape constructions, excluding decks (by builders and at-risk project
managers)
a. Construction services for new residential irrigation and sprinkler system constructions
b. Construction services for other new residential landscape constructions, excluding decks
Subtotal
185. Construction services for additions, renovations, and alterations to residential landscape constructions, excluding
decks
186. Construction services for maintenance and repair of residential landscape constructions, excluding decks
a. Construction services for maintenance and repair of residential irrigation and sprinkler system constructions
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 23: Kind of Business Activities Additional Information
ITEM 23: KIND OF BUSINESS ACTIVITIES
For the $,000.00 of sales, shipments, receipts, or revenue in 2022, please report the percent of the total represented by the following construction and non-construction business
activities. The sum of these percentages should equal 100%.
CONSTRUCTION WORK ACTIVITIES
Report only the main activities for which you were contracted. Work which was incidental to the primary activities of jobs should not be reported separately. If the construction activity is
not listed below, please enter a description of the construction activity in the “Other construction activities” write-in box, along with a percentage of the value of total business for that
specified construction activity.
OTHER BUSINESS ACTIVITIES
Report any non-construction activities. If the activity is not listed below, please enter a description of the non-construction activity in the “Other business activities” write-in box, along
with a percentage of the value of total business for that specified activity.
Description
Code
Value
Construction work activities
1. Acoustical contractor
2. Drywall contractor
3. Insulation contractor (except boiler, pipe, or duct work)
4. Fireproofing for other foundation, structure, and building exterior contractor
5. Fireproof flooring contractor
6. Plastering, lathing, or fresco contractor
7. Bridge and ship painting contractor (except lane painting for bridges)
8. Painting contractor
9. Wall covering or removal contractor
10. Carpet laying or removal contractor
11. Flooring contractor, including wood, resilient, and computer flooring (except fireproof
flooring)
12. Marble, granite, or slate contractor, interior
8310
%
8311
%
8312
%
8314
%
8315
%
8313
%
8320
%
8321
%
8322
%
8330
%
8332
%
8340
%
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13. Tile, terrazzo, or mosaic contractor
14. Finish carpentry contractor
15. Garage door and overhead door installation contractor, residential-type
16. Specialty sheet metal contractor, including metal ceiling, panel, or shelving installation
17. Waterproofing and weather stripping contractor
18. Framing contractor
19. Marble, granite, or slate contractor, exterior
20. Masonry contractor: brick, block, or stone (except brick paving)
21. Stucco contractor
22. Boiler, pipe, or duct work insulation contractor
23. Other kinds of construction
8341
%
8350
%
8351
%
8390
%
8391
%
8130
%
8140
%
8141
%
8143
%
8292
%
9000
%
9914
%
9915
%
9919
%
9922
%
9925
%
9929
%
8005
%
Describe
Other business activity
24. Engineering services
25. Manufacturing -- products manufactured and sold to others
26. Rental of construction machinery or equipment to others, without an operator
27. Wholesale trade
28. Retail trade
29. Other business activities
Describe
TOTAL
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Ownership of Projects Additional Information
ITEM 28: SPECIAL ITEMS - OWNERSHIP OF PROJECTS
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue) on projects owned by the following:
2022
%
1. Private businesses and individuals
%
2. State and local governments
%
3. Federal Government
TOTAL
(Percentages reported in lines 1 through 3 should equal 100%.)
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%
49
Item 28: Special Items - Construction Subcontractors
ITEM 28: SPECIAL ITEMS - CONSTRUCTION SUBCONTRACTORS
What percent of the amount you reported in Item 5 (Sales, Shipments, Receipts, or Revenue) represents work you did for other contractors or builders?
(Enter "0" if you did not subcontract work from other contractors or builders.)
2022
%
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50
Item 28: Special Items - Construction by State
ITEM 28: SPECIAL ITEMS - CONSTRUCTION BY STATE
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue), which occurred in each state
(The sum of the percentages reported should equal 100%.)
2022
2022
%
Montana
%
%
Nebraska
%
%
Nevada
%
%
New Hampshire
%
%
New Jersey
%
%
New Mexico
%
%
New York
%
Delaware
%
North Carolina
%
District of Columbia
%
North Dakota
%
Florida
%
Ohio
%
Georgia
%
Oklahoma
%
Hawaii
%
Oregon
%
Idaho
%
Pennsylvania
%
%
Rhode Island
%
%
South Carolina
%
%
South Dakota
%
%
Tennessee
%
%
Texas
%
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Illinois
Indiana
Iowa
Kansas
Kentucky
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Louisiana
%
Utah
%
Maine
%
Vermont
%
%
Virginia
%
%
Washington
%
%
West Virginia
%
%
Wisconsin
%
%
Wyoming
%
%
United States
%
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
63
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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64
Location Information
DEFINITION OF ESTABLISHMENT
The reporting unit for this questionnaire is a construction establishment which is generally a permanent office, payroll office, or other place where business activities related to
construction are conducted. A construction establishment manages one or more projects or jobs and is usually maintained on a continuing basis.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Temporary construction site
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
New single-family housing construction (excluding for-sale builders), including attached and detached housing
236115 001
New multifamily housing construction (excluding for-sale builders), including apartments and condominiums
236116 001
New housing for-sale builder of single-family housing and multifamily housing
236117 001
Residential remodeler for home improvement (e.g., adding on, renovating, maintenance, and repair), including remodeling homes for resale
236118 001
Industrial building construction (e.g., processing and assembly plants, factories, refineries, waste disposal facilities), excluding warehouses
and sewage disposal plants
236210 001
Commercial and institutional building construction (e.g., office and school buildings, hospitals, health and data facilities, stores, and
warehouses)
236220 001
Water and sewer line and related structures construction (e.g., mains, sewage disposal plants, pumping stations, and water well drilling)
237110 001
Oil and gas pipeline and related structures construction (e.g., mains, petrochemical plants, pumping stations, and oil refineries)
237120 001
Power and communication line and related structures construction (e.g., alternative energy structures, power plants, transformer stations,
high voltage transmission cable connections, and cellular phone towers)
237130 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Highway, street, and bridge construction, including curbs, airport runway construction, and line painting of streets and parking lots
237310 001
Other heavy and civil engineering construction (e.g., tunnels, railways, outside recreation areas, dams, flood and drainage control projects,
dredging, trenching, and marine facilities)
237990 001
Poured concrete foundation and structure contractor (e.g., shotcrete, mud-jacking, gunning, gunite, pumping, and placement footing)
238110 001
Structural steel and precast concrete contractor, including structural iron work
238120 001
Framing contractor, including wood and steel (excluding structural steel or precast concrete)
238130 001
Masonry contractor (e.g., brick, stone, slate, glass block, cement, cinder blocking, stucco setting and other stone work)
238140 001
Glass and glazing contractor (e.g., glass coating and tinting (excluding automotive), window pane, glass sheet, glass curtain wall, and mirror
installation)
238150 001
Roofing contractor, including treating roofs (i.e., spraying, painting or coating) and skylight installation
238160 001
Siding contractor (e.g., gutters, downspouts, fascia, soffit, eavestrough, flashing, and ice apron)
238170 001
Other foundation, structure, and building exterior contractor (e.g., awning, metal balcony and stairway, and falsework construction), including
decorative steel and wrought iron work; poured concrete form installation and dismantling; and welding at site
238190 001
Electrical and other wiring installation contractor (e.g., electronic and environmental controls, telecommunications and fiber optic equipment
(excluding transmission line), solar panel installation, traffic signals, and fire and security systems)
238210 001
Plumbing, heating, and air-conditioning (HVAC) contractor, including installation, maintenance, and repair of refrigeration systems, sprinkler
systems, water systems, gas and oil line individual hookups, and steam and pipe fittings
238220 001
Other building equipment contractor (e.g., millwrights, machine rigging), including installation, maintenance, and repair of ATM equipment,
elevators, escalators, service station gasoline pumps, commercial and industrial doors)
238290 001
Drywall and insulation contractor, including acoustical, plastering, and fireproofing contractors
238310 001
Painting and wall covering contractor, including on-site electrostatic painting, whitewashing, and rustproofing of buildings, ships, bridges,
tanks, and towers (excluding automotive)
238320 001
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Flooring contractor (e.g., laying carpet, linoleum, hardwood, laminate, and vinyl flooring), excluding fireproof, stone, concrete, and ceramic
tile flooring
238330 001
Tile and terrazzo contractor (e.g., marble, granite, slate, ceramic, stone, and mosaic work for floors, walls, and ceilings), excluding exterior
marble, granite, and slate work
238340 001
Finish carpentry contractor (e.g., door, window, cabinetry, countertop, stairway, deck, molding, trim, and paneling work, residential-type,
installation), excluding framing
238350 001
Other building finishing contractor (e.g., waterproofing, spectator seating, modular furniture system attachments, closet organizer systems,
concrete coating, window shades and blinds, and trade show exhibit installation and dismantling)
238390 001
Site preparation contractor, without land subdivision (e.g., land clearing, drilling, demolition, trenching, and earthmoving), and rental of
construction equipment with operators (excluding cranes))
238910 001
All other specialty trade contractor (e.g., driveway paving; constructions of residential and commercial parking lots, sidewalks, patios, and
outdoor swimming pools; installation of fences (excluding electric) and playground equipment; and crane rental with operator)
238990 001
Other specialty trade contractors
238900 001
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Receipts (or billings) derived from contract construction work done for others
Sales of houses and other buildings you built and sold
Construction management and design-build contracts
Site preparation receipts, such as land clearing, laying roads, installing utilities, and subdividing land into lots (Exclude purchase cost of land or estimated value of raw land for
construction projects.)
Architectural services, except the design portion of integrated design-build contracts
Engineering services
Rental or lease of properties
Real estate commissions and property management fees
Rental of construction machinery or equipment to others, without an operator
Manufacturing, mining, and transportation activities
Retail and wholesale trades
Other business activities
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building structure)
Purchased cost of land or estimated value of raw land for construction projects (Include site preparation receipts.)
Non-operating income such as interest, dividends, or the sale of fixed assets.
What were the receipts for all business activities done by this establishment, including receipts, billings, or sales for
construction work? (Construction work includes new construction and remodeling as well as maintenance and repair
work. The activities of prime and trade contractors are considered to be construction. Some trades not traditionally
thought of as construction are included such as land subdivision, excavation, building demolition, painting, carpet-laying,
water well drilling, plumbing and electrical work.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
Check
if
None
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Number of employees at this establishment
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
If the legal form of organization for this business is a corporation, the reporting of other employees and other payroll at this establishment is required. Enter "0" if the establishment
did not have payroll and employment for specific data for this EIN. If payroll and employment for this EIN are zero, please indicate if the EIN is a joint venture or reason why data
are zero in Item 31: Remarks at the end of the survey.
All persons on paid sick leave, paid holidays, and paid vacation during the year at this establishment
Spread on stock options that are taxable to employees at this establishment as wages
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.)
Contractors, subcontractors, or independent contractors
Purchased or managed services, such as janitorial, security, or landscape services (Report values in Item 16, line C9.)
Purchased professional and technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services (Report
values in Item 16, line C9.)
Members of the Armed Forces and pensioners carried on your active rolls
Proprietors and partners, if an unincorporated concern
Number of construction workers at this establishment include:
Apprentices
Working foremen
Equipment operators and mechanics
Journeymen
Job-site record keepers
Craftsmen
Laborers
Truck drivers and helpers
Others engaged directly in construction
Number of other employees at this establishment include:
Supervisors above working foremen
Office staff
Executives
Architects
Purchasing Agents
Personnel staff
Engineers
Accounting staff
Others engaged in non-construction activities
A. Number of employees at this establishment for the pay period including the 12th of the month.
March 2022
June 2022
September 2022
December 2022
1. What was the number of construction workers
(direct labor including first-line supervisors)?
2. What was the number of other employees?
TOTAL (Add lines A1 and A2.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
20
B. HOURS WORKED
Check
if
None
2022 Hours
What was the annual number of hours worked by the construction workers at this establishment (direct labor
including first-line supervisors) reported in line A?
,000
C. PAYROLL
Include:
Payroll for officers at this establishment
Exclude:
Income or costs not recorded as payroll for IRS by establishment.
Employer-paid annual cost for fringe benefits reported in lines 7D1 and 7D2
Check
if
None
2022
1. What was the annual payroll at this establishment before deductions for construction workers (direct labor
including first-line supervisors)?
$
,000.00
2. What was the annual payroll before deductions for other employees?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $0,000.00 reported above, what was the first quarter payroll at this establishment before deductions
(January-March 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
Check
if
None
2022
1. What were the legally required fringe benefits? (Include employer payments for Social Security, Medicare,
unemployment compensation, workmen's compensation, and State disability programs, if required.)
$
,000.00
2. What were the voluntarily provided fringe benefits? (Include such items as payments for life insurance, medical
insurance, pensions, welfare benefits, and union-negotiated benefits.)
$
,000.00
TOTAL (Add lines D1 and D2.)
$
,000.00
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
21
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Include:
Inventories, regardless of where held, for materials and supplies owned by this establishment as of December 31
Exclude:
Work-in-progress and finished units
Using current cost, what was the value of inventories owned
by this establishment as of December 31? (If using LIFO
method of evaluation, adjust to obtain FIFO or current cost.)
Check
if
None
2022
$
2021
,000.00
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
$
,000.00
22
Item 13: Assets, Capital Expenditures, and Retirements Additional Information
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS
Exclude
Land (Report cost of land acquired during the year in Item 16A, line 5.)
Check
if
None
2022
$
,000.00
B. What were the capital expenditures for new and used depreciable assets?
$
,000.00
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc.?
$
,000.00
D. What was the value of depreciable assets at the end of the year? (Add lines A and B minus line C.)
$
,000.00
A. What was the gross value of depreciable assets (usually original cost) at the beginning of the year?
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
23
Item 14: Rental Payments Additional Information
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,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.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
24
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
A. For this establishment, what were the cost of materials, subcontract work, fuels, electricity, and land acquired in 2022 for:
Include:
Current account expenses normally considered as cost of work performed or job-specific costs
1. Cost of materials, parts, and supplies?
Include:
All job-site, office, and construction materials and supplies
Cost of materials purchased by this establishment's subcontractors
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building
structure)
Non-construction-related expenses that were paid to subcontractors by this establishment (Report these
expense details on the next screen, Item 16: Selected Expenses - Continued, in line C.)
Check
if
None
2022
$
,000.00
$
,000.00
a. Natural gas and manufactured gas (propane)?
$
,000.00
b. Gasoline and diesel fuel - ON highway (not at site)?
$
,000.00
c. Gasoline and diesel fuel - OFF highway (at site)?
$
,000.00
$
,000.00
$
,000.00
2. Cost of construction-related work subcontracted out to others?
Exclude:
Cost of materials purchased by this establishment for subcontractors (These costs should be reported in line
A1.)
Check
if
None
3. Cost of fuels for heat, power, lubricants
Check
if
None
d. All other fuels and lubricants, including heating oils, lubricating oils, and greases?
Check
if
None
4. Cost of electricity?
5. When you answered Item 5, did you include the purchased cost of land or estimated value of raw land? Please check one, and answer the below question.
Yes
No
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
25
Check
if
None
6. What was the purchased cost of land or estimated value of raw land for reported construction projects during the
covered time?
$
,000.00
$
,000.00
Check
if
None
B. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
26
Item 16: Selected Expenses - Continued Additional Information
ITEM 16: SELECTED EXPENSES
C. What were the other operating expenses paid by this establishment in 2022 for:
1. Temporary staff and leased employees? (Professional Employer Organizations and staffing agencies for
personnel)
Include:
All charges for payroll, benefits, and services your establishment paid to the Professional Employer
Organizations for the temporary staff and leased employees
Check
if
None
2022
$
,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
Exclude:
Packaged software (Report on line C3.)
Leased and rented equipment (Report on 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
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
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
27
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Computer input preparation
Data Storage
Computer time rental
Optical scanning services
Other computer-related advice and services, including training
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 in line C6.)
Payroll processing and credit card transaction fees (Report payroll processing fees in line C9 and credit
card transaction fees in line C4.)
Expenses for telecommunication services (e.g., Internet, connectivity, telephone) (Report in line C4.)
$
,000.00
Exclude
Materials, parts, and supplies used for repairs and maintenance performed by this firm's employees
$
,000.00
7. Water, sewer, refuse removal, and other non-electric utility payments?
(Report electric utility payments in Item 16, line A4. If the cost of these utilities is included in a leased or rental
payment, report in Item 14, line A.)
Include:
Cost of hazardous waste removal
$
,000.00
$
,000.00
$
,000.00
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
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. such as janitorial, security, or landscape services)
Exclude:
Salaries paid to your own employees for these services (Report in Item 7.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
28
10. Governmental taxes and licensing fees?(Payments to government agencies for taxes and licenses)
Include:
Business and property tax fees for establishment to remain active legal operable business
Permits and licensing fees
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Include:
Expenses for paid temporary day labors not on your payroll or hired as construction subcontractors
Exclude:
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
The construction project types listed below are general to your industry. Select the project types that apply to your establishment. On the next screen, you will report the specific
construction products and services related to the construction projects you select. If you have revenue from other sources not listed, you will have the opportunity to report them later.
At-risk construction project management revenue should be reported with the specific construction project associated with those management services. For example, if at-risk
construction project management is for office buildings, then include the management revenue with the project for office buildings. However, at-fee project management services
should be reported in the specific project for construction project management services.
Description
Select
Amusement, social, and recreational building construction
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
Commercial warehouses, such as distribution buildings and mini-storage
Project Code
334
322
359
327
319
Dormitories and barracks
329
Educational building construction
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
323
333
Farm building construction, nonresidential
331
Health care and institutional building construction
324
Hotel, motel, and inn construction
321
Industrial warehouse construction
Nonresidential mobile building construction, office and other commercial
335
325
Office building construction
332
Public safety building construction
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
30
328
Religious building construction
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
326
336
338
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
318
314
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
317
316
Single detached residential building construction
342
Airport runways and landing fields
346
Bridge and elevated highway
392
Coal mines
Conservation and development construction, including dams, drainage canals, and flood control projects
368
378
Fencing
373
Harbor and port facilities
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
341
357
Hydroelectric power plants
Marine construction, such as dredging, navigational channels, and locks
374
366
Mass transit, including railroads
393
Metal mines
394
Nonmetallic mines
385
Oil and gas fields
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
31
Oil and gas pipelines, pumping stations, storage tanks, and mains
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
353
381
364
Petrochemical plant and petroleum refinery construction
Power and cogeneration plant construction, except hydroelectric construction
Power and communication transmission line, cable, tower, and related facilities
Private driveway and parking area construction, except garages
356
354
343
361
Sewage and water treatment plants
Sewers, sewer lines, septic systems, and related facilities
351
384
Ship maintenance and repair services
375
Swimming pools
347
Tunnels
352
Water mains, storage wells, and related facilities
395
Other nonresidential constructions, except buildings
Other specialized cleaning services, not elsewhere classified
399
376
Residential decks
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
377
Add product/service not listed
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
32
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services associated with the construction projects you previously selected. If you have revenue from sources not listed, describe and report them in the
"All other sales, shipments, receipts, or revenue from this establishment" section at the end of this question.
At-risk construction project management revenue should be reported with the specific constructions or construction services associated with those management services. For
example, if at-risk construction project management is for entire office building constructions, then include the management revenue with the new constructions for office buildings.
However, at-fee project management services should be reported in the specific product lines for construction project management services.
New Constructions and Construction Services – Report only the main activities including the type of buildings, structures, or facilities contracted to construct or work on by this
establishment in the reporting year in which this establishment received receipts only. If you worked on more than one type of building or structure in a multipurpose complex, report
separately for each building or type of structure. However, if you worked on a building that had more than one purpose, i.e. office, residential, or commercial, classify this building by
its major purpose.
New constructions include all components of the entire original building or structure. Land development work on the site and demolition of existing structures are included with
new constructions.
Construction services for new building or structures include separate components of the original building or structure, such as electric work, painting, plumbing, etc.
Construction services for additions, renovations, and alterations to buildings or structures include construction work which adds to the value of useful life of an existing
building or structure, or which adapts a building or structure to a new or different use. Included are “major replacements” of building systems such as the installation of a new
roof or heating system, and the resurfacing of streets or highways. Exclude activities such as the repair of a hole in a roof or the routine patching of highways and streets, which
are classified as “maintenance and repair work”.
Construction services for maintenance and repair of buildings or structures include incidental construction work that keeps a property in ordinary working condition.
Exclude trash and snow removal, lawn maintenance, and janitorial services.
Description
Value
Product Code
Amusement, social, and recreational building construction
1. Amusement, social, and recreational building new constructions (by builders and at-risk project managers)
$
,000.00
3000875000
2. Construction services for new amusement, social, and recreational buildings
$
,000.00
3001350000
3. Construction services for additions, renovations, and alterations to amusement, social, and recreational buildings
$
,000.00
3001750000
4. Construction services for maintenance and repair of amusement, social, and recreational buildings
$
,000.00
3002150000
5. Apartment building (two or more units) new constructions, excluding condominiums (by builders and at-risk project
managers)
$
,000.00
3000625000
6. Construction services for new apartment buildings (two or more units), excluding condominiums
$
,000.00
3001050000
7. Construction services for additions, renovations, and alterations to apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001075000
8. Construction services for maintenance and repair of apartment buildings (two or more units), excluding
condominiums
$
,000.00
3001100000
Apartment building construction (two or more units), excluding condominiums (only rental structure)
Chemical (except petrochemical) complexes/plants, blast furnaces, and mining appurtenances
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
33
9. Chemical (except petrochemical) complex/plant, blast furnace, and mining appurtenance new constructions (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002600000
10. Construction services for new chemical (except petrochemical) complexes/plants, blast furnaces, and mining
appurtenances
$
,000.00
3003250000
11. Construction services for additions, renovations, and alterations to chemical (except petrochemical)
complexes/plants, blast furnaces, and mining appurtenances
$
,000.00
3003900000
12. Construction services for maintenance and repair of chemical (except petrochemical) complexes/plants, blast
furnaces, and mining appurtenances
$
,000.00
3004550000
13. Commercial warehouse new constructions, such as distribution buildings and mini-storage (by builders and at-risk
project managers)
$
,000.00
3000750000
14. Construction services for new commercial warehouses, such as distribution buildings and mini-storage
$
,000.00
3001225000
15. Construction services for additions, renovations, and alterations to commercial warehouses, such as distribution
buildings and mini-storage
$
,000.00
3001625000
16. Construction services for maintenance and repair of commercial warehouses, such as distribution buildings and
mini-storage
$
,000.00
3002025000
17. Educational institution dormitories new constructions (by builders and at-risk project mangers)
$
,000.00
3001005000
18. Military and other public safety dormitories and barracks new constructions (by builders and at-risk project
managers)
$
,000.00
3001010000
$
,000.00
3001480000
20. Construction services for new military and other public safety dormitories and barracks
$
,000.00
3001485000
21. Construction services for additions, renovations, and alterations to educational institution dormitories
$
,000.00
3001880000
22. Construction services for additions, renovations, and alterations to military and other public safety dormitories and
barracks
$
,000.00
3001885000
$
,000.00
3002280000
$
,000.00
3002285000
25. Educational building new constructions (by builders and at-risk project managers)
$
,000.00
3000825000
26. Construction services for new educational buildings
$
,000.00
3001300000
Commercial warehouses, such as distribution buildings and mini-storage
Dormitories and barracks
19. Construction services for new educational institution dormitories
23. Construction services for maintenance and repair of educational institution dormitories
24. Construction services for maintenance and repair of military and other public safety dormitories and barracks
Educational building construction
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
34
27. Construction services for additions, renovations, and alterations to educational buildings
$
,000.00
3001700000
28. Construction services for maintenance and repair of educational buildings
$
,000.00
3002100000
29. Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building new
constructions (by builders and at-risk project managers)
$
,000.00
3000700000
30. Construction services for new factories, assembly plants, industrial research laboratories, and other new
manufacturing and industrial buildings
$
,000.00
3001175000
31. Construction services for additions, renovations, and alterations to factories, assembly plants, industrial research
laboratories, and other manufacturing and industrial buildings
$
,000.00
3001575000
32. Construction services for maintenance and repair of factories, assembly plants, industrial research laboratories, and
other manufacturing and industrial buildings
$
,000.00
3001975000
$
,000.00
3000975000
$
,000.00
3001450000
35. Construction services for additions, renovations, and alterations to farm buildings, nonresidential
$
,000.00
3001850000
36. Construction services for maintenance and repair of farm buildings, nonresidential
$
,000.00
3002250000
$
,000.00
3000850000
$
,000.00
3001325000
39. Construction services for additions, renovations, and alterations to health care and institutional buildings
$
,000.00
3001725000
40. Construction services for maintenance and repair of health care and institutional buildings
$
,000.00
3002125000
41. Hotel, motel, and inn new constructions (by builders and at-risk project managers)
$
,000.00
3000650000
42. Construction services for new hotels, motels, and inns
$
,000.00
3001125000
43. Construction services for additions, renovations, and alterations to hotels, motels, and inns
$
,000.00
3001525000
44. Construction services for maintenance and repair of hotels, motels, and inns
$
,000.00
3001925000
Factory, assembly plant, industrial research laboratory, and other manufacturing and industrial building construction
Farm building construction, nonresidential
33. Farm building new constructions, nonresidential (by builders and at-risk project managers)
34. Construction services for new farm buildings, nonresidential
Health care and institutional building construction
37. Health care and institutional buildings new constructions (by builders and at-risk project managers)
38. Construction services for new health care and institutional buildings
Hotel, motel, and inn construction
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
35
Industrial warehouse construction
45. Industrial warehouse new constructions at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000680000
46. Industrial warehouse new constructions not at manufacturing sites (by builders and at-risk project managers)
$
,000.00
3000685000
47. Construction services for new industrial warehouses at manufacturing sites
$
,000.00
3001155000
48. Construction services for new industrial warehouses not at manufacturing sites
$
,000.00
3001160000
49. Construction services for additions, renovations, and alterations to industrial warehouses at manufacturing sites
$
,000.00
3001555000
50. Construction services for additions, renovations, and alterations to industrial warehouses not at manufacturing sites
$
,000.00
3001560000
51. Construction services for maintenance and repair of industrial warehouses at manufacturing sites
$
,000.00
3001955000
$
,000.00
3001960000
53. Nonresidential mobile building new constructions, office (by builders and at-risk project managers)
$
,000.00
3000930000
54. Nonresidential mobile building new constructions, other commercial (by builders and at-risk project managers)
$
,000.00
3000935000
55. Construction services for new nonresidential mobile building constructions, office
$
,000.00
3001405000
56. Construction services for new nonresidential mobile building constructions, other commercial
$
,000.00
3001410000
57. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
office
$
,000.00
3001805000
58. Construction services for additions, renovations, and alterations to nonresidential mobile building constructions,
other commercial
$
,000.00
3001810000
59. Construction services for maintenance and repair of nonresidential mobile building constructions, office
$
,000.00
3002205000
60. Construction services for maintenance and repair of nonresidential mobile building constructions, other commercial
$
,000.00
3002210000
61. Office building and data center new constructions (by builders and at-risk project managers)
$
,000.00
3000725000
62. Construction services for new office buildings and data centers
$
,000.00
3001200000
63. Construction services for additions, renovations, and alterations to office buildings and data centers
$
,000.00
3001600000
52. Construction services for maintenance and repair of industrial warehouses not at manufacturing sites
Nonresidential mobile building construction, office and other commercial
Office building construction
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
36
64. Construction services for maintenance and repair of office buildings and data centers
$
,000.00
3002000000
65. Public safety building new constructions (by builders and at-risk project managers)
$
,000.00
3000900000
66. Construction services for new public safety buildings
$
,000.00
3001375000
67. Construction services for additions, renovations, and alterations to public safety buildings
$
,000.00
3001775000
68. Construction services for maintenance and repair of public safety buildings
$
,000.00
3002175000
$
,000.00
3000800000
70. Construction services for new religious buildings
$
,000.00
3001275000
71. Construction services for additions, renovations, and alterations to religious buildings
$
,000.00
3001675000
72. Construction services for maintenance and repair of religious buildings
$
,000.00
3002075000
73. Store, restaurant, automobile service station, parking garage, and other commercial building new constructions
(excluding mobile buildings)(by builders and at-risk project managers)
$
,000.00
3000775000
74. Construction services for new stores, restaurants, automobile service stations, parking garages, and other
commercial buildings (excluding mobile buildings)
$
,000.00
3001250000
75. Construction services for additions, renovations, and alterations to stores, restaurants, automobile service stations,
parking garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3001650000
76. Construction services for maintenance and repair of stores, restaurants, automobile service stations, parking
garages, and other commercial buildings (excluding mobile buildings)
$
,000.00
3002050000
77. Nonresidential mobile building new constructions, classroom (by builders and at-risk project managers)
$
,000.00
3000955000
78. Nonresidential mobile building new constructions, industrial (by builders and at-risk project managers)
$
,000.00
3000960000
79. Construction services for new nonresidential mobile building constructions, classroom
$
,000.00
3001430000
80. Construction services for new nonresidential mobile building constructions, industrial
$
,000.00
3001435000
81. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, classrooms
$
,000.00
3001830000
Public safety building construction
Religious building construction
69. Religious building new constructions (by builders and at-risk project managers)
Store, restaurant, automobile service station, parking garage, and other commercial building construction
Other nonresidential mobile building construction, including classroom and industrial
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
37
82. Construction services for additions, renovations, and alterations to other nonresidential mobile building
constructions, industrial
$
,000.00
3001835000
83. Construction services for maintenance and repair of other nonresidential mobile building constructions, classrooms
$
,000.00
3002230000
84. Construction services for maintenance and repair of other nonresidential mobile building constructions, industrial
$
,000.00
3002235000
85. All other nonresidential building new constructions (by builders and at-risk project managers)
$
,000.00
3001025000
86. Construction services for all other new nonresidential buildings
$
,000.00
3001500000
87. Construction services for additions, renovations, and alterations to all other nonresidential buildings
$
,000.00
3001900000
88. Construction services for maintenance and repair of all other nonresidential buildings
$
,000.00
3002300000
89. Constructions of new apartment type condominiums, excluding single family condominiums (by builders and at-risk
project managers)
$
,000.00
3000100000
90. Construction services for new apartment type condominiums, excluding single family condominiums
$
,000.00
3000200000
91. Construction services for additions, renovations, and alterations to apartment type condominiums, excluding single
family condominiums
$
,000.00
3000300000
92. Construction services for maintenance and repair of apartment type condominiums, excluding single family
condominiums
$
,000.00
3000400000
93. Constructions of new manufactured (mobile) homes, all width sizes (including multisection) (by builders and at-risk
project managers)
$
,000.00
3000075000
94. Construction services for new manufactured homes (mobile homes), all width sizes (including multisection)
$
,000.00
3000175000
95. Construction services for additions, renovations, and alterations to manufactured homes (mobile homes), all width
sizes (including multisection)
$
,000.00
3000275000
96. Construction services for maintenance and repair of manufactured homes (mobile homes), all width sizes (including
multisection)
$
,000.00
3000375000
97. Constructions of new single attached residential buildings, including row houses and town houses (by builders and
at-risk project managers)
$
,000.00
3000050000
98. Construction services for new single attached residential buildings, including row houses and town houses
$
,000.00
3000150000
All other nonresidential building construction
Apartment building construction (two or more units), condo-type, excluding single family condominiums
Residential manufactured (mobile) home construction
Single attached residential building construction, including row houses and town houses
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
38
99. Construction services for additions, renovations, and alterations to single attached residential buildings, including
row houses and town houses
$
,000.00
3000250000
100. Construction services for maintenance and repair of single attached residential buildings, including row houses and
town houses
$
,000.00
3000350000
101. Constructions of new single detached residential buildings (by builders and at-risk project managers)
$
,000.00
3000025000
102. Construction services for new single detached residential buildings
$
,000.00
3000125000
103. Construction services for additions, renovations, and alterations to single detached residential buildings
$
,000.00
3000225000
104. Construction services for maintenance and repair of single detached residential buildings
$
,000.00
3000325000
105. Airport runway and landing field new constructions (by heavy construction contractors and at-risk project
managers)
$
,000.00
3002675000
106. Construction services for new airport runways and landing fields
$
,000.00
3003325000
107. Construction services for additions, renovations, and alterations to airport runways and landing fields
$
,000.00
3003975000
108. Construction services for maintenance and repair of airport runways and landing fields
$
,000.00
3004625000
$
,000.00
3002375000
$
,000.00
3003025000
111. Construction services for additions, renovations, and alterations to bridges and elevated highways
$
,000.00
3003675000
112. Construction services for maintenance and repair of bridges and elevated highways
$
,000.00
3004325000
113. Coal mining prospect and test drilling services
$
,000.00
1001950000
114. Sinking coal mine shafts and driving coal mine tunnels services
$
,000.00
1001975000
115. Other coal mining services, including strip, auger or underground mining, drilling, overburden stripping, recovering
culm bank, and repair and maintenance services not for your own account
$
,000.00
1002000000
116. Coal mine new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002875000
Single detached residential building construction
Airport runways and landing fields
Bridge and elevated highway
109. Bridge and elevated highway new constructions (by heavy construction contractors and at-risk project managers)
110. Construction services for new bridges and elevated highways
Coal mines
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
39
117. Construction services for new coal mine constructions
$
,000.00
3003525000
118. Construction services for additions, renovations, and alterations to coal mine constructions
$
,000.00
3004175000
119. Conservation and development new constructions, including dams, drainage canals, and flood control projects (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002650000
120. Construction services for new conservation and development constructions, including dams, drainage canals, and
flood control projects
$
,000.00
3003300000
121. Construction services for additions, renovations, and alterations to conservation and development constructions,
including dams, drainage canals, and flood control projects
$
,000.00
3003950000
122. Construction services for maintenance and repair of conservation and development constructions, including dams,
drainage canals, and flood control projects
$
,000.00
3004600000
$
,000.00
3002825000
$
,000.00
3003475000
125. Construction services for additions, renovations, and alterations to fencing constructions
$
,000.00
3004125000
126. Construction services for maintenance and repair of fencing constructions
$
,000.00
3004750000
$
,000.00
3002725000
$
,000.00
3003375000
129. Construction services for additions, renovations, and alterations to harbor and port facilities
$
,000.00
3004025000
130. Construction services for maintenance and repair of harbor and port facilities
$
,000.00
3004675000
131. Highway, street, and related work new constructions, including public sidewalks, curbs, guardrails and signs (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002325000
132. Construction services for new highways, streets, and related work, including public sidewalks, curbs, guardrails
and signs
$
,000.00
3002975000
133. Construction services for additions, renovations, and alterations to highways, streets, and related works, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3003625000
Conservation and development construction, including dams, drainage canals, and flood control projects
Fencing
123. Fencing new constructions (by heavy construction contractors and at-risk project managers)
124. Construction services for new fencing constructions
Harbor and port facilities
127. Harbor and port facilities new constructions (by heavy construction contractors and at-risk project managers)
128. Construction services for new harbor and port facilities
Highway, street, and related work construction, including public sidewalks, curbs, guardrails, and signs
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
40
134. Construction services for maintenance and repair of highways, streets, and related work constructions, including
public sidewalks, curbs, guardrails and signs
$
,000.00
3004275000
$
,000.00
3002575000
136. Construction services for new power plants, hydroelectric
$
,000.00
3003225000
137. Construction services for additions, renovations, and alterations to power plants, hydroelectric
$
,000.00
3003875000
$
,000.00
3004525000
$
,000.00
3002750000
$
,000.00
3003400000
141. Construction services for additions, renovations, and alterations to marine constructions, including dredging,
navigational channels, and locks
$
,000.00
3004050000
142. Construction services for maintenance and repair of marine constructions, including dredging, navigational
channels, and locks
$
,000.00
3004700000
$
,000.00
3002700000
$
,000.00
3003350000
145. Construction services contractors for additions, renovations, and alterations to mass transit constructions, including
railroads
$
,000.00
3004000000
146. Construction services for maintenance and repair of mass transit constructions, including railroads
$
,000.00
3004650000
$
,000.00
1002025000
$
,000.00
1002050000
149. Metal mining prospect services and test drilling services
$
,000.00
1002075000
150. Sinking metal mine shafts and driving metal mine tunnels services
$
,000.00
1002100000
$
,000.00
1002125000
Hydroelectric power plants
135. Power plant new constructions, hydroelectric (by heavy construction contractors and at-risk project managers)
138. Construction services for maintenance and repair of power plants, hydroelectric
Marine construction, such as dredging, navigational channels, and locks
139. Marine new constructions, including dredging, navigational channels, and locks (by heavy construction contractors
and at-risk project managers)
140. Construction services for new marine constructions, including dredging, navigational channels, and locks
Mass transit, including railroads
143. Mass transit new constructions, including railroads (by heavy construction contractors and at-risk project
managers)
144. Construction services for new mass transit constructions, including railroads
Metal mines
147. Metal mining exploration work, excluding prospect services, test drilling, and geophysical surveying services
148. Open-pit metal ores mining not for your own account
151. Other metal mining services, including overburden stripping and repair and maintenance services
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
41
152. Metal mine new constructions (by heavy construction contractors and at-risk project managers)
$
,000.00
3002900000
153. Construction services for new metal mine constructions
$
,000.00
3003550000
$
,000.00
3004200000
$
,000.00
1002150000
156. Nonmetallic mineral prospect services and test drilling services
$
,000.00
1002175000
157. Other nonmetallic mineral services, including overburden stripping, drilling services, blasting, and repair and
maintenance services
$
,000.00
1002200000
$
,000.00
3002925000
$
,000.00
3003575000
$
,000.00
3004225000
$
,000.00
1001800000
162. Perforating oil and gas well casings
$
,000.00
1001825000
163. Installing oil and gas field production equipment, including wellhead fittings, pumps, and engines
$
,000.00
1001850000
$
,000.00
1001875000
$
,000.00
1001900000
$
,000.00
1001925000
$
,000.00
3002850000
$
,000.00
3003500000
$
,000.00
3004150000
$
,000.00
3002500000
154. Construction services for additions, renovations, and alterations to metal mine constructions
Nonmetallic mines
155. Open-pit or quarry nonmetallic minerals mining not for your own account
158. Nonmetallic mine new constructions (by heavy construction contractors and at-risk project managers)
159. Construction services for new nonmetallic mine constructions
160. Construction services for additions, renovations, and alterations to nonmetallic mine constructions
Oil and gas fields
161. Oil and gas field gathering services
164. Pumping oil and gas wells but not operating leases
165. Other oil and gas field repair and maintenance services
166. All other oil and gas field services
167. Oil and gas field new constructions (by heavy construction contractors and at-risk project managers)
168. Construction services for new oil and gas field constructions
169. Construction services for additions, renovations, and alterations to oil and gas field constructions
Oil and gas pipelines, pumping stations, storage tanks, and mains
170. Oil and gas pipeline, pumping station, storage tank, and main new constructions (by heavy construction
contractors and at-risk project managers)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
42
171. Construction services for new oil and gas pipelines, pumping stations, storage tanks, and mains
$
,000.00
3003150000
172. Construction services for additions, renovations, and alterations to oil and gas pipelines, pumping stations, storage
tanks, and mains
$
,000.00
3003800000
173. Construction services for maintenance and repair of oil and gas pipelines, pumping stations, storage tanks, and
mains
$
,000.00
3004450000
174. Outdoor recreational area new constructions, including athletic fields, courts, golf courses, and campgrounds (by
heavy construction contractors and at-risk project managers)
$
,000.00
3002800000
175. Construction services for new outdoor recreational areas, including athletic fields, courts, golf courses, and
campgrounds
$
,000.00
3003450000
176. Construction services for additions, renovations, and alterations to outdoor recreational area constructions,
including athletic fields, courts, golf courses, and campgrounds
$
,000.00
3004100000
177. Construction services for maintenance and repair of outdoor recreational area constructions, including athletic
fields, courts, golf courses, and campgrounds
$
,000.00
3004725000
178. Petrochemical plant and petroleum refinery new constructions (by heavy construction contractors and at-risk
project managers)
$
,000.00
3002625000
179. Construction services for new petrochemical plants and petroleum refineries
$
,000.00
3003275000
180. Construction services for additions, renovations, and alterations to petrochemical plants and petroleum refineries
$
,000.00
3003925000
$
,000.00
3004575000
$
,000.00
3002550000
$
,000.00
3003200000
184. Construction services for additions, renovations, and alterations to power and cogeneration plants, except
hydroelectric
$
,000.00
3003850000
185. Construction services for maintenance and repair of power and cogeneration plants, except hydroelectric
$
,000.00
3004500000
186. Power and communication transmission line, cable, tower, and related facilities new constructions (by heavy
construction contractors and at-risk project managers)
$
,000.00
3002525000
187. Construction services for new power and communication transmission lines, cables, towers, and related facilities
$
,000.00
3003175000
Outdoor recreational area construction, including athletic fields, courts, golf courses, and campgrounds
Petrochemical plant and petroleum refinery construction
181. Construction services for maintenance and repair of petrochemical plants and petroleum refineries
Power and cogeneration plant construction, except hydroelectric construction
182. Power and cogeneration plant new constructions, except hydroelectric (by heavy construction contractors and atrisk project managers)
183. Construction services for new power and cogeneration plants, except hydroelectric
Power and communication transmission line, cable, tower, and related facilities
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
43
188. Construction services for additions, renovations, and alterations to power and communication transmission lines,
cables, towers, and related facilities
$
,000.00
3003825000
189. Construction services for maintenance and repair of power and communication transmission lines, cables, towers,
and related facilities
$
,000.00
3004475000
190. Private driveway and parking area new constructions, except garages (by heavy construction contractors and atrisk project managers)
$
,000.00
3002350000
191. Construction services for new private driveways and parking areas, excluding garages
$
,000.00
3003000000
192. Construction services for additions, renovations, and alterations to private driveways and parking areas, excluding
garages
$
,000.00
3003650000
193. Construction services for maintenance and repair of private driveways and parking areas, excluding garages
$
,000.00
3004300000
$
,000.00
3002475000
$
,000.00
3003125000
196. Construction services for additions, renovations, and alterations to sewage and water treatment plants
$
,000.00
3003775000
197. Construction services for maintenance and repair of sewage and water treatment plants
$
,000.00
3004425000
198. Sewer, sewer line, septic system, and related facilities new constructions (by heavy construction contractors and
at-risk project managers)
$
,000.00
3002425000
199. Construction services for new sewers, sewer lines, septic systems, and related facilities
$
,000.00
3003075000
200. Construction services for additions, renovations, and alterations to sewers, sewer lines, septic systems, and
related facilities
$
,000.00
3003725000
201. Construction services for maintenance and repair of sewers, sewer lines, septic systems, and related facilities
$
,000.00
3004375000
$
,000.00
2053950000
$
,000.00
2053975000
$
,000.00
3002775000
Private driveway and parking area construction, except garages
Sewage and water treatment plants
194. Sewage and water treatment plant new constructions(by heavy construction contractors and at-risk project
managers)
195. Construction services for new sewage and water treatment plants
Sewers, sewer lines, septic systems, and related facilities
Ship maintenance and repair services
202. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, military
203. Ship modification, conversion, overhaul, and other manufacturing services performed in a shipyard, nonmilitary
Swimming pools
204. Swimming pool new constructions (by builders and at-risk project managers)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
44
205. Construction services for new swimming pools
$
,000.00
3003425000
206. Construction services for additions, renovations, and alterations to swimming pools
$
,000.00
3004075000
$
,000.00
3002400000
$
,000.00
3003050000
$
,000.00
3003700000
$
,000.00
3004350000
211. Water main, storage, well, and related facilities new constructions (by heavy construction contractors and at-risk
project managers)
$
,000.00
3002450000
212. Construction services for new water mains, storage, wells, and related facilities
$
,000.00
3003100000
213. Construction services for additions, renovations, and alterations to water mains, storage, wells, and related
facilities
$
,000.00
3003750000
214. Construction services for maintenance and repair of water mains, storage, wells, and related facilities
$
,000.00
3004400000
$
,000.00
3002950000
$
,000.00
3003600000
$
,000.00
3004250000
$
,000.00
3004775000
$
,000.00
7008725003
$
,000.00
7008725006
$
,000.00
7008725009
Tunnels
207. Tunnel new constructions (by heavy construction contractors and at-risk project managers)
208. Construction services for new tunnels
209. Construction services for additions, renovations, and alterations to tunnels
210. Construction services for maintenance and repair of tunnels
Water mains, storage wells, and related facilities
Other nonresidential constructions, except buildings
215. Other nonresidential new constructions, except buildings (by heavy construction contractors and at-risk project
managers)
216. Construction services for other new nonresidential constructions, excluding buildings
217. Construction services for additions, renovations, and alterations to other nonresidential constructions, excluding
buildings
218. Construction services for maintenance and repair of all other nonresidential constructions, excluding buildings
Other specialized cleaning services, not elsewhere classified
219. Other specialized cleaning services, not elsewhere classified
a. Drain and gutter cleaning services
b. Parking lot sweeping services
c. Swimming pool cleaning and maintenance services
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
45
d. All other specialized cleaning services, not elsewhere classified
$
,000.00
7008725012
$
,000.00
7008725000
$
,000.00
3000425000
$
,000.00
3000450000
$
,000.00
3000475000
$
,000.00
3000500000
$
,000.00
3000525003
$
,000.00
3000525006
$
,000.00
3000525000
a. Construction services for new residential irrigation and sprinkler system constructions
$
,000.00
3000550003
b. Construction services for other new residential landscape constructions, excluding decks
$
,000.00
3000550006
$
,000.00
3000550000
a. Construction services for additions, renovations, and alterations to residential irrigation and sprinkler system
constructions
$
,000.00
3000575003
b. Construction services for additions, renovations, and alterations to other residential landscape constructions,
excluding decks
$
,000.00
3000575006
$
,000.00
3000575000
$
,000.00
3000600003
Subtotal
Residential decks
220. Residential deck new constructions (by builders and at-risk project managers)
221. Construction services for new residential deck constructions
222. Construction services for additions, renovations, and alterations to residential deck constructions
223. Construction services for maintenance and repair of residential deck constructions
Residential landscape constructions, including irrigation and sprinkler systems, excluding decks
224. Residential landscape new constructions, excluding decks (by builders and at-risk project managers)
a. Residential irrigation and sprinkler system new constructions (by builders and at-risk project managers)
b. Other residential landscape new constructions, excluding decks (by builders and at-risk project managers)
Subtotal
225. Construction services for new residential landscape constructions, excluding decks (by builders and at-risk project
managers)
Subtotal
226. Construction services for additions, renovations, and alterations to residential landscape constructions, excluding
decks
Subtotal
227. Construction services for maintenance and repair of residential landscape constructions, excluding decks
a. Construction services for maintenance and repair of residential irrigation and sprinkler system constructions
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
46
b. Construction services for maintenance and repair of other residential landscape constructions, excluding decks
Subtotal
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
3000600006
$
,000.00
3000600000
$
,000.00
9900000000
Add product/service not listed
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
47
Item 23: Kind of Business Activities Additional Information
ITEM 23: KIND OF BUSINESS ACTIVITIES
For the $,000.00 of sales, shipments, receipts, or revenue in 2022, please report the percent of the total represented by the following construction and non-construction business
activities. The sum of these percentages should equal 100%.
CONSTRUCTION WORK ACTIVITIES
Report only the main activities for which you were contracted. Work which was incidental to the primary activities of jobs should not be reported separately. If the construction activity is
not listed below, please enter a description of the construction activity in the “Other construction activities” write-in box, along with a percentage of the value of total business for that
specified construction activity.
OTHER BUSINESS ACTIVITIES
Report any non-construction activities. If the activity is not listed below, please enter a description of the non-construction activity in the “Other business activities” write-in box, along
with a percentage of the value of total business for that specified activity.
Description
Code
Value
Construction work activities
8910
%
8911
%
8914
%
8915
%
8916
%
8991
%
8913
%
7991
%
8912
%
7992
%
11. Asphalt, concrete, and brick paving contractor, residential or commercial driveways and
parking areas
8990
%
12. Ornamental metal contractor, including metal stairway, balcony, and wrought iron
installation
8191
%
1. Septic tank, cesspool, and dry well contractor (except sewer hookups to buildings)
2. Excavation work, earthmoving, or land clearing contractor
3. Wrecking, demolition, or blasting contractor
4. Concrete cutting or drilling contractor
5. Rental of construction machinery or equipment (except cranes) with operator
6. Rental of cranes with operator
7. Trenching contractor (except underwater)
8. Trenching contractor, underwater
9. Foundation digging, drilling, or pile driving contractor (except underwater)
10. Pile driving contractor, underwater
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
48
13. Fence construction contractor
14. Swimming pool contractor
15. Other kinds of construction
8992
%
8993
%
9000
%
9916
%
9919
%
9925
%
9929
%
8005
%
Describe
Other business activity
16. Mining -- minerals produced and sold to others
17. Rental of construction machinery or equipment to others, without an operator
18. Retail trade
19. Other business activities
Describe
TOTAL
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
49
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
50
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
51
Item 28: Special Items - Ownership of Projects Additional Information
ITEM 28: SPECIAL ITEMS - OWNERSHIP OF PROJECTS
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue) on projects owned by the following:
2022
%
1. Private businesses and individuals
%
2. State and local governments
%
3. Federal Government
TOTAL
(Percentages reported in lines 1 through 3 should equal 100%.)
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
%
52
Item 28: Special Items - Construction Subcontractors
ITEM 28: SPECIAL ITEMS - CONSTRUCTION SUBCONTRACTORS
What percent of the amount you reported in Item 5 (Sales, Shipments, Receipts, or Revenue) represents work you did for other contractors or builders?
(Enter "0" if you did not subcontract work from other contractors or builders.)
2022
%
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
53
Item 28: Special Items - Construction by State
ITEM 28: SPECIAL ITEMS - CONSTRUCTION BY STATE
Percent of the construction work reported in Item 5 (Sales, Shipments, Receipts, or Revenue), which occurred in each state
(The sum of the percentages reported should equal 100%.)
2022
2022
%
Montana
%
%
Nebraska
%
%
Nevada
%
%
New Hampshire
%
%
New Jersey
%
Colorado
%
New Mexico
%
Connecticut
%
New York
%
Delaware
%
North Carolina
%
District of Columbia
%
North Dakota
%
Florida
%
Ohio
%
Georgia
%
Oklahoma
%
Hawaii
%
Oregon
%
%
Pennsylvania
%
%
Rhode Island
%
%
South Carolina
%
%
South Dakota
%
%
Tennessee
%
%
Texas
%
Alabama
Alaska
Arizona
Arkansas
California
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
54
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
%
Utah
%
%
Vermont
%
%
Virginia
%
%
Washington
%
%
West Virginia
%
%
Wisconsin
%
%
Wyoming
%
%
United States
%
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
55
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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56
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
57
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
58
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
59
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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60
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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61
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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62
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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63
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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64
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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65
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
66
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_CC-23890_su.pdf Generated 2022-02-23 15:51:40
,000.00
67
Attachment D-5
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 31-33
Attachment Sector
D-5
31-33
Instrument
Path
Instrument Path Title
33153
33242
33591
33640
Nonferrous Metal Die-Casting Foundries
Metal Can Manufacturing
Primary Battery Manufacturing
Aircraft Manufacturing
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Iron foundry
331511 001
Steel investment foundry
331512 001
Steel foundry (excluding investment)
331513 001
Nonferrous metal die-casting foundry
331523 001
Aluminum foundry (excluding die-casting)
331524 001
Other nonferrous metal foundry (excluding die-casting)
331529 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
17
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE More
A. What was the total value of products shipped and other receipts for this establishment?
(Report detail in Item 22.)
Include:
All products physically shipped from this establishment during 2022
Products donated and physically shipped from this establishment during 2022
Shipments to other domestic plants of your company for further assembly, fabrication, or manufacture
Exclude:
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
B. 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
%
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
18
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) 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
Exclude:
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report values in Item 16, line D1.)
Temporary staffing obtained from a staffing service (Report values in Item 16, line D1.)
Purchased professional and technical services (Report values in Item 16, line D9.)
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. TOTAL EMPLOYMENT AND PAYROLL More
For all employees at this establishment, what was the:
Check
if
None
2022 Number
1. Total number of employees for the pay period including March 12?
2. Total annual payroll (before deductions)?
2022
Exclude: Employer-paid annual cost for fringe benefits reported in lines E1 through E3
3. Total first quarter payroll (January - March)?
$
,000.00
$
,000.00
B. PRODUCTION WORKER EMPLOYMENT AND PAYROLL More
For production workers at this establishment (direct labor including first-line supervisors), what was the:
1. Number of employees for the pay period including March 12?
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
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
C. NON-PRODUCTION EMPLOYMENT AND PAYROLL
For non-production employees at this establishment, what was the:
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
19
1. Number of employees for the pay period including March 12?
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
Check
if
None
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
D. HOURS WORKED More
Check
if
None
2022 Hours
What was the annual number of hours worked by the production workers at this establishment (direct labor
including first-line supervisors) reported in line B1?
,000
E. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS More
What were the employer's annual costs at this establishment for:
Check
if
None
1. Health Insurance? - Insurance premiums on hospitals, medical plans, and single-service plans such as dental,
vision, and prescription drug plans
2022
$
,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)
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
20
3. Payroll taxes, employer-paid insurance premiums, and other employer-paid benefits?
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)
"Quality of life” benefits (e.g., childcare assistance, education assistance, subsidized commuting)
Other benefits not specified above
More
4. TOTAL (Add lines E1 through E3.)
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
$
,000.00
$
,000.00
21
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES More
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.
What was the value of inventories owned by this establishment as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:
Check
if
None
A. Finished goods (final output of this establishment, but still
within ownership)?
Check
if
None
End of 2022
End of 2021
$
,000.00
$
,000.00
B. Work-in-process (goods that have been substantially
transformed in the manufacturing process, but are not yet
the final output of the establishment)?
$
,000.00
$
,000.00
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)?
$
,000.00
$
,000.00
$
,000.00
$
,000.00
TOTAL (Add lines A through C.)
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22
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD More
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2022, and the $,000.00 reported in Item 9 as the total value of
inventories owned by this establishment as of December 31, 2021, how much is subject to the following valuation methods:
A. Non-LIFO (Last-In, First-Out) valuation methods
Check
if
None
Check
if
None
End of 2022
End of 2021
$
,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
TOTAL (Add lines A1 through A4.)
$
,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
1. First-In, First-Out (FIFO)?
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
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Item 13: Assets, Capital Expenditures, and Retirements
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS More
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
A. What was the gross value of depreciable assets (acquisition costs) at this establishment at the beginning of the year for:
Check
if
None
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines A1 and A2)
$
,000.00
B. What were the capital expenditures for new and used depreciable assets at this establishment in 2022 for:
Check
if
None
1. New and used buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
a. Automobiles, trucks, etc. for highway use?
$
,000.00
b. Computers and peripheral data processing equipment?
$
,000.00
c. All other expenditures for machinery and equipment?
$
,000.00
$
,000.00
2. New and used machinery and equipment?
TOTAL (Add lines B1 and B2a through B2c.)
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc. at this establishment for:
Check
if
None
2022
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
24
D. What was the value of depreciable assets at this establishment at the end of the year for:
Check
if
None
2022
1. Buildings and other structures? (Add lines A1 and B1, and subtract line C1)
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment (Add lines A2 and B2, and subtract line C2)
$
,000.00
TOTAL (Add lines D1 and D2)
$
,000.00
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
25
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS More
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
B. Rental or lease of machinery and equipment?
$
,000.00
TOTAL (Add lines A and B.)
$
,000.00
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
26
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES More
A. For this establishment, what were the production-related costs in 2022 for:
1. Materials, parts, containers, packaging, supplies, etc. used for manufacturing processes, repairs, services for
others, or other operating supplies? (Report detail in Item 18.)
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 D.)
Check
if
None
2022
$
,000.00
2. Products bought and sold without further processing? (Report associated sales in Item 5, line A and in Wholesale
product codes in Item 22.)
$
,000.00
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).)
$
,000.00
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).) More
$
,000.00
5. Purchased electricity? (Report comparable quantity on line B1.) More
$
,000.00
TOTAL (Add lines A1 through A5.)
$
,000.00
B. For this establishment, what was the quantity of:
Check
if
None
2022 Kilowatt Hours
,000
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) More
,000
3. Electricity sold or transferred to other establishments? (Also include quantity on lines B1 and/or B2.) More
,000
Check
if
None
C. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
2022
$
,000.00
27
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
D. What were the other operating expenses (expenses normally considered as non-production-related costs purchased from other companies) paid by this establishment in 2022 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
2022
$
,000.00
2. Expensed equipment? (Expensed computer hardware and other equipment) More
$
,000.00
3. Expensed purchases of software? (Purchases of prepackaged, custom-coded or vendor-customized
software) More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
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.) More
$
,000.00
8. Purchased advertising and promotional services? More
$
,000.00
9. Purchased professional and technical services? More
$
,000.00
4. Purchased communication services?
Include:
Telephone, cellular, and Internet services
Other wired and wireless communication services
Credit card transaction fees
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Data storage
Other computer-related advice and services, including training
More
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof repairs, replacing parts, overhauling of equipment, and other repairs chargeable
as current operating costs
Exclude:
Extensive "repairs" or reconstruction that is capitalized. Report these as a capital expenditure in Item 13.
More
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
28
10. Governmental taxes and licensing fees? (Payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Exclude:
Other expenses reported in Items 7, 13, 14, and 16
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
29
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
General - The sum of the costs of the itemized materials in this section should equal the figure reported on Item 16, line A1 (Cost of materials, parts, containers, packaging, etc.
used). The following is a breakout of the $,000.00 currently reported there.
Please review the entire list and report separately each item consumed.
Report materials, parts, and supplies purchased, transferred from other plants of your company, or withdrawn from inventory.
If the information as requested cannot be taken directly from your book records, reasonable estimates are acceptable.
Exclude:
Products bought and sold without further processing, reported in Item 16, line A2
Materials owned by other companies but used by this establishment to make products under contract or commission
Description
Census
Material
Code
Value
1. Nonferrous metal shapes, forms, sheet, strip, powder, and wire (excluding castings and forgings), excluding
aluminum and copper
$
,000.00
33141000
2. Miscellaneous fabricated metal products, excluding hardware, containers, screw machine products (bolts, nuts,
screws, etc.), bearing components, castings, forgings, and wire products
$
,000.00
33200091
3. Miscellaneous aluminum and aluminum-base alloy shapes and forms, including powder (excluding castings,
forgings, ingot, pig, shot, wire, sheet, plate, foil, welded tubing, rods, bars, and pipe)
$
,000.00
33131020
4. Aluminum and aluminum-base alloy scrap, excluding home scrap
$
,000.00
33000042
5. Grinding wheels and other abrasive products, excluding industrial diamonds
$
,000.00
32791010
6. Cost of all other materials and components, parts, containers, and supplies consumed
$
,000.00
00970099
$
,000.00
77100000
Describe
TOTAL
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
30
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contribute to the sales, shipments, receipts or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for a product or service.
Select ALL that apply, at the most detailed level possible.
For manufacturing products, include:
Products made in this establishment and shipped
Products transferred to other establishments within your company
Products made elsewhere by others from materials supplied by this establishment
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer)
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Select
Product Code
Manufacturing of:
2028100000
1. Aluminum and aluminum-base alloy die-castings
2. Nonferrous metals and alloys (excluding aluminum) die-castings
3. Steel investment castings, including carbon, alloy and stainless steel, hi-temp metal (iron, nickel or cobalt-based alloys)
2028250000
2028025000
2016225000
4. Punches, die parts, and other special tooling
All other sales, shipments, receipts, or revenue from this establishment
Add product/service not listed
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
31
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
If quantities are requested, please use the unit of measure specified.
Below are the products and services you previously selected. If you make products or have revenue from sources not listed, click the “Add product/service not listed” button and
search for a product or service.
For manufacturing 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 in this establishment and shipped, excluding freight charged and excise taxes
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.
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.
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer). Report your commission or contract receipts in the appropriate Contract Manufacturing products line(s)
you selected or “Add product/service not listed”
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Value
Product Code
Manufacturing of:
$
,000.00
2028100000
$
,000.00
2028250000
3. Steel investment castings, including carbon, alloy and stainless steel, hi-temp metal (iron, nickel or cobalt-based
alloys)
$
,000.00
2028025000
4. Punches, die parts, and other special tooling
$
,000.00
2016225000
$
,000.00
9900000000
1. Aluminum and aluminum-base alloy die-castings
2. Nonferrous metals and alloys (excluding aluminum) die-castings
All other sales, shipments, receipts, or revenue from this establishment
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
32
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
33
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
34
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
35
Item 28: Industrial Robots and Robotic Equipment
ITEM 28: INDUSTRIAL ROBOTS AND ROBOTIC EQUIPMENT
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.
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
Exclude:
Automated guided vehicles (AGVs)
Driverless forklifts
Automated storage and retrieval systems
CNC machining equipment
Check
if
None
2022
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.
2022 Number
,000.00
If you are unable to provide the number of industrial robots IN OPERATION, please explain:
C. What was the number of industrial robots PURCHASED for this plant? Refer to instructions above for definitions.
2022 Number
If you are unable to provide the number of industrial robots PURCHASED, please explain:
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
36
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
37
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
38
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
39
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
40
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
41
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
42
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
43
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
44
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
1000
characters remaining
45
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MC-33153_su.pdf Generated 2022-02-24 07:22:40
,000.00
46
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Metal can manufacturing, including lids and ends
332431 001
Other metal container manufacturing, light gauge, including barrels, drums, mailboxes, etc.
332439 001
Metal tank (heavy gauge) manufacturing, including cutting, forming, and joining heavy gauge metal
332420 001
Power boiler and heat exchanger manufacturing
332410 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
17
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE More
A. What was the total value of products shipped and other receipts for this establishment?
(Report detail in Item 22.)
Include:
All products physically shipped from this establishment during 2022
Products donated and physically shipped from this establishment during 2022
Shipments to other domestic plants of your company for further assembly, fabrication, or manufacture
Exclude:
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
B. 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
%
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
18
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) 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
Exclude:
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report values in Item 16, line D1.)
Temporary staffing obtained from a staffing service (Report values in Item 16, line D1.)
Purchased professional and technical services (Report values in Item 16, line D9.)
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. TOTAL EMPLOYMENT AND PAYROLL More
For all employees at this establishment, what was the:
Check
if
None
2022 Number
1. Total number of employees for the pay period including March 12?
2. Total annual payroll (before deductions)?
2022
Exclude: Employer-paid annual cost for fringe benefits reported in lines E1 through E3
3. Total first quarter payroll (January - March)?
$
,000.00
$
,000.00
B. PRODUCTION WORKER EMPLOYMENT AND PAYROLL More
For production workers at this establishment (direct labor including first-line supervisors), what was the:
1. Number of employees for the pay period including March 12?
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
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
C. NON-PRODUCTION EMPLOYMENT AND PAYROLL
For non-production employees at this establishment, what was the:
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
19
1. Number of employees for the pay period including March 12?
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
Check
if
None
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
D. HOURS WORKED More
Check
if
None
2022 Hours
What was the annual number of hours worked by the production workers at this establishment (direct labor
including first-line supervisors) reported in line B1?
,000
E. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS More
What were the employer's annual costs at this establishment for:
Check
if
None
1. Health Insurance? - Insurance premiums on hospitals, medical plans, and single-service plans such as dental,
vision, and prescription drug plans
2022
$
,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)
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
20
3. Payroll taxes, employer-paid insurance premiums, and other employer-paid benefits?
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)
"Quality of life” benefits (e.g., childcare assistance, education assistance, subsidized commuting)
Other benefits not specified above
More
4. TOTAL (Add lines E1 through E3.)
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
$
,000.00
$
,000.00
21
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES More
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.
What was the value of inventories owned by this establishment as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:
Check
if
None
A. Finished goods (final output of this establishment, but still
within ownership)?
Check
if
None
End of 2022
End of 2021
$
,000.00
$
,000.00
B. Work-in-process (goods that have been substantially
transformed in the manufacturing process, but are not yet
the final output of the establishment)?
$
,000.00
$
,000.00
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)?
$
,000.00
$
,000.00
$
,000.00
$
,000.00
TOTAL (Add lines A through C.)
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
22
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD More
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2022, and the $,000.00 reported in Item 9 as the total value of
inventories owned by this establishment as of December 31, 2021, how much is subject to the following valuation methods:
A. Non-LIFO (Last-In, First-Out) valuation methods
Check
if
None
Check
if
None
End of 2022
End of 2021
$
,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
TOTAL (Add lines A1 through A4.)
$
,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
1. First-In, First-Out (FIFO)?
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
23
Item 13: Assets, Capital Expenditures, and Retirements
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS More
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
A. What was the gross value of depreciable assets (acquisition costs) at this establishment at the beginning of the year for:
Check
if
None
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines A1 and A2)
$
,000.00
B. What were the capital expenditures for new and used depreciable assets at this establishment in 2022 for:
Check
if
None
1. New and used buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
a. Automobiles, trucks, etc. for highway use?
$
,000.00
b. Computers and peripheral data processing equipment?
$
,000.00
c. All other expenditures for machinery and equipment?
$
,000.00
$
,000.00
2. New and used machinery and equipment?
TOTAL (Add lines B1 and B2a through B2c.)
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc. at this establishment for:
Check
if
None
2022
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
24
D. What was the value of depreciable assets at this establishment at the end of the year for:
Check
if
None
2022
1. Buildings and other structures? (Add lines A1 and B1, and subtract line C1)
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment (Add lines A2 and B2, and subtract line C2)
$
,000.00
TOTAL (Add lines D1 and D2)
$
,000.00
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
25
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS More
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
B. Rental or lease of machinery and equipment?
$
,000.00
TOTAL (Add lines A and B.)
$
,000.00
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
26
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES More
A. For this establishment, what were the production-related costs in 2022 for:
1. Materials, parts, containers, packaging, supplies, etc. used for manufacturing processes, repairs, services for
others, or other operating supplies? (Report detail in Item 18.)
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 D.)
Check
if
None
2022
$
,000.00
2. Products bought and sold without further processing? (Report associated sales in Item 5, line A and in Wholesale
product codes in Item 22.)
$
,000.00
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).)
$
,000.00
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).) More
$
,000.00
5. Purchased electricity? (Report comparable quantity on line B1.) More
$
,000.00
TOTAL (Add lines A1 through A5.)
$
,000.00
B. For this establishment, what was the quantity of:
Check
if
None
2022 Kilowatt Hours
,000
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) More
,000
3. Electricity sold or transferred to other establishments? (Also include quantity on lines B1 and/or B2.) More
,000
Check
if
None
C. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
2022
$
,000.00
27
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
D. What were the other operating expenses (expenses normally considered as non-production-related costs purchased from other companies) paid by this establishment in 2022 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
2022
$
,000.00
2. Expensed equipment? (Expensed computer hardware and other equipment) More
$
,000.00
3. Expensed purchases of software? (Purchases of prepackaged, custom-coded or vendor-customized
software) More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
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.) More
$
,000.00
8. Purchased advertising and promotional services? More
$
,000.00
9. Purchased professional and technical services? More
$
,000.00
4. Purchased communication services?
Include:
Telephone, cellular, and Internet services
Other wired and wireless communication services
Credit card transaction fees
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Data storage
Other computer-related advice and services, including training
More
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof repairs, replacing parts, overhauling of equipment, and other repairs chargeable
as current operating costs
Exclude:
Extensive "repairs" or reconstruction that is capitalized. Report these as a capital expenditure in Item 13.
More
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
28
10. Governmental taxes and licensing fees? (Payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Exclude:
Other expenses reported in Items 7, 13, 14, and 16
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
29
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
General - The sum of the costs of the itemized materials in this section should equal the figure reported on Item 16, line A1 (Cost of materials, parts, containers, packaging, etc.
used). The following is a breakout of the $,000.00 currently reported there.
Please review the entire list and report separately each item consumed.
Report materials, parts, and supplies purchased, transferred from other plants of your company, or withdrawn from inventory.
If the information as requested cannot be taken directly from your book records, reasonable estimates are acceptable.
Exclude:
Products bought and sold without further processing, reported in Item 16, line A2
Materials owned by other companies but used by this establishment to make products under contract or commission
Description
Census
Material
Code
Value
$
,000.00
33120073
2. Miscellaneous iron, steel, and ferroalloy ingot, shapes, and forms (excluding castings, forgings, bars, structural
shapes, wire, sheet, strip, and semifinished shapes)
$
,000.00
33110090
3. Aluminum and aluminum-base alloy sheet, plate, foil (including packaging products), and welded tubing
$
,000.00
33131501
4. Miscellaneous aluminum and aluminum-base alloy shapes and forms, including powder (excluding castings,
forgings, ingot, pig, shot, wire, sheet, plate, foil, welded tubing, rods, bars, and pipe)
$
,000.00
33131020
5. Nonferrous metal shapes, forms, sheet, strip, powder, and wire (excluding castings and forgings), excluding
aluminum and copper
$
,000.00
33141000
6. Metal containers, cans, lids, ends, and parts
$
,000.00
33200030
7. Paints, varnishes, stains, lacquers, shellacs, japans, enamels, and allied products
$
,000.00
32551002
$
,000.00
00970099
$
,000.00
77100000
1. Steel sheet, steel strip, and tin mill products
8. Cost of all other materials and components, parts, containers, and supplies consumed
Describe
TOTAL
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
30
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contribute to the sales, shipments, receipts or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for a product or service.
Select ALL that apply, at the most detailed level possible.
For manufacturing products, include:
Products made in this establishment and shipped
Products transferred to other establishments within your company
Products made elsewhere by others from materials supplied by this establishment
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer)
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Select
Product Code
Manufacturing of:
1. Steel cans and tinware end products, including ice cream cans, lids, ends, and parts
2048550000
2048575000
2. Aluminum cans, including lids, ends, and parts
3. Other metal processing and metalworking contract manufacturing services, performed using materials owned by others (i.e., the
customer)
2053610000
All other sales, shipments, receipts, or revenue from this establishment
4003650000
4. Wholesale sales of recyclable ferrous metal scrap
4003675000
5. Wholesale sales of recyclable nonferrous metal scrap
Add product/service not listed
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
31
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
If quantities are requested, please use the unit of measure specified.
Below are the products and services you previously selected. If you make products or have revenue from sources not listed, click the “Add product/service not listed” button and
search for a product or service.
For manufacturing 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 in this establishment and shipped, excluding freight charged and excise taxes
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.
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.
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer). Report your commission or contract receipts in the appropriate Contract Manufacturing products line(s)
you selected or “Add product/service not listed”
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Value
Product Code
Manufacturing of:
$
,000.00
2048550000
$
,000.00
2048575000
$
,000.00
2053610000
4. Wholesale sales of recyclable ferrous metal scrap
$
,000.00
4003650000
5. Wholesale sales of recyclable nonferrous metal scrap
$
,000.00
4003675000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
1. Steel cans and tinware end products, including ice cream cans, lids, ends, and parts
2. Aluminum cans, including lids, ends, and parts
3. Other metal processing and metalworking contract manufacturing services, performed using materials owned by
others (i.e., the customer)
All other sales, shipments, receipts, or revenue from this establishment
Add product/service not listed
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
32
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
33
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
34
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
35
Item 28: Industrial Robots and Robotic Equipment
ITEM 28: INDUSTRIAL ROBOTS AND ROBOTIC EQUIPMENT
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.
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
Exclude:
Automated guided vehicles (AGVs)
Driverless forklifts
Automated storage and retrieval systems
CNC machining equipment
Check
if
None
2022
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.
2022 Number
,000.00
If you are unable to provide the number of industrial robots IN OPERATION, please explain:
C. What was the number of industrial robots PURCHASED for this plant? Refer to instructions above for definitions.
2022 Number
If you are unable to provide the number of industrial robots PURCHASED, please explain:
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
36
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
37
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
38
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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39
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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40
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
41
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
42
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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43
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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44
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
1000
characters remaining
45
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MC-33242_su.pdf Generated 2022-02-24 07:23:50
,000.00
46
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Primary battery manufacturing
335912 001
Storage battery manufacturing
335911 001
Fiber optic cable manufacturing, made from purchased fiber optic strand
335921 001
Other communication and energy wire manufacturing
335929 001
Current-carrying wiring device manufacturing
335931 001
Noncurrent-carrying wiring device manufacturing
335932 001
Carbon and graphite product manufacturing
335991 001
All other miscellaneous electrical equipment and component manufacturing, including laser systems and equipment, surge suppressors,
semiconductor power conversion apparatus, etc.
335999 001
Other primary business or activity
779000 001
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE More
A. What was the total value of products shipped and other receipts for this establishment?
(Report detail in Item 22.)
Include:
All products physically shipped from this establishment during 2022
Products donated and physically shipped from this establishment during 2022
Shipments to other domestic plants of your company for further assembly, fabrication, or manufacture
Exclude:
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
B. 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
%
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18
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) 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
Exclude:
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report values in Item 16, line D1.)
Temporary staffing obtained from a staffing service (Report values in Item 16, line D1.)
Purchased professional and technical services (Report values in Item 16, line D9.)
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. TOTAL EMPLOYMENT AND PAYROLL More
For all employees at this establishment, what was the:
Check
if
None
2022 Number
1. Total number of employees for the pay period including March 12?
2. Total annual payroll (before deductions)?
2022
Exclude: Employer-paid annual cost for fringe benefits reported in lines E1 through E3
3. Total first quarter payroll (January - March)?
$
,000.00
$
,000.00
B. PRODUCTION WORKER EMPLOYMENT AND PAYROLL More
For production workers at this establishment (direct labor including first-line supervisors), what was the:
1. Number of employees for the pay period including March 12?
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
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
C. NON-PRODUCTION EMPLOYMENT AND PAYROLL
For non-production employees at this establishment, what was the:
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19
1. Number of employees for the pay period including March 12?
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
Check
if
None
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
D. HOURS WORKED More
Check
if
None
2022 Hours
What was the annual number of hours worked by the production workers at this establishment (direct labor
including first-line supervisors) reported in line B1?
,000
E. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS More
What were the employer's annual costs at this establishment for:
Check
if
None
1. Health Insurance? - Insurance premiums on hospitals, medical plans, and single-service plans such as dental,
vision, and prescription drug plans
2022
$
,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)
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20
3. Payroll taxes, employer-paid insurance premiums, and other employer-paid benefits?
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)
"Quality of life” benefits (e.g., childcare assistance, education assistance, subsidized commuting)
Other benefits not specified above
More
4. TOTAL (Add lines E1 through E3.)
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
$
,000.00
$
,000.00
21
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES More
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.
What was the value of inventories owned by this establishment as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:
Check
if
None
A. Finished goods (final output of this establishment, but still
within ownership)?
Check
if
None
End of 2022
End of 2021
$
,000.00
$
,000.00
B. Work-in-process (goods that have been substantially
transformed in the manufacturing process, but are not yet
the final output of the establishment)?
$
,000.00
$
,000.00
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)?
$
,000.00
$
,000.00
$
,000.00
$
,000.00
TOTAL (Add lines A through C.)
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22
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD More
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2022, and the $,000.00 reported in Item 9 as the total value of
inventories owned by this establishment as of December 31, 2021, how much is subject to the following valuation methods:
A. Non-LIFO (Last-In, First-Out) valuation methods
Check
if
None
Check
if
None
End of 2022
End of 2021
$
,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
TOTAL (Add lines A1 through A4.)
$
,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
1. First-In, First-Out (FIFO)?
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23
Item 13: Assets, Capital Expenditures, and Retirements
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS More
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
A. What was the gross value of depreciable assets (acquisition costs) at this establishment at the beginning of the year for:
Check
if
None
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines A1 and A2)
$
,000.00
B. What were the capital expenditures for new and used depreciable assets at this establishment in 2022 for:
Check
if
None
1. New and used buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
a. Automobiles, trucks, etc. for highway use?
$
,000.00
b. Computers and peripheral data processing equipment?
$
,000.00
c. All other expenditures for machinery and equipment?
$
,000.00
$
,000.00
2. New and used machinery and equipment?
TOTAL (Add lines B1 and B2a through B2c.)
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc. at this establishment for:
Check
if
None
2022
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
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24
D. What was the value of depreciable assets at this establishment at the end of the year for:
Check
if
None
2022
1. Buildings and other structures? (Add lines A1 and B1, and subtract line C1)
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment (Add lines A2 and B2, and subtract line C2)
$
,000.00
TOTAL (Add lines D1 and D2)
$
,000.00
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25
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS More
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
B. Rental or lease of machinery and equipment?
$
,000.00
TOTAL (Add lines A and B.)
$
,000.00
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26
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES More
A. For this establishment, what were the production-related costs in 2022 for:
1. Materials, parts, containers, packaging, supplies, etc. used for manufacturing processes, repairs, services for
others, or other operating supplies? (Report detail in Item 18.)
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 D.)
Check
if
None
2022
$
,000.00
2. Products bought and sold without further processing? (Report associated sales in Item 5, line A and in Wholesale
product codes in Item 22.)
$
,000.00
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).)
$
,000.00
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).) More
$
,000.00
5. Purchased electricity? (Report comparable quantity on line B1.) More
$
,000.00
TOTAL (Add lines A1 through A5.)
$
,000.00
B. For this establishment, what was the quantity of:
Check
if
None
2022 Kilowatt Hours
,000
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) More
,000
3. Electricity sold or transferred to other establishments? (Also include quantity on lines B1 and/or B2.) More
,000
Check
if
None
C. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
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2022
$
,000.00
27
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
D. What were the other operating expenses (expenses normally considered as non-production-related costs purchased from other companies) paid by this establishment in 2022 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
2022
$
,000.00
2. Expensed equipment? (Expensed computer hardware and other equipment) More
$
,000.00
3. Expensed purchases of software? (Purchases of prepackaged, custom-coded or vendor-customized
software) More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
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.) More
$
,000.00
8. Purchased advertising and promotional services? More
$
,000.00
9. Purchased professional and technical services? More
$
,000.00
4. Purchased communication services?
Include:
Telephone, cellular, and Internet services
Other wired and wireless communication services
Credit card transaction fees
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Data storage
Other computer-related advice and services, including training
More
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof repairs, replacing parts, overhauling of equipment, and other repairs chargeable
as current operating costs
Exclude:
Extensive "repairs" or reconstruction that is capitalized. Report these as a capital expenditure in Item 13.
More
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
28
10. Governmental taxes and licensing fees? (Payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Exclude:
Other expenses reported in Items 7, 13, 14, and 16
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
29
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
General - The sum of the costs of the itemized materials in this section should equal the figure reported on Item 16, line A1 (Cost of materials, parts, containers, packaging, etc.
used). The following is a breakout of the $,000.00 currently reported there.
Please review the entire list and report separately each item consumed.
Report materials, parts, and supplies purchased, transferred from other plants of your company, or withdrawn from inventory.
If the information as requested cannot be taken directly from your book records, reasonable estimates are acceptable.
Exclude:
Products bought and sold without further processing, reported in Item 16, line A2
Materials owned by other companies but used by this establishment to make products under contract or commission
Description
Census
Material
Code
Value
$
,000.00
33599100
2. Metal crowns, closures, and other stamped metal products
$
,000.00
33211900
3. Miscellaneous fabricated metal products, excluding hardware, containers, screw machine products (bolts, nuts,
screws, etc.), bearing components, castings, forgings, and wire products
$
,000.00
33200091
4. Nonferrous metal shapes, forms, sheet, strip, powder, and wire (excluding castings and forgings), excluding
aluminum and copper
$
,000.00
33141000
5. Plastics products, including packaging, foam products, film, sheet, rod, tube, fabricated shapes, bottles, etc.
(excluding containers, hoses, belting, and gaskets)
$
,000.00
32610001
6. Paper and paperboard products
$
,000.00
32200000
7. All basic organic and inorganic chemicals, excluding petrochemicals
$
,000.00
32518000
8. Thermoplastic and thermosetting resins and plastics materials
$
,000.00
32521100
9. Cost of all other materials and components, parts, containers, and supplies consumed
$
,000.00
00970099
$
,000.00
77100000
1. Carbon and graphite products, including electrodes
Describe
TOTAL
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30
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contribute to the sales, shipments, receipts or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for a product or service.
Select ALL that apply, at the most detailed level possible.
For manufacturing products, include:
Products made in this establishment and shipped
Products transferred to other establishments within your company
Products made elsewhere by others from materials supplied by this establishment
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer)
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Select
Product Code
Manufacturing of:
1. Primary batteries, including parts (excluding lead acid batteries and battery cases and containers)
2. Other nonferrous metals and alloys, including lead, tungsten, and molybdenum, rolled, drawn, and extruded shapes (including sheet,
strip, traps, etc.), excluding pipe, tube and wire
3. Nickel, nickel-base alloy, lead, zinc, and tin plumbing pipe and tube
4. Nickel, nickel-base alloy, and other nonferrous metal and alloy pipes and tubes, including lead, zinc, tin, tungsten, and molybdenum
(excluding plumbing pipe and tube)
5. Storage batteries, lead-acid-type, BCI dimensional size group 8D (1.5 cu ft (.042 cu m) and smaller)
6. Storage batteries, including lithium-ion (excluding lead acid)
7. Motive-power-type lead acid storage batteries, larger than BCI dimensional size group 8D (1.5 cu ft (.042 cu m)) (including mining
and industrial locomotive)
8. Parts for all storage batteries (excluding cases and containers)
9. All other lead acid storage batteries, larger than BCI dimensional size group 8D (1.6 cu ft (.042 cu m)) (including communication and
standby emergency)
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
2010950000
2027426000
2038270000
2027580000
2030050000
2030125000
2030075000
2030150000
2030100000
31
2043900000
10. Semiconductor battery chargers
11. Power wire and cable, made from nonferrous metals for electric transmission and distribution
2039275000
All other sales, shipments, receipts, or revenue from this establishment
4001700000
12. Wholesale sales of batteries, except automotive
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
If quantities are requested, please use the unit of measure specified.
Below are the products and services you previously selected. If you make products or have revenue from sources not listed, click the “Add product/service not listed” button and
search for a product or service.
For manufacturing 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 in this establishment and shipped, excluding freight charged and excise taxes
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.
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.
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer). Report your commission or contract receipts in the appropriate Contract Manufacturing products line(s)
you selected or “Add product/service not listed”
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Value
Product Code
Manufacturing of:
1. Primary batteries, including parts (excluding lead acid batteries and battery cases and containers)
$
,000.00
2010950000
2. Other nonferrous metals and alloys, including lead, tungsten, and molybdenum, rolled, drawn, and extruded shapes
(including sheet, strip, traps, etc.), excluding pipe, tube and wire
$
,000.00
2027426000
3. Nickel, nickel-base alloy, lead, zinc, and tin plumbing pipe and tube
$
,000.00
2038270000
4. Nickel, nickel-base alloy, and other nonferrous metal and alloy pipes and tubes, including lead, zinc, tin, tungsten, and
molybdenum (excluding plumbing pipe and tube)
$
,000.00
2027580000
5. Storage batteries, lead-acid-type, BCI dimensional size group 8D (1.5 cu ft (.042 cu m) and smaller)
$
,000.00
2030050000
6. Storage batteries, including lithium-ion (excluding lead acid)
$
,000.00
2030125000
7. Motive-power-type lead acid storage batteries, larger than BCI dimensional size group 8D (1.5 cu ft (.042 cu m))
(including mining and industrial locomotive)
$
,000.00
2030075000
8. Parts for all storage batteries (excluding cases and containers)
$
,000.00
2030150000
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
33
9. All other lead acid storage batteries, larger than BCI dimensional size group 8D (1.6 cu ft (.042 cu m)) (including
communication and standby emergency)
$
,000.00
2030100000
10. Semiconductor battery chargers
$
,000.00
2043900000
11. Power wire and cable, made from nonferrous metals for electric transmission and distribution
$
,000.00
2039275000
12. Wholesale sales of batteries, except automotive
$
,000.00
4001700000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
All other sales, shipments, receipts, or revenue from this establishment
Add product/service not listed
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34
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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35
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Industrial Robots and Robotic Equipment
ITEM 28: INDUSTRIAL ROBOTS AND ROBOTIC EQUIPMENT
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.
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
Exclude:
Automated guided vehicles (AGVs)
Driverless forklifts
Automated storage and retrieval systems
CNC machining equipment
Check
if
None
2022
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.
2022 Number
,000.00
If you are unable to provide the number of industrial robots IN OPERATION, please explain:
C. What was the number of industrial robots PURCHASED for this plant? Refer to instructions above for definitions.
2022 Number
If you are unable to provide the number of industrial robots PURCHASED, please explain:
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38
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
39
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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40
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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41
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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42
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
43
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
44
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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45
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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46
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
1000
characters remaining
47
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MC-33591_su.pdf Generated 2022-02-24 07:21:30
,000.00
48
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Under construction, development, or exploration
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Aircraft manufacturing, including manufacturing complete aircraft, developing and making aircraft prototypes, aircraft conversion, and
complete aircraft overhaul and rebuilding
336411 001
Aircraft engine and engine parts manufacturing, including developing and making prototypes of aircraft engines and engine parts, aircraft
propulsion system conversion, and aircraft propulsions systems overhaul and rebuilding
336412 001
Other aircraft parts and auxiliary equipment manufacturing, including manufacturing aircraft subassemblies, parts, or auxiliary equipment,
and/or developing and making prototypes of aircraft parts and auxiliary equipment
336413 001
Guided missile and space vehicle manufacturing, including developing and making prototypes of guided missiles and space vehicles
336414 001
Guided missile and space vehicle propulsion unit and propulsion unit parts manufacturing, including developing and making prototypes of
propulsion units and propulsion unit parts
336415 001
Other guided missile and space vehicle parts and auxiliary equipment manufacturing, including developing and making prototypes
336419 001
Other primary business or activity
779000 001
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
17
Item 5: Sales, Shipments, Receipts, or Revenue
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE More
A. What was the total value of products shipped and other receipts for this establishment?
(Report detail in Item 22.)
Include:
All products physically shipped from this establishment during 2022
Products donated and physically shipped from this establishment during 2022
Shipments to other domestic plants of your company for further assembly, fabrication, or manufacture
Exclude:
Freight charges
Excise taxes
Check
if
None
2022
$
,000.00
B. 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
%
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
18
Item 7: Employment and Payroll
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) 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
Exclude:
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN (Report values in Item 16, line D1.)
Temporary staffing obtained from a staffing service (Report values in Item 16, line D1.)
Purchased professional and technical services (Report values in Item 16, line D9.)
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. TOTAL EMPLOYMENT AND PAYROLL More
For all employees at this establishment, what was the:
Check
if
None
2022 Number
1. Total number of employees for the pay period including March 12?
2. Total annual payroll (before deductions)?
2022
Exclude: Employer-paid annual cost for fringe benefits reported in lines E1 through E3
3. Total first quarter payroll (January - March)?
$
,000.00
$
,000.00
B. PRODUCTION WORKER EMPLOYMENT AND PAYROLL More
For production workers at this establishment (direct labor including first-line supervisors), what was the:
1. Number of employees for the pay period including March 12?
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
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
C. NON-PRODUCTION EMPLOYMENT AND PAYROLL
For non-production employees at this establishment, what was the:
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
19
1. Number of employees for the pay period including March 12?
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
Check
if
None
2022 Number
2022
2. Annual payroll (before deductions)?
3. First quarter payroll (January - March)?
$
,000.00
$
,000.00
D. HOURS WORKED More
Check
if
None
2022 Hours
What was the annual number of hours worked by the production workers at this establishment (direct labor
including first-line supervisors) reported in line B1?
,000
E. EMPLOYER-PAID ANNUAL COST FOR FRINGE BENEFITS More
What were the employer's annual costs at this establishment for:
Check
if
None
1. Health Insurance? - Insurance premiums on hospitals, medical plans, and single-service plans such as dental,
vision, and prescription drug plans
2022
$
,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)
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
20
3. Payroll taxes, employer-paid insurance premiums, and other employer-paid benefits?
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)
"Quality of life” benefits (e.g., childcare assistance, education assistance, subsidized commuting)
Other benefits not specified above
More
4. TOTAL (Add lines E1 through E3.)
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
$
,000.00
$
,000.00
21
Item 9: Value of Inventories
ITEM 9: VALUE OF INVENTORIES More
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.
What was the value of inventories owned by this establishment as of December 31 before Last-In, First-Out (LIFO) adjustment (if any) for:
Check
if
None
A. Finished goods (final output of this establishment, but still
within ownership)?
Check
if
None
End of 2022
End of 2021
$
,000.00
$
,000.00
B. Work-in-process (goods that have been substantially
transformed in the manufacturing process, but are not yet
the final output of the establishment)?
$
,000.00
$
,000.00
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)?
$
,000.00
$
,000.00
$
,000.00
$
,000.00
TOTAL (Add lines A through C.)
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
22
Item 10: Inventories by Valuation Method
ITEM 10: INVENTORIES BY VALUATION METHOD More
Of the $,000.00 reported in Item 9 as the total value of inventories owned by this establishment as of December 31, 2022, and the $,000.00 reported in Item 9 as the total value of
inventories owned by this establishment as of December 31, 2021, how much is subject to the following valuation methods:
A. Non-LIFO (Last-In, First-Out) valuation methods
Check
if
None
Check
if
None
End of 2022
End of 2021
$
,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
TOTAL (Add lines A1 through A4.)
$
,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
1. First-In, First-Out (FIFO)?
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
23
Item 13: Assets, Capital Expenditures, and Retirements
ITEM 13: ASSETS, CAPITAL EXPENDITURES, AND RETIREMENTS More
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
A. What was the gross value of depreciable assets (acquisition costs) at this establishment at the beginning of the year for:
Check
if
None
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines A1 and A2)
$
,000.00
B. What were the capital expenditures for new and used depreciable assets at this establishment in 2022 for:
Check
if
None
1. New and used buildings and other structures?
(Exclude the value of land on which structures stand)
2022
$
,000.00
a. Automobiles, trucks, etc. for highway use?
$
,000.00
b. Computers and peripheral data processing equipment?
$
,000.00
c. All other expenditures for machinery and equipment?
$
,000.00
$
,000.00
2. New and used machinery and equipment?
TOTAL (Add lines B1 and B2a through B2c.)
C. What was the gross value of depreciable assets sold, retired, scrapped, destroyed, etc. at this establishment for:
Check
if
None
2022
1. Buildings and other structures?
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment?
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
24
D. What was the value of depreciable assets at this establishment at the end of the year for:
Check
if
None
2022
1. Buildings and other structures? (Add lines A1 and B1, and subtract line C1)
(Exclude the value of land on which structures stand)
$
,000.00
2. Machinery and equipment (Add lines A2 and B2, and subtract line C2)
$
,000.00
TOTAL (Add lines D1 and D2)
$
,000.00
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
25
Item 14: Rental Payments
ITEM 14: RENTAL PAYMENTS More
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?
Include:
Job-site trailers
Land on which the buildings and other structures stand
Check
if
None
2022
$
,000.00
B. Rental or lease of machinery and equipment?
$
,000.00
TOTAL (Add lines A and B.)
$
,000.00
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
26
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES More
A. For this establishment, what were the production-related costs in 2022 for:
1. Materials, parts, containers, packaging, supplies, etc. used for manufacturing processes, repairs, services for
others, or other operating supplies? (Report detail in Item 18.)
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 D.)
Check
if
None
2022
$
,000.00
2. Products bought and sold without further processing? (Report associated sales in Item 5, line A and in Wholesale
product codes in Item 22.)
$
,000.00
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).)
$
,000.00
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).) More
$
,000.00
5. Purchased electricity? (Report comparable quantity on line B1.) More
$
,000.00
TOTAL (Add lines A1 through A5.)
$
,000.00
B. For this establishment, what was the quantity of:
Check
if
None
2022 Kilowatt Hours
,000
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) More
,000
3. Electricity sold or transferred to other establishments? (Also include quantity on lines B1 and/or B2.) More
,000
Check
if
None
C. For this establishment, what were the depreciation/amortization charges for the current year obtained from your income
statement? (Include depreciation on all assets reported in Item 13.)
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
2022
$
,000.00
27
Item 16: Selected Expenses - Continued
ITEM 16: SELECTED EXPENSES
D. What were the other operating expenses (expenses normally considered as non-production-related costs purchased from other companies) paid by this establishment in 2022 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
2022
$
,000.00
2. Expensed equipment? (Expensed computer hardware and other equipment) More
$
,000.00
3. Expensed purchases of software? (Purchases of prepackaged, custom-coded or vendor-customized
software) More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
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.) More
$
,000.00
8. Purchased advertising and promotional services? More
$
,000.00
9. Purchased professional and technical services? More
$
,000.00
4. Purchased communication services?
Include:
Telephone, cellular, and Internet services
Other wired and wireless communication services
Credit card transaction fees
5. Data processing and other purchased computer services?
Include:
Computer facilities management services
Data storage
Other computer-related advice and services, including training
More
6. Purchased repairs and maintenance to buildings and/or machinery and equipment?
Include:
Repairs for painting, roof repairs, replacing parts, overhauling of equipment, and other repairs chargeable
as current operating costs
Exclude:
Extensive "repairs" or reconstruction that is capitalized. Report these as a capital expenditure in Item 13.
More
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
28
10. Governmental taxes and licensing fees? (Payments to government agencies for taxes and licenses)
Include:
Business and property taxes
Exclude:
Income taxes
$
,000.00
$
,000.00
$
,000.00
11. All other operating expenses not reported elsewhere?
Exclude:
Other expenses reported in Items 7, 13, 14, and 16
Purchases of merchandise for resale
Non-operating expenses
Describe
TOTAL (Add lines 1 through 11.)
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
29
Item 18: Detailed Cost of Materials, Parts, and Supplies
ITEM 18: DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
Of the $,000.00 of materials, parts, and supplies in 2022, reported on Item 16, line A1, how much was for the following specified materials?
General - The sum of the costs of the itemized materials in this section should equal the figure reported on Item 16, line A1 (Cost of materials, parts, containers, packaging, etc.
used). The following is a breakout of the $,000.00 currently reported there.
Please review the entire list and report separately each item consumed.
Report materials, parts, and supplies purchased, transferred from other plants of your company, or withdrawn from inventory.
If the information as requested cannot be taken directly from your book records, reasonable estimates are acceptable.
Exclude:
Products bought and sold without further processing, reported in Item 16, line A2
Materials owned by other companies but used by this establishment to make products under contract or commission
Description
Census
Material
Code
Value
$
,000.00
33641201
2. Aircraft engine parts, excluding instruments
$
,000.00
33641203
3. Structural landing gear, fuselage, empennage, and wing components including other structural components and
engine mounts
$
,000.00
33641312
4. Complete mechanical, hydraulic and pneumatic subassemblies
$
,000.00
33291209
5. Electronic communication systems and equipment, including wireless, radio, television, satellite, and airborne
transmitters and receivers (microwave, UHF, VHF, etc.)
$
,000.00
33422005
6. Nautical and navigation equipment
$
,000.00
33451105
7. Measuring and controlling instruments and devices (seismometers, surveying and plotting instruments, aircraft
engine instruments, etc.)
$
,000.00
33451920
8. Semiconductors, including transistors, diodes, rectifiers, and integrated circuits for electronic circuitry, and
related devices, including electronic control modules
$
,000.00
33441310
9. Metal crowns, closures, and other stamped metal products
$
,000.00
33211900
$
,000.00
33261011
$
,000.00
33636000
$
,000.00
00970099
$
,000.00
77100000
1. Aircraft engines
10. Aircraft metal hardware, including metal bolts, nuts, screws, washers, rivets, and other screw machine products
11. Motor vehicle seating and interior trim
12. Cost of all other materials and components, parts, containers, and supplies consumed
Describe
TOTAL
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
30
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
31
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contribute to the sales, shipments, receipts or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for a product or service.
Select ALL that apply, at the most detailed level possible.
For manufacturing products, include:
Products made in this establishment and shipped
Products transferred to other establishments within your company
Products made elsewhere by others from materials supplied by this establishment
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer)
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Select
Product Code
Manufacturing of:
2012125000
1. Civilian aircraft
2012125003
a. Manned civilian aircraft
2012125006
b. Unmanned robotic civilian aircraft
2. Military aircraft, including all aircraft for U.S. military and any other aircraft built to military specifications
a. Manned military aircraft, including manned aircraft for U.S. military and any other manned aircraft built to military specifications
b. Unmanned robotic military aircraft, including unmanned aircraft for U.S. military and any other unmanned aircraft built to military
specifications
3. Modification, conversion, and overhaul of previously accepted aircraft
a. Modification, conversion, and overhaul of previously accepted aircraft for civilian customers
b. Modification, conversion, and overhaul of military aircraft and all other aircraft built to military specifications
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
2012100000
2012100003
2012100006
2054050000
2054050006
2054050003
32
4. Aeronautical services on complete aircraft for civilian customers
5. Aeronautical services on complete aircraft for military customers
2053835000
2053825000
2019200000
6. Developing and making prototypes of complete aircraft
7. Developing and making prototypes of aircraft parts (excluding engines)
2019250000
2029425000
8. Civilian aircraft engines
9. Military aircraft engines (including other aircraft engines built to military specifications)
2029400000
2029475000
10. Parts and accessories for civilian aircraft engines
2029450000
11. Parts and accessories for military aircraft engines
12. Aircraft propellers and helicopter rotors, including blades and parts
2029500000
2032450000
13. Aircraft landing gear for civilian and military aircraft
14. Search, detection, navigation, and guidance systems and equipment
15. Other aircraft subassemblies and parts for civilian aircraft
16. Other aircraft subassemblies and parts for military aircraft (including other aircraft built to military specifications)
2017500000
2032500000
2032475000
All other sales, shipments, receipts, or revenue from this establishment
17. Wholesale sales of aircraft equipment and supplies, including engines and engine parts
4004300000
4002000000
18. Wholesale sales of aircraft and aeronautical equipment
Add product/service not listed
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
33
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
General – Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
If quantities are requested, please use the unit of measure specified.
Below are the products and services you previously selected. If you make products or have revenue from sources not listed, click the “Add product/service not listed” button and
search for a product or service.
For manufacturing 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 in this establishment and shipped, excluding freight charged and excise taxes
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.
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.
For contract manufacturing products, include:
Products made from materials owned by others (i.e., the customer). Report your commission or contract receipts in the appropriate Contract Manufacturing products line(s)
you selected or “Add product/service not listed”
For wholesale products, include:
Products that are bought from other establishments or transferred or imported from other establishments of your company and then sold without further manufacture,
processing, or assembly by this establishment
For other non-manufacturing products or services, please select a product or service listed below or “Add product/service not listed”.
Examples: Receipts for construction, installation, repair, and service contracts
Description
Value
Product Code
Manufacturing of:
1. Civilian aircraft
a. Manned civilian aircraft
$
,000.00
2012125003
b. Unmanned robotic civilian aircraft
$
,000.00
2012125006
Subtotal
$
,000.00
2012125000
a. Manned military aircraft, including manned aircraft for U.S. military and any other manned aircraft built to military
specifications
$
,000.00
2012100003
b. Unmanned robotic military aircraft, including unmanned aircraft for U.S. military and any other unmanned aircraft
built to military specifications
$
,000.00
2012100006
Subtotal
$
,000.00
2012100000
2. Military aircraft, including all aircraft for U.S. military and any other aircraft built to military specifications
3. Modification, conversion, and overhaul of previously accepted aircraft
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
34
a. Modification, conversion, and overhaul of previously accepted aircraft for civilian customers
$
,000.00
2054050006
b. Modification, conversion, and overhaul of military aircraft and all other aircraft built to military specifications
$
,000.00
2054050003
Subtotal
$
,000.00
2054050000
4. Aeronautical services on complete aircraft for civilian customers
$
,000.00
2053835000
5. Aeronautical services on complete aircraft for military customers
$
,000.00
2053825000
6. Developing and making prototypes of complete aircraft
$
,000.00
2019200000
7. Developing and making prototypes of aircraft parts (excluding engines)
$
,000.00
2019250000
$
,000.00
2029425000
9. Military aircraft engines (including other aircraft engines built to military specifications)
$
,000.00
2029400000
10. Parts and accessories for civilian aircraft engines
$
,000.00
2029475000
11. Parts and accessories for military aircraft engines
$
,000.00
2029450000
12. Aircraft propellers and helicopter rotors, including blades and parts
$
,000.00
2029500000
13. Aircraft landing gear for civilian and military aircraft
$
,000.00
2032450000
14. Search, detection, navigation, and guidance systems and equipment
$
,000.00
2017500000
15. Other aircraft subassemblies and parts for civilian aircraft
$
,000.00
2032500000
16. Other aircraft subassemblies and parts for military aircraft (including other aircraft built to military specifications)
$
,000.00
2032475000
$
,000.00
4004300000
18. Wholesale sales of aircraft and aeronautical equipment
$
,000.00
4002000000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
8. Civilian aircraft engines
All other sales, shipments, receipts, or revenue from this establishment
17. Wholesale sales of aircraft equipment and supplies, including engines and engine parts
Add product/service not listed
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
35
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
36
Item 28: Special Items - Defense-Related Manufacturing Activity
ITEM 28: SPECIAL ITEMS - DEFENSE-RELATED MANUFACTURING ACTIVITY
Did this establishment ship national defense related products in 2022?
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
37
Item 28: Special Items - Defense-Related Manufacturing Activity - Continued
ITEM 28: SPECIAL ITEMS - DEFENSE-RELATED MANUFACTURING ACTIVITY
For this physical location, report the value of sales, shipments, receipts, or revenue generated in 2022 where the Department of Defense (DOD) was the ultimate customer.
Include:
Domestic U.S. Manufacturing activity (50 states and the District of Columbia).
Shipments for which the DOD was the ultimate customer (U.S. Army, U.S. Navy, U.S. Air Force, U.S. Marines).
Interplant Transfers to other locations, divisions or subsidiaries of your company.
Exported products.
Shipments to commercial entities or subcontractors who sell to the DOD.
Exclude:
Nonmanufacturing activities (i.e. services, wholesale).
Shipments to Government agencies such as National Aeronautics and Space Administration, Department of Energy, Federal Aviation Administration, Department of Homeland
Security, U.S. Coast Guard, U.S. Merchant Marine, and foreign governments.
Resale of purchased merchandise (sale of products bought and sold without further processing or transformation).
Shipments from foreign subsidiaries or affiliates.
Special notes for Aerospace Industries (NAICS 336411, 336412, 336413, 336414, 336415, 336419 Only):
Fixed Price Contract: Report the value of sales during the year of complete aircraft, missiles, and space vehicles. Long term fixed price contracts may be recorded as payments
received, keeping consistent with the financial reports of the establishment.
Cost Plus Contract: Report the value of work done during the year. This may be calculated by multiplying the estimated percentage of work completed during the year by the
contract price of the aircraft or missile.
2022
$
,000.00
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
38
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
39
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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40
Item 28: Industrial Robots and Robotic Equipment
ITEM 28: INDUSTRIAL ROBOTS AND ROBOTIC EQUIPMENT
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.
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
Exclude:
Automated guided vehicles (AGVs)
Driverless forklifts
Automated storage and retrieval systems
CNC machining equipment
Check
if
None
2022
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.
2022 Number
,000.00
If you are unable to provide the number of industrial robots IN OPERATION, please explain:
C. What was the number of industrial robots PURCHASED for this plant? Refer to instructions above for definitions.
2022 Number
If you are unable to provide the number of industrial robots PURCHASED, please explain:
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
41
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
42
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
43
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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44
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
45
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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46
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
47
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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48
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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49
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
1000
characters remaining
50
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MC-33640_su.pdf Generated 2022-02-24 07:20:04
,000.00
51
Attachment D-6
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 42
Attachment Sector
D-6
42
Instrument
Path
Instrument Path Title
42311
42435
42441
42542
Motor Vehicles
Clothing and Accessories
General-Line Groceries
Pharmaceuticals, Cosmetics, and Toiletries Agents and Brokers
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4A: Primary Business or Activity Additional Information
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
New and used automobiles and motorcycles
423110 101
Retail new and used motor vehicle dealer
441110 003
Automobile auction, wholesale
425120 315
Light trucks and cargo vans, 14,000 lb. or less
423110 301
Medium trucks and tractors, 14,001 lb. to 33,000 lb.
423110 401
Heavy trucks, road tractors, and truck trailers, over 33,000 lb.
423110 501
Buses, recreational vehicles (RVs), motor homes, and campers
423110 201
Truck equipment distributor/upfitter primarily completing trucks by installing and assembling truck bodies and/or other equipment onto truck
chassis
336211 002
All-terrain vehicles (ATVs), snowmobiles, motor scooters, and mopeds
423110 102
New motor vehicle parts, warehouse distributor, sold primarily to jobbers or other wholesalers
423120 101
New motor vehicle parts, jobber, sold primarily to retailers and repair shops
423120 201
Used motor vehicle parts and supplies dealer
423140 001
Other primary business or activity
779000 001
Select Sector
Describe
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Item 4B: Type of Operation Additional Information
ITEM 4B: TYPE OF OPERATION
Which ONE of the following best describes this establishment's primary type of operation in 2022?
For further clarification, click the "Additional Information" link above.
Merchant wholesaler, buying and selling on own account
12
Importer
13
Exporter
11
Merchant wholesale distributor or jobber
14
Own-brand importer and marketer
20
Manufacturers' sales branch or office
Agent, broker, or commission merchant
46
Manufacturers' representative or agent
41
Auction company
42
Broker, representing buyers and sellers
43
Commission merchant
44
Import agent
45
Export agent
49
Electronic market - business-to-business marketplace that facilitates the sale of goods via the Internet or other electronic
means, and operates on a commission or fee basis
Other type of operation
77
Other type of operation
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
A. What were the sales and operating receipts?
(Include the gross selling value of business conducted for others. Include shipping and handling charges. Exclude
sales taxes and Hawaii’s General Excise Tax.)
Check
if
None
2022
$
,000.00
B. Did this establishment earn commissions for the sale of merchandise?
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Commissions Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - COMMISSIONS
C. What was the gross selling value of goods sold on a commission basis?
(This value should be included in the $,000.00 of sales and operating receipts reported in Item 5, line A.
For further clarification, click the "Additional Information" link above.)
2022
$
,000.00
2022
D. What were the commissions, including selling or listing fees, received on transactions reported on line C?
$
,000.00
2022
E. What was this establishment's average commission rate earned for the transactions reported on line C?
(For this response, you may report up to two decimal places.)
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%
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - CONTINUED
F. During 2022, what was the percent of total revenue (as reported in Item 5, line A ($,000.00)) from products sold by this establishment that were manufactured or mined in the United
States by your company or its subsidiaries?
0%
1-25%
26-49%
50-75%
76-100%
G. Did e-commerce account for more than 50% of this establishment's sales and/or operating receipts as reported in Item 5, line A ($,000.00)?
E-commerce sales and operating receipts are sales of goods and services where an order is placed by the buyer, or price and terms of sale are negotiated, over an Internet, mobile
device, extranet, Electronic Data Interchange (EDI) network, electronic mail, or other online system/application. Payment may or may not be made online.
Yes
No
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Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
2022
$
,000.00
$
,000.00
22
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
For further clarification, click the "Additional Information" link above.
Yes
No
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23
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
What were the inventories and Last-in, First-out (LIFO) adjustment, if any, for products owned by this establishment as of December 31?
For further clarification, click the "Additional Information" link above.
Check
if
None
Check
if
None
End of 2022
End of 2021
1. Total inventories before LIFO adjustment
(if any)
$
,000.00
$
,000.00
2. LIFO reserve
(if any)
$
,000.00
$
,000.00
3. Total inventories after LIFO adjustment
(Line 1 minus line 2.)
$
,000.00
$
,000.00
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Item 10: Inventories by Valuation Method Additional Information
ITEM 10: INVENTORIES BY VALUATION METHOD
How much of the inventory reported in Item 9, line 1, for 2022 ($,000.00) is subject to the following valuation methods?
For further clarification, click the "Additional Information" link above.
Check
if
None
End of 2022
$
,000.00
B. First-in, First-out (FIFO)
$
,000.00
C. Average cost
$
,000.00
D. Standard cost
$
,000.00
E. Other valuation method
$
,000.00
$
,000.00
A. LIFO valuation method before adjustment
Describe
F. TOTAL (Sum of lines A through E should equal Item 9, line 1.)
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25
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
A. What were the operating expenses?
(Include payroll. Exclude cost of goods sold and interest expense.)
$
,000.00
B. What were purchases of merchandise for resale, net of returns, allowances, and trade and cash discounts?
(Include amounts allowed for trade-ins.)
$
,000.00
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
For further clarification, click the "Additional Information" link above.
2022
%
1. Household consumers and individuals
%
2. Export sales
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Repair shops for use in repair work
%
6. Manufacturing and mining industrial users for use as input goods in production
%
7. Restaurants, hotels, food services, and contract feeding
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Building contractors, heavy construction, and special trade contractors
%
%
10. Farmers for use in farm production
%
11. Governmental bodies (Federal, state, and local)
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
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%
12. Other
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
%
28
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contributed to the sales, shipments, receipts, or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for the product or service.
For further clarification, click the "Additional Information" link above.
Description
Select
1. Wholesale sales of new and used automobiles, including crossovers
Product Code
4001325000
4001325004
a. Wholesale sales of new automobiles, nonelectric
b. Wholesale sales of new automobiles, electric and hybrid
4001325005
4001325007
c. Wholesale sales of used automobiles, nonelectric
d. Wholesale sales of used automobiles, electric and hybrid
2. Wholesale sales of new and used light trucks, 14,000 lb. or less, including vans, cargo vans, and SUVs
a. Wholesale sales of new light trucks and SUVs, nonelectric
b. Wholesale sales of new light trucks and SUVs, electric and hybrid
c. Wholesale sales of used light trucks and SUVs, nonelectric
d. Wholesale sales of used light trucks and SUVs, electric and hybrid
e. Wholesale sales of new and used vans and cargo vans, nonelectric
f. Wholesale sales of new and used vans and cargo vans, electric and hybrid
4001325008
4001350000
4001350004
4001350005
4001350007
4001350008
4001350011
4001350012
4004200000
3. Wholesale sales of new light truck, van, and SUV bodies
4. Wholesale sales of medium trucks and tractors, 14,001 lb. to 33,000 lb.
4001950000
4001950003
a. Wholesale sales of new medium trucks and tractors
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
30
4001950006
b. Wholesale sales of used medium trucks and tractors
4004325000
5. Wholesale sales of new medium truck bodies
6. Wholesale sales of heavy trucks, trailers, and road tractors, more than 33,000 lb.
4001975000
4001975003
a. Wholesale sales of new heavy trucks
4001975006
b. Wholesale sales of new heavy truck tractors
4001975009
c. Wholesale sales of new truck trailers
d. Wholesale sales of used heavy trucks, tractors, and trailers
4001975012
4004350000
7. Wholesale sales of new heavy truck bodies
8. Wholesale sales of motorcycles and other sports vehicles, including utility trailers
4001250000
4001250003
a. Wholesale sales of motorcycles
4001250006
b. Wholesale sales of utility trailers
c. Wholesale sales of all-terrain vehicles (ATVs), snowmobiles, motor scooters, mopeds, and other motorized recreational-use
vehicles
4001250009
4001925000
9. Wholesale sales of buses
10. Wholesale sales of motor homes, travel trailers, and campers
11. Wholesale sales of new and rebuilt automotive, light truck, and trailer parts and supplies, except automotive bodies and chemicals
a. Wholesale sales of hoses, belts, gaskets, and wiper blades
b. Wholesale sales of filters, including oil, air, gas, and transmission
c. Wholesale sales of engine parts, except electrical parts
d. Wholesale sales of suspension parts, including shocks, struts, and ball joints
4001375000
4004175000
4004175021
4004175024
4004175027
4004175033
4004175003
e. Wholesale sales of automotive batteries
4004175006
f. Wholesale sales of complete engines
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
31
g. Wholesale sales of electrical engine parts, including ignition parts
h. Wholesale sales of brake parts, including fluid and all disk and drum parts
4004175009
4004175012
4004175015
i. Wholesale sales of exhaust system parts
4004175018
j. Wholesale sales of automotive glass
4004175031
k. Wholesale sales of body parts and repair materials
l. Wholesale sales of automotive accessories, except car stereos and CD players
m. Wholesale sales of other automotive parts and supplies
12. Wholesale sales of car stereos, tape players, and CD players
13. Wholesale sales of used automotive parts and accessories
4004175039
4004175036
4004195000
4004250000
4004150000
14. Wholesale sales of tires and tubes
4004150003
a. Wholesale sales of new automobile tires and tubes
b. Wholesale sales of re-treaded and used automobile tires and repair materials
c. Wholesale sales of new truck and bus tires, including industrial, off-road, and farm tractor tires
d. Wholesale sales of re-treaded and used truck and bus tires and repair materials, including industrial, off-road, and farm tractor
tires
4004150006
4004150009
4004150012
4004150015
e. Wholesale sales of aircraft tires
15. Wholesale sales of automotive chemicals, including polishes and cleaners, fuel and oil additives, and antifreeze
16. Wholesale sales of refined petroleum products, except liquefied petroleum (LP)
4004225000
4002775000
4002050000
17. Wholesale sales of other transportation equipment
4002075000
18. Wholesale sales of farm machinery and equipment
19. Wholesale sales of construction, forestry, and mining machinery and equipment, including attachments
20. Maintenance and repair services for automobiles and light-duty trucks
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
4002100000
7002625000
32
7003800000
21. Rental of automobiles and light-duty trucks
22. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles, and musical
instruments)
23. Rental and leasing of heavy trucks, truck trailers, and buses
24. Maintenance and repair services for heavy trucks and buses
25. Maintenance and repair services for other industrial, commercial, and service industry machinery and equipment, not elsewhere
classified
26. Rental and leasing services for motor homes, travel trailers, campers, and utility trailers
7001800000
7009275000
7009375000
7009490000
7002875000
Add product/service not listed
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
33
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services that you previously selected. If a product or service is not listed, click the “Add product/service not listed” button and search for the product or
service.
For further clarification, click the "Additional Information" link above.
Description
Value
Product Code
1. Wholesale sales of new and used automobiles, including crossovers
a. Wholesale sales of new automobiles, nonelectric
$
,000.00
4001325004
b. Wholesale sales of new automobiles, electric and hybrid
$
,000.00
4001325005
$
,000.00
4001325007
d. Wholesale sales of used automobiles, electric and hybrid
$
,000.00
4001325008
Subtotal
$
,000.00
4001325000
a. Wholesale sales of new light trucks and SUVs, nonelectric
$
,000.00
4001350004
b. Wholesale sales of new light trucks and SUVs, electric and hybrid
$
,000.00
4001350005
c. Wholesale sales of used light trucks and SUVs, nonelectric
$
,000.00
4001350007
d. Wholesale sales of used light trucks and SUVs, electric and hybrid
$
,000.00
4001350008
e. Wholesale sales of new and used vans and cargo vans, nonelectric
$
,000.00
4001350011
f. Wholesale sales of new and used vans and cargo vans, electric and hybrid
$
,000.00
4001350012
Subtotal
$
,000.00
4001350000
$
,000.00
4004200000
c. Wholesale sales of used automobiles, nonelectric
2. Wholesale sales of new and used light trucks, 14,000 lb. or less, including vans, cargo vans, and SUVs
3. Wholesale sales of new light truck, van, and SUV bodies
4. Wholesale sales of medium trucks and tractors, 14,001 lb. to 33,000 lb.
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
34
a. Wholesale sales of new medium trucks and tractors
$
,000.00
4001950003
b. Wholesale sales of used medium trucks and tractors
$
,000.00
4001950006
Subtotal
$
,000.00
4001950000
$
,000.00
4004325000
a. Wholesale sales of new heavy trucks
$
,000.00
4001975003
b. Wholesale sales of new heavy truck tractors
$
,000.00
4001975006
c. Wholesale sales of new truck trailers
$
,000.00
4001975009
d. Wholesale sales of used heavy trucks, tractors, and trailers
$
,000.00
4001975012
$
,000.00
4001975000
$
,000.00
4004350000
a. Wholesale sales of motorcycles
$
,000.00
4001250003
b. Wholesale sales of utility trailers
$
,000.00
4001250006
c. Wholesale sales of all-terrain vehicles (ATVs), snowmobiles, motor scooters, mopeds, and other motorized
recreational-use vehicles
$
,000.00
4001250009
Subtotal
$
,000.00
4001250000
9. Wholesale sales of buses
$
,000.00
4001925000
10. Wholesale sales of motor homes, travel trailers, and campers
$
,000.00
4001375000
a. Wholesale sales of hoses, belts, gaskets, and wiper blades
$
,000.00
4004175021
b. Wholesale sales of filters, including oil, air, gas, and transmission
$
,000.00
4004175024
5. Wholesale sales of new medium truck bodies
6. Wholesale sales of heavy trucks, trailers, and road tractors, more than 33,000 lb.
Subtotal
7. Wholesale sales of new heavy truck bodies
8. Wholesale sales of motorcycles and other sports vehicles, including utility trailers
11. Wholesale sales of new and rebuilt automotive, light truck, and trailer parts and supplies, except automotive bodies
and chemicals
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
35
c. Wholesale sales of engine parts, except electrical parts
$
,000.00
4004175027
d. Wholesale sales of suspension parts, including shocks, struts, and ball joints
$
,000.00
4004175033
e. Wholesale sales of automotive batteries
$
,000.00
4004175003
$
,000.00
4004175006
g. Wholesale sales of electrical engine parts, including ignition parts
$
,000.00
4004175009
h. Wholesale sales of brake parts, including fluid and all disk and drum parts
$
,000.00
4004175012
i. Wholesale sales of exhaust system parts
$
,000.00
4004175015
j. Wholesale sales of automotive glass
$
,000.00
4004175018
$
,000.00
4004175031
l. Wholesale sales of automotive accessories, except car stereos and CD players
$
,000.00
4004175039
m. Wholesale sales of other automotive parts and supplies
$
,000.00
4004175036
Subtotal
$
,000.00
4004175000
12. Wholesale sales of car stereos, tape players, and CD players
$
,000.00
4004195000
13. Wholesale sales of used automotive parts and accessories
$
,000.00
4004250000
a. Wholesale sales of new automobile tires and tubes
$
,000.00
4004150003
b. Wholesale sales of re-treaded and used automobile tires and repair materials
$
,000.00
4004150006
c. Wholesale sales of new truck and bus tires, including industrial, off-road, and farm tractor tires
$
,000.00
4004150009
d. Wholesale sales of re-treaded and used truck and bus tires and repair materials, including industrial, off-road, and
farm tractor tires
$
,000.00
4004150012
e. Wholesale sales of aircraft tires
$
,000.00
4004150015
Subtotal
$
,000.00
4004150000
f. Wholesale sales of complete engines
k. Wholesale sales of body parts and repair materials
14. Wholesale sales of tires and tubes
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
36
15. Wholesale sales of automotive chemicals, including polishes and cleaners, fuel and oil additives, and antifreeze
$
,000.00
4004225000
16. Wholesale sales of refined petroleum products, except liquefied petroleum (LP)
$
,000.00
4002775000
17. Wholesale sales of other transportation equipment
$
,000.00
4002050000
18. Wholesale sales of farm machinery and equipment
$
,000.00
4002075000
$
,000.00
4002100000
20. Maintenance and repair services for automobiles and light-duty trucks
$
,000.00
7002625000
21. Rental of automobiles and light-duty trucks
$
,000.00
7003800000
22. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles,
and musical instruments)
$
,000.00
7001800000
$
,000.00
7009275000
24. Maintenance and repair services for heavy trucks and buses
$
,000.00
7009375000
25. Maintenance and repair services for other industrial, commercial, and service industry machinery and equipment,
not elsewhere classified
$
,000.00
7009490000
26. Rental and leasing services for motor homes, travel trailers, campers, and utility trailers
$
,000.00
7002875000
$
,000.00
9900000000
19. Wholesale sales of construction, forestry, and mining machinery and equipment, including attachments
23. Rental and leasing of heavy trucks, truck trailers, and buses
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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37
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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38
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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39
Item 28: Special Items - Employment by Primary Function Additional Information
ITEM 28: SPECIAL ITEMS - EMPLOYMENT BY PRIMARY FUNCTION
List the number of employees reported in Item 7, line A (), by the employee's primary function.
For further clarification, click the "Additional Information" link above.
2022 Paid
Employees
1. Selling
2. Sales support - including office, clerical, warehousing, customer service, maintenance employees, and drivers
3. General support of other establishments in your company - including central administrative, accounting, research, and other support
employees
4. Packaging
5. Production - including employees who manufacture products from raw materials or semi-finished products
(Report 'knockdown' assembly employees on line 6 below.)
6. 'Knockdown' assembly - assembling prefabricated components designed for a single application or reassembly of completed products
7. Other
Describe
8. TOTAL
(Sum of lines 1 through 7 should equal Item 7, line A.)
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40
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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41
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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42
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
43
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
44
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
45
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
46
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
47
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
48
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
49
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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50
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
1000
characters remaining
51
Item 32: Establishment Information Additional Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Describe kind of business at this location
Type of operation at this location
(For further clarification, click the "Additional
Information" link above.)
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_WH-42311_su.pdf Generated 2022-02-23 16:44:02
,000.00
52
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
14
Item 4A: Primary Business or Activity Additional Information
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Women's, children's, and infants' clothing and accessories, including uniforms, handbags, and unisex clothing
424330 003
Men's and boys' clothing and accessories, including uniforms
424320 002
Sporting and recreational goods and supplies
423910 001
Footwear
424340 001
Advertising specialty (e.g., keychain, magnet, pen) distribution services
541890 202
Other primary business or activity
779000 001
Select Sector
Describe
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 4B: Type of Operation Additional Information
ITEM 4B: TYPE OF OPERATION
Which ONE of the following best describes this establishment's primary type of operation in 2022?
For further clarification, click the "Additional Information" link above.
Merchant wholesaler, buying and selling on own account
12
Importer
13
Exporter
11
Merchant wholesale distributor or jobber
14
Own-brand importer and marketer
20
Manufacturers' sales branch or office
Agent, broker, or commission merchant
46
Manufacturers' representative or agent
41
Auction company
42
Broker, representing buyers and sellers
43
Commission merchant
44
Import agent
45
Export agent
49
Electronic market - business-to-business marketplace that facilitates the sale of goods via the Internet or other electronic
means, and operates on a commission or fee basis
Other type of operation
77
Other type of operation
Describe
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
A. What were the sales and operating receipts?
(Include the gross selling value of business conducted for others. Include shipping and handling charges. Exclude
sales taxes and Hawaii’s General Excise Tax.)
Check
if
None
2022
$
,000.00
B. Did this establishment earn commissions for the sale of merchandise?
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Commissions Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - COMMISSIONS
C. What was the gross selling value of goods sold on a commission basis?
(This value should be included in the $,000.00 of sales and operating receipts reported in Item 5, line A.
For further clarification, click the "Additional Information" link above.)
2022
$
,000.00
2022
D. What were the commissions, including selling or listing fees, received on transactions reported on line C?
$
,000.00
2022
E. What was this establishment's average commission rate earned for the transactions reported on line C?
(For this response, you may report up to two decimal places.)
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
%
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - CONTINUED
F. During 2022, what was the percent of total revenue (as reported in Item 5, line A ($,000.00)) from products sold by this establishment that were manufactured or mined in the United
States by your company or its subsidiaries?
0%
1-25%
26-49%
50-75%
76-100%
G. Did e-commerce account for more than 50% of this establishment's sales and/or operating receipts as reported in Item 5, line A ($,000.00)?
E-commerce sales and operating receipts are sales of goods and services where an order is placed by the buyer, or price and terms of sale are negotiated, over an Internet, mobile
device, extranet, Electronic Data Interchange (EDI) network, electronic mail, or other online system/application. Payment may or may not be made online.
Yes
No
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Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
2022
$
,000.00
$
,000.00
22
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
For further clarification, click the "Additional Information" link above.
Yes
No
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
What were the inventories and Last-in, First-out (LIFO) adjustment, if any, for products owned by this establishment as of December 31?
For further clarification, click the "Additional Information" link above.
Check
if
None
Check
if
None
End of 2022
End of 2021
1. Total inventories before LIFO adjustment
(if any)
$
,000.00
$
,000.00
2. LIFO reserve
(if any)
$
,000.00
$
,000.00
3. Total inventories after LIFO adjustment
(Line 1 minus line 2.)
$
,000.00
$
,000.00
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 10: Inventories by Valuation Method Additional Information
ITEM 10: INVENTORIES BY VALUATION METHOD
How much of the inventory reported in Item 9, line 1, for 2022 ($,000.00) is subject to the following valuation methods?
For further clarification, click the "Additional Information" link above.
Check
if
None
End of 2022
$
,000.00
B. First-in, First-out (FIFO)
$
,000.00
C. Average cost
$
,000.00
D. Standard cost
$
,000.00
E. Other valuation method
$
,000.00
$
,000.00
A. LIFO valuation method before adjustment
Describe
F. TOTAL (Sum of lines A through E should equal Item 9, line 1.)
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
A. What were the operating expenses?
(Include payroll. Exclude cost of goods sold and interest expense.)
$
,000.00
B. What were purchases of merchandise for resale, net of returns, allowances, and trade and cash discounts?
(Include amounts allowed for trade-ins.)
$
,000.00
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
For further clarification, click the "Additional Information" link above.
2022
%
1. Household consumers and individuals
%
2. Export sales
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Repair shops for use in repair work
%
6. Manufacturing and mining industrial users for use as input goods in production
%
7. Restaurants, hotels, food services, and contract feeding
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Building contractors, heavy construction, and special trade contractors
%
%
10. Farmers for use in farm production
%
11. Governmental bodies (Federal, state, and local)
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
27
%
12. Other
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
%
28
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included? Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contributed to the sales, shipments, receipts, or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for the product or service.
For further clarification, click the "Additional Information" link above.
Description
Select
1. Wholesale sales of women's, misses', and girls' clothing, including socks and hosiery
a. Wholesale sales of women's, misses', and girls' dresses, blouses, and sweaters, including unisex t-shirts and other clothing
b. Wholesale sales of women's, misses', and girls' suits and coats
c. Wholesale sales of women's, misses', and girls' outerwear, including skirts, slacks, and jeans
d. Wholesale sales of women's, misses', and girls' underwear and sleepwear
e. Wholesale sales of other women's, misses', and girls' clothing (except accessories), including uniforms
Product Code
4000525000
4000525003
4000525006
4000525009
4000525012
4000525015
4000500000
2. Wholesale sales of men's and boys' clothing
a. Wholesale sales of men's and boys' suits, coats, and formal wear
b. Wholesale sales of men's and boys' dress and casual shirts, sweaters, slacks, and jeans
c. Wholesale sales of men's and boys' underwear and sleepwear
d. Wholesale sales of men's and boys' work clothing and uniforms, except athletic uniforms
e. Wholesale sales of other men's and boys' clothing, except accessories
3. Wholesale sales of men's and women's clothing accessories (except infants' and children's)
a. Wholesale sales of men's clothing accessories, including hats, gloves, and neckwear
b. Wholesale sales of women's clothing accessories, including hats, gloves, and handbags
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
4000500003
4000500006
4000500009
4000500012
4000500015
4000625000
4000625003
4000625006
30
4. Wholesale sales of infants' and children's clothing, to size 6X, including accessories
4000550000
4000600000
5. Wholesale sales of footwear and footwear accessories
a. Wholesale sales of athletic footwear, except cleated and other specialized athletic footwear
4000600003
4000600006
b. Wholesale sales of infants' footwear
c. Wholesale sales of women's, misses', and girls' footwear (including slippers), except athletic footwear
d. Wholesale sales of men's and boys' footwear (including slippers), except athletic footwear
e. Wholesale sales of shoe accessories (polishes, laces, trees, storage bags, etc.)
6. Coordinating the production of advertising specialties bearing the logo and/or name of a business for purposes of promoting the
business and its products or services, and delivering the finished advertising specialties to the client (may include clothing items,
mugs, key chains, and other novelties or promotional items)
4000600009
4000600012
4000600015
7012750000
4001400000
7. Wholesale sales of luggage, including backpacks
4004625000
8. Wholesale sales of textile bags, bagging and burlap
4000575000
9. Wholesale sales of athletic uniforms
4001175000
10. Wholesale sales of sporting and recreational equipment
4001775000
11. Wholesale sales of infants' goods and accessories
4000650000
12. Wholesale sales of costume jewelry
4000675000
13. Wholesale sales of jewelry, except costume
14. Wholesale sales of general household furnishings, except artificial flowers, plants, and trees
15. Wholesale sales of other textile house furnishings (except floor coverings), including bedspreads, blankets, bedding, towels,
washcloths, other linens and domestics
16. Wholesale sales of personal safety equipment, supplies, and devices, including work gloves (except disposable)
17. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry
4000850000
4000800000
4005492000
7000200000
Add product/service not listed
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services that you previously selected. If a product or service is not listed, click the “Add product/service not listed” button and search for the product or
service.
For further clarification, click the "Additional Information" link above.
Description
Value
Product Code
1. Wholesale sales of women's, misses', and girls' clothing, including socks and hosiery
a. Wholesale sales of women's, misses', and girls' dresses, blouses, and sweaters, including unisex t-shirts and other
clothing
$
,000.00
4000525003
b. Wholesale sales of women's, misses', and girls' suits and coats
$
,000.00
4000525006
c. Wholesale sales of women's, misses', and girls' outerwear, including skirts, slacks, and jeans
$
,000.00
4000525009
d. Wholesale sales of women's, misses', and girls' underwear and sleepwear
$
,000.00
4000525012
$
,000.00
4000525015
$
,000.00
4000525000
a. Wholesale sales of men's and boys' suits, coats, and formal wear
$
,000.00
4000500003
b. Wholesale sales of men's and boys' dress and casual shirts, sweaters, slacks, and jeans
$
,000.00
4000500006
c. Wholesale sales of men's and boys' underwear and sleepwear
$
,000.00
4000500009
d. Wholesale sales of men's and boys' work clothing and uniforms, except athletic uniforms
$
,000.00
4000500012
e. Wholesale sales of other men's and boys' clothing, except accessories
$
,000.00
4000500015
Subtotal
$
,000.00
4000500000
$
,000.00
4000625003
e. Wholesale sales of other women's, misses', and girls' clothing (except accessories), including uniforms
Subtotal
2. Wholesale sales of men's and boys' clothing
3. Wholesale sales of men's and women's clothing accessories (except infants' and children's)
a. Wholesale sales of men's clothing accessories, including hats, gloves, and neckwear
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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b. Wholesale sales of women's clothing accessories, including hats, gloves, and handbags
$
,000.00
4000625006
Subtotal
$
,000.00
4000625000
$
,000.00
4000550000
a. Wholesale sales of athletic footwear, except cleated and other specialized athletic footwear
$
,000.00
4000600003
b. Wholesale sales of infants' footwear
$
,000.00
4000600006
c. Wholesale sales of women's, misses', and girls' footwear (including slippers), except athletic footwear
$
,000.00
4000600009
$
,000.00
4000600012
e. Wholesale sales of shoe accessories (polishes, laces, trees, storage bags, etc.)
$
,000.00
4000600015
Subtotal
$
,000.00
4000600000
6. Coordinating the production of advertising specialties bearing the logo and/or name of a business for purposes of
promoting the business and its products or services, and delivering the finished advertising specialties to the client
(may include clothing items, mugs, key chains, and other novelties or promotional items)
$
,000.00
7012750000
7. Wholesale sales of luggage, including backpacks
$
,000.00
4001400000
8. Wholesale sales of textile bags, bagging and burlap
$
,000.00
4004625000
$
,000.00
4000575000
10. Wholesale sales of sporting and recreational equipment
$
,000.00
4001175000
11. Wholesale sales of infants' goods and accessories
$
,000.00
4001775000
12. Wholesale sales of costume jewelry
$
,000.00
4000650000
13. Wholesale sales of jewelry, except costume
$
,000.00
4000675000
$
,000.00
4000850000
15. Wholesale sales of other textile house furnishings (except floor coverings), including bedspreads, blankets, bedding,
towels, washcloths, other linens and domestics
$
,000.00
4000800000
16. Wholesale sales of personal safety equipment, supplies, and devices, including work gloves (except disposable)
$
,000.00
4005492000
4. Wholesale sales of infants' and children's clothing, to size 6X, including accessories
5. Wholesale sales of footwear and footwear accessories
d. Wholesale sales of men's and boys' footwear (including slippers), except athletic footwear
9. Wholesale sales of athletic uniforms
14. Wholesale sales of general household furnishings, except artificial flowers, plants, and trees
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
33
17. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry
$
,000.00
7000200000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_WH-42435_su.pdf Generated 2022-02-23 17:50:47
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Employment by Primary Function Additional Information
ITEM 28: SPECIAL ITEMS - EMPLOYMENT BY PRIMARY FUNCTION
List the number of employees reported in Item 7, line A (), by the employee's primary function.
For further clarification, click the "Additional Information" link above.
2022 Paid
Employees
1. Selling
2. Sales support - including office, clerical, warehousing, customer service, maintenance employees, and drivers
3. General support of other establishments in your company - including central administrative, accounting, research, and other support
employees
4. Packaging
5. Production - including employees who manufacture products from raw materials or semi-finished products
(Report 'knockdown' assembly employees on line 6 below.)
6. 'Knockdown' assembly - assembling prefabricated components designed for a single application or reassembly of completed products
7. Other
Describe
8. TOTAL
(Sum of lines 1 through 7 should equal Item 7, line A.)
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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39
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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40
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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41
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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42
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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43
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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44
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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45
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
47
Item 32: Establishment Information Additional Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Describe kind of business at this location
Type of operation at this location
(For further clarification, click the "Additional
Information" link above.)
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
48
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4A: Primary Business or Activity Additional Information
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
General-line groceries
424410 001
Soft drinks, bottled water, juices, and nonalcoholic beverages, including beverage concentrates
424490 301
Coffee, tea, and powdered drink mixes
424490 101
Bread and baked goods, including baking ingredients, spices, and cooking oil
424490 202
Nonperishable (canned and packaged) food, including condensed and evaporated milk
424490 401
Packaged frozen food, excluding dairy products
424420 001
Confectioneries, including candy, nuts, chips, and popcorn
424450 001
Fresh fruits and vegetables
424480 001
Dairy products, excluding dried, canned, and raw milk and cream
424430 201
Eggs, poultry, and poultry products, excluding live, canned, or frozen packaged poultry
424440 201
Meat and meat products
424470 001
Fish and seafood
424460 001
Other grocery specialties, including breakfast cereals, dried fruit, dried milk, polished rice, and pet food
424490 604
Other primary business or activity
779000 001
Select Sector
Describe
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Item 4B: Type of Operation Additional Information
ITEM 4B: TYPE OF OPERATION
Which ONE of the following best describes this establishment's primary type of operation in 2022?
For further clarification, click the "Additional Information" link above.
Merchant wholesaler, buying and selling on own account
12
Importer
13
Exporter
11
Merchant wholesale distributor or jobber
14
Own-brand importer and marketer
20
Manufacturers' sales branch or office
Agent, broker, or commission merchant
46
Manufacturers' representative or agent
41
Auction company
42
Broker, representing buyers and sellers
43
Commission merchant
44
Import agent
45
Export agent
49
Electronic market - business-to-business marketplace that facilitates the sale of goods via the Internet or other electronic
means, and operates on a commission or fee basis
Other type of operation
77
Other type of operation
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
A. What were the sales and operating receipts?
(Include the gross selling value of business conducted for others. Include shipping and handling charges. Exclude
sales taxes and Hawaii’s General Excise Tax.)
Check
if
None
2022
$
,000.00
B. Did this establishment earn commissions for the sale of merchandise?
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Commissions Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - COMMISSIONS
C. What was the gross selling value of goods sold on a commission basis?
(This value should be included in the $,000.00 of sales and operating receipts reported in Item 5, line A.
For further clarification, click the "Additional Information" link above.)
2022
$
,000.00
2022
D. What were the commissions, including selling or listing fees, received on transactions reported on line C?
$
,000.00
2022
E. What was this establishment's average commission rate earned for the transactions reported on line C?
(For this response, you may report up to two decimal places.)
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%
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - CONTINUED
F. During 2022, what was the percent of total revenue (as reported in Item 5, line A ($,000.00)) from products sold by this establishment that were manufactured or mined in the United
States by your company or its subsidiaries?
0%
1-25%
26-49%
50-75%
76-100%
G. Did e-commerce account for more than 50% of this establishment's sales and/or operating receipts as reported in Item 5, line A ($,000.00)?
E-commerce sales and operating receipts are sales of goods and services where an order is placed by the buyer, or price and terms of sale are negotiated, over an Internet, mobile
device, extranet, Electronic Data Interchange (EDI) network, electronic mail, or other online system/application. Payment may or may not be made online.
Yes
No
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Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
22
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
For further clarification, click the "Additional Information" link above.
Yes
No
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Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
What were the inventories and Last-in, First-out (LIFO) adjustment, if any, for products owned by this establishment as of December 31?
For further clarification, click the "Additional Information" link above.
Check
if
None
Check
if
None
End of 2022
End of 2021
1. Total inventories before LIFO adjustment
(if any)
$
,000.00
$
,000.00
2. LIFO reserve
(if any)
$
,000.00
$
,000.00
3. Total inventories after LIFO adjustment
(Line 1 minus line 2.)
$
,000.00
$
,000.00
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Item 10: Inventories by Valuation Method Additional Information
ITEM 10: INVENTORIES BY VALUATION METHOD
How much of the inventory reported in Item 9, line 1, for 2022 ($,000.00) is subject to the following valuation methods?
For further clarification, click the "Additional Information" link above.
Check
if
None
End of 2022
$
,000.00
B. First-in, First-out (FIFO)
$
,000.00
C. Average cost
$
,000.00
D. Standard cost
$
,000.00
E. Other valuation method
$
,000.00
$
,000.00
A. LIFO valuation method before adjustment
Describe
F. TOTAL (Sum of lines A through E should equal Item 9, line 1.)
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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
A. What were the operating expenses?
(Include payroll. Exclude cost of goods sold and interest expense.)
$
,000.00
B. What were purchases of merchandise for resale, net of returns, allowances, and trade and cash discounts?
(Include amounts allowed for trade-ins.)
$
,000.00
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
For further clarification, click the "Additional Information" link above.
2022
%
1. Household consumers and individuals
%
2. Export sales
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Repair shops for use in repair work
%
6. Manufacturing and mining industrial users for use as input goods in production
%
7. Restaurants, hotels, food services, and contract feeding
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Building contractors, heavy construction, and special trade contractors
%
%
10. Farmers for use in farm production
%
11. Governmental bodies (Federal, state, and local)
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%
12. Other
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
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%
28
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contributed to the sales, shipments, receipts, or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for the product or service.
For further clarification, click the "Additional Information" link above.
Description
Select
1. Wholesale sales of nonperishable (canned and packaged) food
a. Wholesale sales of nonperishable (canned and packaged) fruits and vegetables
b. Wholesale sales of nonperishable (canned and packaged) fish and seafood
c. Wholesale sales of nonperishable (canned and packaged) meat
d. Wholesale sales of nonperishable (canned and packaged) milk
e. Wholesale sales of sauces, salad dressing, dips, and vinegar
f. Wholesale sales of preserves, jellies, jams, peanut butter, and honey
Product Code
4000250000
4000250003
4000250012
4000250009
4000250015
4000250024
4000250021
4000250018
g. Wholesale sales of pickles and olives
4000250027
h. Wholesale sales of condiments
4000250033
i. Wholesale sales of soup
4000250006
j. Wholesale sales of baby food
k. Wholesale sales of other nonperishable (canned and packaged) food, including nonperishable poultry
4000250036
4000025000
2. Wholesale sales of packaged frozen food
4000025009
a. Wholesale sales of frozen vegetables
4000025006
b. Wholesale sales of frozen fish and seafood products
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30
4000025015
c. Wholesale sales of frozen meat products
4000025018
d. Wholesale sales of frozen baked goods
4000025021
e. Wholesale sales of frozen poultry products
4000025012
f. Wholesale sales of frozen fruits and fruit juices
4000025003
g. Wholesale sales of frozen meals
h. Wholesale sales of other frozen foods, except frozen dairy products
4000025024
4000275000
3. Wholesale sales of grocery specialties
4000275006
a. Wholesale sales of pasta
4000275009
b. Wholesale sales of polished rice
4000275003
c. Wholesale sales of breakfast cereals and bars
4000275012
d. Wholesale sales of packaged meals, except frozen
e. Wholesale sales of other grocery specialties, including dried and soy milk, and edible dried beans
4000275015
4000225000
4. Wholesale sales of baking ingredients
a. Wholesale sales of cooking oils and margarine (butter substitutes)
4000225003
4000225012
b. Wholesale sales of spices
4000225006
c. Wholesale sales of flour
4000225009
d. Wholesale sales of refined sugar
4000225015
e. Wholesale sales of baking mixes and dough
5. Wholesale sales of dairy products, except dried, canned, condensed, and evaporated dairy products
4000050000
4000050006
a. Wholesale sales of cheese
b. Wholesale sales of milk and cream, except raw milk and cream
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4000050009
31
4000050003
c. Wholesale sales of butter
d. Wholesale sales of ice cream and other frozen dairy products
4000050012
4000050015
e. Wholesale sales of yogurt
4000050018
f. Wholesale sales of other dairy products
6. Wholesale sales of soft drinks, bottled water, juices, and nonalcoholic beverages
4000350000
4000350003
a. Wholesale sales of packaged soft drinks
4000350009
b. Wholesale sales of bottled water
c. Wholesale sales of nonfrozen fruit and vegetable juices
d. Wholesale sales of sport and energy drinks, including bottled and canned coffee and tea
e. Wholesale sales of pre-mix and post-mix bulk soft drinks
4000350018
4000350015
4000350006
4000350012
f. Wholesale sales of nonalcoholic beer and mixers
7. Wholesale sales of coffee, tea, and powdered drink mixes
4000300000
4000300003
a. Wholesale sales of coffee, except bottled and canned
4000300006
b. Wholesale sales of tea, except bottled and canned
4000300009
c. Wholesale sales of powdered drink mixes
8. Wholesale sales of confectionery and snack foods, including chips (except cannabis-infused)
4000110000
4000110003
a. Wholesale sales of candy, including chocolate
4000110012
b. Wholesale sales of chips and popcorn
4000110009
c. Wholesale sales of nuts, except raw
4000110006
d. Wholesale sales of chewing gum
4000110015
e. Wholesale sales of other confectioneries
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32
9. Wholesale sales of fresh meat and meat products, except canned and frozen
4000175000
4000175003
a. Wholesale sales of beef
4000175012
b. Wholesale sales of pork
c. Wholesale sales of fresh sausage and prepared meats
4000175015
4000175006
d. Wholesale sales of veal
4000175009
e. Wholesale sales of lamb and mutton
f. Wholesale sales of other meat and meat products, including bison, venison, deli (sliced) meats, and edible organs
10. Wholesale sales of eggs and poultry, except canned and frozen poultry products
4000175018
4000075000
4000200000
11. Wholesale sales of fresh fruits and vegetables
4000125000
12. Wholesale sales of cookies, bread, and baked goods
4000125006
a. Wholesale sales of cookies and cakes
4000125003
b. Wholesale sales of bread and rolls
c. Wholesale sales of other baked goods, including crackers
13. Wholesale sales of fish and seafood, except canned and frozen fish
14. Wholesale sales of grains, beans, and seeds used in food production
15. Wholesale sales of food and beverage basic materials, including flavoring extracts, fruit peel, sausage casings, hop extract, malt,
and yeast
4000125009
4000150000
4002875000
4000325000
4002925000
16. Wholesale sales of raw milk and cream
17. Wholesale sales of restaurant, commercial food service and hotel equipment
4002560000
4005230000
18. Wholesale sales of cleaning chemicals
19. Wholesale sales of disposable paper and plastic products, including cups, plates, and containers
20. Wholesale sales of tableware, kitchenware, cookware, and glassware, except cutlery and novelty glassware
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
4005280000
4000900000
33
21. Wholesale sales of bath, facial, and hand soaps, including shampoos and hand sanitizers
4001600000
4001305000
22. Wholesale sales of pet food
23. Wholesale sales of cosmetics, beauty supplies, perfumes and colognes, including hair preparations and hair brushes (except
cannabis-based topicals)
24. Wholesale sales of other personal care supplies, including toothbrushes (except electric), razor blades, and razors (except electric)
25. Wholesale sales of wine and distilled liquor, including premixed alcoholic drinks
26. Wholesale sales of tobacco products and electronic cigarettes
4001565000
4001650000
4000400000
4000450000
Add product/service not listed
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
34
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services that you previously selected. If a product or service is not listed, click the “Add product/service not listed” button and search for the product or
service.
For further clarification, click the "Additional Information" link above.
Description
Value
Product Code
1. Wholesale sales of nonperishable (canned and packaged) food
a. Wholesale sales of nonperishable (canned and packaged) fruits and vegetables
$
,000.00
4000250003
b. Wholesale sales of nonperishable (canned and packaged) fish and seafood
$
,000.00
4000250012
c. Wholesale sales of nonperishable (canned and packaged) meat
$
,000.00
4000250009
$
,000.00
4000250015
e. Wholesale sales of sauces, salad dressing, dips, and vinegar
$
,000.00
4000250024
f. Wholesale sales of preserves, jellies, jams, peanut butter, and honey
$
,000.00
4000250021
g. Wholesale sales of pickles and olives
$
,000.00
4000250018
h. Wholesale sales of condiments
$
,000.00
4000250027
i. Wholesale sales of soup
$
,000.00
4000250033
j. Wholesale sales of baby food
$
,000.00
4000250006
k. Wholesale sales of other nonperishable (canned and packaged) food, including nonperishable poultry
$
,000.00
4000250036
Subtotal
$
,000.00
4000250000
$
,000.00
4000025009
d. Wholesale sales of nonperishable (canned and packaged) milk
2. Wholesale sales of packaged frozen food
a. Wholesale sales of frozen vegetables
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
35
b. Wholesale sales of frozen fish and seafood products
$
,000.00
4000025006
c. Wholesale sales of frozen meat products
$
,000.00
4000025015
d. Wholesale sales of frozen baked goods
$
,000.00
4000025018
$
,000.00
4000025021
f. Wholesale sales of frozen fruits and fruit juices
$
,000.00
4000025012
g. Wholesale sales of frozen meals
$
,000.00
4000025003
h. Wholesale sales of other frozen foods, except frozen dairy products
$
,000.00
4000025024
Subtotal
$
,000.00
4000025000
a. Wholesale sales of pasta
$
,000.00
4000275006
b. Wholesale sales of polished rice
$
,000.00
4000275009
c. Wholesale sales of breakfast cereals and bars
$
,000.00
4000275003
d. Wholesale sales of packaged meals, except frozen
$
,000.00
4000275012
e. Wholesale sales of other grocery specialties, including dried and soy milk, and edible dried beans
$
,000.00
4000275015
Subtotal
$
,000.00
4000275000
a. Wholesale sales of cooking oils and margarine (butter substitutes)
$
,000.00
4000225003
b. Wholesale sales of spices
$
,000.00
4000225012
c. Wholesale sales of flour
$
,000.00
4000225006
$
,000.00
4000225009
$
,000.00
4000225015
e. Wholesale sales of frozen poultry products
3. Wholesale sales of grocery specialties
4. Wholesale sales of baking ingredients
d. Wholesale sales of refined sugar
e. Wholesale sales of baking mixes and dough
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
36
$
,000.00
4000225000
a. Wholesale sales of cheese
$
,000.00
4000050006
b. Wholesale sales of milk and cream, except raw milk and cream
$
,000.00
4000050009
c. Wholesale sales of butter
$
,000.00
4000050003
d. Wholesale sales of ice cream and other frozen dairy products
$
,000.00
4000050012
$
,000.00
4000050015
f. Wholesale sales of other dairy products
$
,000.00
4000050018
Subtotal
$
,000.00
4000050000
a. Wholesale sales of packaged soft drinks
$
,000.00
4000350003
b. Wholesale sales of bottled water
$
,000.00
4000350009
c. Wholesale sales of nonfrozen fruit and vegetable juices
$
,000.00
4000350018
d. Wholesale sales of sport and energy drinks, including bottled and canned coffee and tea
$
,000.00
4000350015
e. Wholesale sales of pre-mix and post-mix bulk soft drinks
$
,000.00
4000350006
f. Wholesale sales of nonalcoholic beer and mixers
$
,000.00
4000350012
Subtotal
$
,000.00
4000350000
a. Wholesale sales of coffee, except bottled and canned
$
,000.00
4000300003
b. Wholesale sales of tea, except bottled and canned
$
,000.00
4000300006
c. Wholesale sales of powdered drink mixes
$
,000.00
4000300009
Subtotal
$
,000.00
4000300000
Subtotal
5. Wholesale sales of dairy products, except dried, canned, condensed, and evaporated dairy products
e. Wholesale sales of yogurt
6. Wholesale sales of soft drinks, bottled water, juices, and nonalcoholic beverages
7. Wholesale sales of coffee, tea, and powdered drink mixes
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
37
8. Wholesale sales of confectionery and snack foods, including chips (except cannabis-infused)
a. Wholesale sales of candy, including chocolate
$
,000.00
4000110003
b. Wholesale sales of chips and popcorn
$
,000.00
4000110012
c. Wholesale sales of nuts, except raw
$
,000.00
4000110009
d. Wholesale sales of chewing gum
$
,000.00
4000110006
e. Wholesale sales of other confectioneries
$
,000.00
4000110015
Subtotal
$
,000.00
4000110000
$
,000.00
4000175003
$
,000.00
4000175012
c. Wholesale sales of fresh sausage and prepared meats
$
,000.00
4000175015
d. Wholesale sales of veal
$
,000.00
4000175006
e. Wholesale sales of lamb and mutton
$
,000.00
4000175009
f. Wholesale sales of other meat and meat products, including bison, venison, deli (sliced) meats, and edible organs
$
,000.00
4000175018
Subtotal
$
,000.00
4000175000
10. Wholesale sales of eggs and poultry, except canned and frozen poultry products
$
,000.00
4000075000
11. Wholesale sales of fresh fruits and vegetables
$
,000.00
4000200000
$
,000.00
4000125006
b. Wholesale sales of bread and rolls
$
,000.00
4000125003
c. Wholesale sales of other baked goods, including crackers
$
,000.00
4000125009
Subtotal
$
,000.00
4000125000
9. Wholesale sales of fresh meat and meat products, except canned and frozen
a. Wholesale sales of beef
b. Wholesale sales of pork
12. Wholesale sales of cookies, bread, and baked goods
a. Wholesale sales of cookies and cakes
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
38
13. Wholesale sales of fish and seafood, except canned and frozen fish
$
,000.00
4000150000
14. Wholesale sales of grains, beans, and seeds used in food production
$
,000.00
4002875000
15. Wholesale sales of food and beverage basic materials, including flavoring extracts, fruit peel, sausage casings, hop
extract, malt, and yeast
$
,000.00
4000325000
16. Wholesale sales of raw milk and cream
$
,000.00
4002925000
17. Wholesale sales of restaurant, commercial food service and hotel equipment
$
,000.00
4002560000
18. Wholesale sales of cleaning chemicals
$
,000.00
4005230000
19. Wholesale sales of disposable paper and plastic products, including cups, plates, and containers
$
,000.00
4005280000
20. Wholesale sales of tableware, kitchenware, cookware, and glassware, except cutlery and novelty glassware
$
,000.00
4000900000
21. Wholesale sales of bath, facial, and hand soaps, including shampoos and hand sanitizers
$
,000.00
4001600000
22. Wholesale sales of pet food
$
,000.00
4001305000
23. Wholesale sales of cosmetics, beauty supplies, perfumes and colognes, including hair preparations and hair
brushes (except cannabis-based topicals)
$
,000.00
4001565000
24. Wholesale sales of other personal care supplies, including toothbrushes (except electric), razor blades, and razors
(except electric)
$
,000.00
4001650000
25. Wholesale sales of wine and distilled liquor, including premixed alcoholic drinks
$
,000.00
4000400000
26. Wholesale sales of tobacco products and electronic cigarettes
$
,000.00
4000450000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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39
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Employment by Primary Function Additional Information
ITEM 28: SPECIAL ITEMS - EMPLOYMENT BY PRIMARY FUNCTION
List the number of employees reported in Item 7, line A (), by the employee's primary function.
For further clarification, click the "Additional Information" link above.
2022 Paid
Employees
1. Selling
2. Sales support - including office, clerical, warehousing, customer service, maintenance employees, and drivers
3. General support of other establishments in your company - including central administrative, accounting, research, and other support
employees
4. Packaging
5. Production - including employees who manufacture products from raw materials or semi-finished products
(Report 'knockdown' assembly employees on line 6 below.)
6. 'Knockdown' assembly - assembling prefabricated components designed for a single application or reassembly of completed products
7. Other
Describe
8. TOTAL
(Sum of lines 1 through 7 should equal Item 7, line A.)
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41
Item 28: Special Items - Goods Purchased from Farmers Additional Information
ITEM 28: SPECIAL ITEMS - GOODS PURCHASED FROM FARMERS
Were 50 percent or more of the goods sold by this establishment in 2022 purchased directly from farmers?
For further clarification, click the "Additional Information" link above.
Yes
No
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42
Item 28: Special Items - General Line Groceries
ITEM 28: SPECIAL ITEMS - GENERAL LINE GROCERIES
Which ONE of the following is this establishment?
Voluntary group wholesaler (An establishment affiliated with independent retailers engaged in joint sales promotions under a group name)
Retail-cooperative wholesaler (An establishment owned and operated cooperatively by independent retailers buying collectively)
Other grocery wholesaler
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43
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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44
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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45
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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46
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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47
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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48
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
49
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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50
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
51
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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52
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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53
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
1000
characters remaining
54
Item 32: Establishment Information Additional Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Describe kind of business at this location
Type of operation at this location
(For further clarification, click the "Additional
Information" link above.)
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_WH-42441_su.pdf Generated 2022-02-23 17:53:08
,000.00
55
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4A: Primary Business or Activity Additional Information
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Health and beauty accessories manufacturer's representatives, agents, or brokers, including cosmetics, toiletries, vitamins, and first aid
supplies
425120 423
General-line drugs manufacturer's representatives, agents, or brokers, including over-the-counter drugs, antibiotics, and dietary supplements
425120 421
Specialty-line drugs manufacturer's representatives, agents, or brokers, including those which require special handling, injectables, short
shelf life, experimental, and nuclear
425120 422
Miscellaneous nondurable goods manufacturer's representatives, agents, or brokers
425120 491
Medical, dental, hospital, and ophthalmic equipment, devices, and supplies manufacturer's representatives, agents, or brokers
425120 345
Pharmaceuticals, cosmetics, and toiletries electronic markets
425110 421
Cannabis and marijuana (recreational or medical) wholesaling, excluding growing
424590 601
Cannabidiol (CBD oil) and other cannabis and hemp extracts and concentrates
424690 301
Cannabis-based topicals, including gels, creams, lotions, and balms
424210 303
Other primary business or activity
779000 001
Select Sector
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
15
Item 4B: Type of Operation Additional Information
ITEM 4B: TYPE OF OPERATION
Which ONE of the following best describes this establishment's primary type of operation in 2022?
For further clarification, click the "Additional Information" link above.
Merchant wholesaler, buying and selling on own account
12
Importer
13
Exporter
11
Merchant wholesale distributor or jobber
14
Own-brand importer and marketer
20
Manufacturers' sales branch or office
Agent, broker, or commission merchant
46
Manufacturers' representative or agent
41
Auction company
42
Broker, representing buyers and sellers
43
Commission merchant
44
Import agent
45
Export agent
49
Electronic market - business-to-business marketplace that facilitates the sale of goods via the Internet or other electronic
means, and operates on a commission or fee basis
Other type of operation
77
Other type of operation
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
A. What were the sales and operating receipts?
(Include the gross selling value of business conducted for others. Include shipping and handling charges. Exclude
sales taxes and Hawaii’s General Excise Tax.)
Check
if
None
2022
$
,000.00
B. Did this establishment earn commissions for the sale of merchandise?
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
19
Item 5: Sales, Shipments, Receipts, or Revenue - Commissions Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - COMMISSIONS
C. What was the gross selling value of goods sold on a commission basis?
(This value should be included in the $,000.00 of sales and operating receipts reported in Item 5, line A.
For further clarification, click the "Additional Information" link above.)
2022
$
,000.00
2022
D. What were the commissions, including selling or listing fees, received on transactions reported on line C?
$
,000.00
2022
E. What was this establishment's average commission rate earned for the transactions reported on line C?
(For this response, you may report up to two decimal places.)
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
%
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - CONTINUED
F. During 2022, what was the percent of total revenue (as reported in Item 5, line A ($,000.00)) from products sold by this establishment that were manufactured or mined in the United
States by your company or its subsidiaries?
0%
1-25%
26-49%
50-75%
76-100%
G. Did e-commerce account for more than 50% of this establishment's sales and/or operating receipts as reported in Item 5, line A ($,000.00)?
E-commerce sales and operating receipts are sales of goods and services where an order is placed by the buyer, or price and terms of sale are negotiated, over an Internet, mobile
device, extranet, Electronic Data Interchange (EDI) network, electronic mail, or other online system/application. Payment may or may not be made online.
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
2022
$
,000.00
$
,000.00
22
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
For further clarification, click the "Additional Information" link above.
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
23
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
What were the inventories and Last-in, First-out (LIFO) adjustment, if any, for products owned by this establishment as of December 31?
For further clarification, click the "Additional Information" link above.
Check
if
None
Check
if
None
End of 2022
End of 2021
1. Total inventories before LIFO adjustment
(if any)
$
,000.00
$
,000.00
2. LIFO reserve
(if any)
$
,000.00
$
,000.00
3. Total inventories after LIFO adjustment
(Line 1 minus line 2.)
$
,000.00
$
,000.00
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
24
Item 10: Inventories by Valuation Method Additional Information
ITEM 10: INVENTORIES BY VALUATION METHOD
How much of the inventory reported in Item 9, line 1, for 2022 ($,000.00) is subject to the following valuation methods?
For further clarification, click the "Additional Information" link above.
Check
if
None
End of 2022
$
,000.00
B. First-in, First-out (FIFO)
$
,000.00
C. Average cost
$
,000.00
D. Standard cost
$
,000.00
E. Other valuation method
$
,000.00
$
,000.00
A. LIFO valuation method before adjustment
Describe
F. TOTAL (Sum of lines A through E should equal Item 9, line 1.)
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
25
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
A. What were the operating expenses?
(Include payroll. Exclude cost of goods sold and interest expense.)
$
,000.00
B. What were purchases of merchandise for resale, net of returns, allowances, and trade and cash discounts?
(Include amounts allowed for trade-ins.)
$
,000.00
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
26
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
For further clarification, click the "Additional Information" link above.
2022
%
1. Household consumers and individuals
%
2. Export sales
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Repair shops for use in repair work
%
6. Manufacturing and mining industrial users for use as input goods in production
%
7. Restaurants, hotels, food services, and contract feeding
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Building contractors, heavy construction, and special trade contractors
%
%
10. Farmers for use in farm production
%
11. Governmental bodies (Federal, state, and local)
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
27
%
12. Other
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
%
28
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
29
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
The products and services listed below are generally associated with your industry.
Please select the products or services that contributed to the sales, shipments, receipts, or revenue of this establishment. If a product or service is not listed, click the “Add
product/service not listed” button and search for the product or service.
For further clarification, click the "Additional Information" link above.
Description
Select
1. Wholesale sales of nonprescription drugs and over-the-counter medications
2. Wholesale sales of prescription cannabis-based pharmaceutical preparations (except pre-rolled or loose dried buds)
3. Wholesale sales of prescription drugs and antibiotics (except cannabis-based pharmaceutical preparations)
4. Wholesale sales of cannabis-based health supplements/vitamins
5. Wholesale sales of vitamins and nutritional and herbal supplements (except cannabis-based health supplements/vitamins)
6. Wholesale sales of cannabis-based topicals, including gels, creams, and balms
7. Wholesale sales of cosmetics, beauty supplies, perfumes and colognes, including hair preparations and hair brushes (except
cannabis-based topicals)
a. Wholesale sales of cosmetics and beauty supplies, including lotions and creams
b. Wholesale sales of beauty salon and barber supplies, including combs, curlers, and shampoos
Product Code
4001450000
4001430000
4001435000
4001480000
4001485000
4001560000
4001565000
4001565003
4001565006
4001565009
c. Wholesale sales of perfumes and colognes
8. Wholesale sales of health aids and household first aid supplies
a. Wholesale sales of household first aid kits, including nonsurgical bandages and gauze
4001555000
4001555003
4001555006
b. Wholesale sales of insect repellent
c. Wholesale sales of other health aids and household first aid supplies
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
4001555009
30
4001580000
9. Wholesale sales of sunblock
10. Wholesale sales of specialty pharmaceuticals, including vaccines, laboratory diagnostic reagents, and other specialty
pharmaceuticals
11. Wholesale sales of cannabis extracts and concentrates, including CBD oil
12. Wholesale sales of bath, facial, and hand soaps, including shampoos and hand sanitizers
13. Wholesale sales of other personal care supplies, including toothbrushes (except electric), razor blades, and razors (except electric)
4005125000
4003385000
4001600000
4001650000
Add product/service not listed
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
31
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Please do not combine product lines. If the information is not directly available from your records, reasonable estimates are acceptable.
Below are the products and services that you previously selected. If a product or service is not listed, click the “Add product/service not listed” button and search for the product or
service.
For further clarification, click the "Additional Information" link above.
Description
Value
Product Code
1. Wholesale sales of nonprescription drugs and over-the-counter medications
$
,000.00
4001450000
2. Wholesale sales of prescription cannabis-based pharmaceutical preparations (except pre-rolled or loose dried buds)
$
,000.00
4001430000
3. Wholesale sales of prescription drugs and antibiotics (except cannabis-based pharmaceutical preparations)
$
,000.00
4001435000
4. Wholesale sales of cannabis-based health supplements/vitamins
$
,000.00
4001480000
5. Wholesale sales of vitamins and nutritional and herbal supplements (except cannabis-based health
supplements/vitamins)
$
,000.00
4001485000
6. Wholesale sales of cannabis-based topicals, including gels, creams, and balms
$
,000.00
4001560000
a. Wholesale sales of cosmetics and beauty supplies, including lotions and creams
$
,000.00
4001565003
b. Wholesale sales of beauty salon and barber supplies, including combs, curlers, and shampoos
$
,000.00
4001565006
c. Wholesale sales of perfumes and colognes
$
,000.00
4001565009
Subtotal
$
,000.00
4001565000
a. Wholesale sales of household first aid kits, including nonsurgical bandages and gauze
$
,000.00
4001555003
b. Wholesale sales of insect repellent
$
,000.00
4001555006
$
,000.00
4001555009
7. Wholesale sales of cosmetics, beauty supplies, perfumes and colognes, including hair preparations and hair brushes
(except cannabis-based topicals)
8. Wholesale sales of health aids and household first aid supplies
c. Wholesale sales of other health aids and household first aid supplies
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
32
$
,000.00
4001555000
9. Wholesale sales of sunblock
$
,000.00
4001580000
10. Wholesale sales of specialty pharmaceuticals, including vaccines, laboratory diagnostic reagents, and other
specialty pharmaceuticals
$
,000.00
4005125000
11. Wholesale sales of cannabis extracts and concentrates, including CBD oil
$
,000.00
4003385000
12. Wholesale sales of bath, facial, and hand soaps, including shampoos and hand sanitizers
$
,000.00
4001600000
13. Wholesale sales of other personal care supplies, including toothbrushes (except electric), razor blades, and razors
(except electric)
$
,000.00
4001650000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Subtotal
Add product/service not listed
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
33
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
34
Item 28: Special Items - Employment by Primary Function Additional Information
ITEM 28: SPECIAL ITEMS - EMPLOYMENT BY PRIMARY FUNCTION
List the number of employees reported in Item 7, line A (), by the employee's primary function.
For further clarification, click the "Additional Information" link above.
2022 Paid
Employees
1. Selling
2. Sales support - including office, clerical, warehousing, customer service, maintenance employees, and drivers
3. General support of other establishments in your company - including central administrative, accounting, research, and other support
employees
4. Packaging
5. Production - including employees who manufacture products from raw materials or semi-finished products
(Report 'knockdown' assembly employees on line 6 below.)
6. 'Knockdown' assembly - assembling prefabricated components designed for a single application or reassembly of completed products
7. Other
Describe
8. TOTAL
(Sum of lines 1 through 7 should equal Item 7, line A.)
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
35
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
36
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
37
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
38
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
39
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
40
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
41
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
42
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
43
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
44
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
45
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
1000
characters remaining
46
Item 32: Establishment Information Additional Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
Describe kind of business at this location
Type of operation at this location
(For further clarification, click the "Additional
Information" link above.)
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_WH-42542_su.pdf Generated 2022-02-23 18:34:41
,000.00
47
Attachment D-7
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 44-45
Attachment Sector
D-7
44-45
Instrument
Path
Instrument Path Title
44211
44512
44831
45111
Furniture Stores
Convenience Stores
Jewelry Stores
Sporting Goods Stores
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Furniture store, except custom
442110 501
Sleep/mattress shop
442110 301
Office and business furniture store
442110 503
Specialty furniture store, except custom, including recliners, outdoor furniture, baby and children's furniture, etc.
442110 504
Furniture warehouse showroom
442110 502
Home furnishings store, including china, glassware, metalware, lamps, lampshades, pictures, frames, mirrors, etc.
442299 001
Floor coverings store
442210 001
Household appliance store, including parts
443141 001
Custom upholstered furniture store
337121 002
Custom nonupholstered wood furniture store
337122 002
Custom wood cabinet shop, freestanding cabinetry
337122 003
Cabinet shop, including stock and custom kitchen and bath cabinets to be installed
444190 223
Interior decorator/designer
541410 004
Antique furniture store
453310 102
Antique store
453310 103
Secondhand store, except pawn shop
453310 20C
Furniture repair, refinishing, and reupholstery
811420 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total sales of merchandise and other operating receipts?
(Exclude sales taxes or other taxes collected.)
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
2022
%
1. Household consumers and individuals
2. Retailers for resale
%
3. Wholesalers/distributors for resale
%
%
4. Repair shops for use in repair work
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Restaurants, hotels, food services, and contract feeding
%
7. Businesses for end use in their own operation, not for resale or production
%
8. Building contractors, heavy construction, and special trade contractors
%
9. Farmers for use in farm production
%
10. Governmental bodies (Federal, state, and local)
%
11. Export sales
%
12. Other
%
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20
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
%
21
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
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22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Retail sales of indoor home furniture
(Report new and used office furniture on line 5, used furniture (non-office related) on line 12h, antique furniture on line 12a, and parts
and materials used in furniture repair or upholstery work on line 25.)
a. Retail sales of upholstered furniture (except dual-purpose pieces and infants' furniture)
b. Retail sales of sleep sofas, daybeds, futons, and other dual-purpose pieces
c. Retail sales of all other indoor furniture (except infants' furniture)
d. Retail sales of infants' furniture, including cribs, bassinets, high chairs, etc.
(Report playpens on line 22.)
Product Code
5000550000
5000550003
5000550006
5000550009
5000550012
5000680000
2. Retail sales of other home furnishings and accessories
a. Retail sales of decorative accessories and home furnishings (Include lamps, lampshades, decorative glassware, vases, giftware,
mirrors, pictures, picture frames, clocks, magazine racks, desk sets, closet and bathroom accessories, etc.)
(Report ceiling fans, light bulbs, and lighting fixtures on line 20.)
5000680003
5000680006
b. Retail sales of artificial/silk flowers, plants, and trees
c. Retail sales of seasonal decorations (except decorative plates, napkins, and cups)
3. Retail sales of mattresses, box springs, and air mattresses
5000680009
5000600000
5000575000
4. Retail sales of outdoor/patio furniture
5. Retail sales of new and used office equipment and furniture (exclude computers)
a. Retail sales of office equipment, new and used, including dictaphones, copying machines, calculating machines, etc.
b. Retail sales of office furniture, new and used, including computer-related furniture
6. Retail sales of major household appliances and related parts and accessories
a. Retail sales of kitchen appliances and related parts and accessories, including refrigerators, freezers, dishwashers, microwave
ovens, etc.
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
5001525000
5001525003
5001525006
5000700000
5000700003
23
b. Retail sales of laundry appliances and related parts and accessories, including clothes washers and dryers
c. Retail sales of other major household appliances and related parts and accessories, including room air-conditioners,
dehumidifiers, vacuum cleaners, sewing machines, etc.
5000700006
5000700009
7. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers; frypans; personal care
appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
5000725000
8. Retail sales of tableware, kitchenware, cookware, glassware (Include flatware, cutlery, paper and plastic tableware, and pots and
pans.)
5000750000
5001875000
9. Retail sales of flooring and floor coverings
a. Retail sales of soft-surface (textile) floor coverings to be installed
b. Retail sales of carpets and rugs not requiring installation
5001875003
5001875006
5001875009
c. Retail sales of hardwood flooring
5001875011
d. Retail sales of linoleum flooring
5001875013
e. Retail sales of ceramic flooring
f. Retail sales of other hard-surface floor coverings and accessories
10. Retail sales of domestics and other textile home furnishings (except carpet and rugs)
a. Retail sales of furniture coverings, including ready-made and custom-made (except parts and materials used in furniture repair or
upholstery work)
b. Retail sales of domestics, including towels, sheets, blankets, table linens and coverings, etc.
11. Retail sales of window treatments, including rods, poles, and fixtures
12. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
5001875015
5000650000
5000650003
5000650006
5000625000
5000850000
5000850003
a. Retail sales of antiques, items over 100 years old
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
c. Retail sales of art goods, including original pictures and sculptures
d. Retail sales of precious metals, coins, medals, and other numismatic items
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
5000850006
5000850009
5000850012
5000850015
24
5000850018
f. Retail sales of estate/antique jewelry
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and garden goods
(Report used office furniture on line 5b.)
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical instruments, etc.
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
k. Retail sales of used household and personal goods, not elsewhere classified
5000850021
5000850024
5000850027
5000850031
5000850033
5000875000
13. Retail sales of televisions, audio and video equipment
14. Retail sales of computers and peripheral equipment, communications equipment, and related products
15. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants (Include powered lawn and garden
tools, outdoor grills, pools, pool chemicals, and pool supplies, and outdoor nursery stock.)
16. Retail sales of fabrics, yarns, and other sewing materials and supplies
5001550000
5000805000
5001775000
5000925000
17. Retail sales of books
18. Retail sales of toys, games, and hobby and craft supplies
19. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
20. Retail sales of plumbing, electrical, and HVAC supplies (Include heating stoves (wood, kerosene, and oil) and prefabricated
fireplaces, ceiling fans, light bulbs, and light fixtures.)
21. Retail sales of wallpaper and other flexible wallcoverings
22. Retail sales of miscellaneous household goods, not elsewhere classified (Include nonautomotive batteries and baby goods such as
swings, collapsible playpens, infant and booster car seats, etc.)
23. Local transportation and delivery of purchased or serviced items
24. Rental services for home furniture, furnishings, and accessories
5001125000
5001930000
5001900000
5001825000
5000860000
7011125000
7000700000
25. Off-site cleaning and repair services for home furniture, furnishings, and accessories, except curtain and drape cleaning services
(Include parts and materials used in repair. Include value of service contracts.)
7000770000
26. Maintenance and repair services for household and personal goods, not elsewhere classified (Include parts and materials used in
repair. Include value of service contracts.)
7000800000
Add product/service not listed
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25
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
26
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Retail sales of indoor home furniture
(Report new and used office furniture on line 5, used furniture (non-office related) on line 12h, antique furniture on line
12a, and parts and materials used in furniture repair or upholstery work on line 25.)
a. Retail sales of upholstered furniture (except dual-purpose pieces and infants' furniture)
$
,000.00
5000550003
b. Retail sales of sleep sofas, daybeds, futons, and other dual-purpose pieces
$
,000.00
5000550006
c. Retail sales of all other indoor furniture (except infants' furniture)
$
,000.00
5000550009
d. Retail sales of infants' furniture, including cribs, bassinets, high chairs, etc.
(Report playpens on line 22.)
$
,000.00
5000550012
Subtotal
$
,000.00
5000550000
a. Retail sales of decorative accessories and home furnishings (Include lamps, lampshades, decorative glassware,
vases, giftware, mirrors, pictures, picture frames, clocks, magazine racks, desk sets, closet and bathroom
accessories, etc.)
(Report ceiling fans, light bulbs, and lighting fixtures on line 20.)
$
,000.00
5000680003
b. Retail sales of artificial/silk flowers, plants, and trees
$
,000.00
5000680006
c. Retail sales of seasonal decorations (except decorative plates, napkins, and cups)
$
,000.00
5000680009
Subtotal
$
,000.00
5000680000
$
,000.00
5000600000
$
,000.00
5000575000
a. Retail sales of office equipment, new and used, including dictaphones, copying machines, calculating machines,
etc.
$
,000.00
5001525003
b. Retail sales of office furniture, new and used, including computer-related furniture
$
,000.00
5001525006
2. Retail sales of other home furnishings and accessories
3. Retail sales of mattresses, box springs, and air mattresses
4. Retail sales of outdoor/patio furniture
5. Retail sales of new and used office equipment and furniture (exclude computers)
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
27
$
,000.00
5001525000
a. Retail sales of kitchen appliances and related parts and accessories, including refrigerators, freezers, dishwashers,
microwave ovens, etc.
$
,000.00
5000700003
b. Retail sales of laundry appliances and related parts and accessories, including clothes washers and dryers
$
,000.00
5000700006
c. Retail sales of other major household appliances and related parts and accessories, including room airconditioners, dehumidifiers, vacuum cleaners, sewing machines, etc.
$
,000.00
5000700009
Subtotal
$
,000.00
5000700000
7. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers;
frypans; personal care appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
$
,000.00
5000725000
8. Retail sales of tableware, kitchenware, cookware, glassware (Include flatware, cutlery, paper and plastic tableware,
and pots and pans.)
$
,000.00
5000750000
a. Retail sales of soft-surface (textile) floor coverings to be installed
$
,000.00
5001875003
b. Retail sales of carpets and rugs not requiring installation
$
,000.00
5001875006
c. Retail sales of hardwood flooring
$
,000.00
5001875009
d. Retail sales of linoleum flooring
$
,000.00
5001875011
e. Retail sales of ceramic flooring
$
,000.00
5001875013
f. Retail sales of other hard-surface floor coverings and accessories
$
,000.00
5001875015
Subtotal
$
,000.00
5001875000
a. Retail sales of furniture coverings, including ready-made and custom-made (except parts and materials used in
furniture repair or upholstery work)
$
,000.00
5000650003
b. Retail sales of domestics, including towels, sheets, blankets, table linens and coverings, etc.
$
,000.00
5000650006
Subtotal
$
,000.00
5000650000
$
,000.00
5000625000
Subtotal
6. Retail sales of major household appliances and related parts and accessories
9. Retail sales of flooring and floor coverings
10. Retail sales of domestics and other textile home furnishings (except carpet and rugs)
11. Retail sales of window treatments, including rods, poles, and fixtures
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
28
12. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
a. Retail sales of antiques, items over 100 years old
$
,000.00
5000850003
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
$
,000.00
5000850006
$
,000.00
5000850009
d. Retail sales of precious metals, coins, medals, and other numismatic items
$
,000.00
5000850012
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
$
,000.00
5000850015
f. Retail sales of estate/antique jewelry
$
,000.00
5000850018
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
$
,000.00
5000850021
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and
garden goods
(Report used office furniture on line 5b.)
$
,000.00
5000850024
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical
instruments, etc.
$
,000.00
5000850027
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
$
,000.00
5000850031
k. Retail sales of used household and personal goods, not elsewhere classified
$
,000.00
5000850033
Subtotal
$
,000.00
5000850000
13. Retail sales of televisions, audio and video equipment
$
,000.00
5000875000
14. Retail sales of computers and peripheral equipment, communications equipment, and related products
$
,000.00
5001550000
15. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants (Include powered lawn
and garden tools, outdoor grills, pools, pool chemicals, and pool supplies, and outdoor nursery stock.)
$
,000.00
5000805000
16. Retail sales of fabrics, yarns, and other sewing materials and supplies
$
,000.00
5001775000
17. Retail sales of books
$
,000.00
5000925000
18. Retail sales of toys, games, and hobby and craft supplies
$
,000.00
5001125000
19. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
$
,000.00
5001930000
c. Retail sales of art goods, including original pictures and sculptures
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
29
20. Retail sales of plumbing, electrical, and HVAC supplies (Include heating stoves (wood, kerosene, and oil) and
prefabricated fireplaces, ceiling fans, light bulbs, and light fixtures.)
$
,000.00
5001900000
21. Retail sales of wallpaper and other flexible wallcoverings
$
,000.00
5001825000
22. Retail sales of miscellaneous household goods, not elsewhere classified (Include nonautomotive batteries and baby
goods such as swings, collapsible playpens, infant and booster car seats, etc.)
$
,000.00
5000860000
23. Local transportation and delivery of purchased or serviced items
$
,000.00
7011125000
24. Rental services for home furniture, furnishings, and accessories
$
,000.00
7000700000
25. Off-site cleaning and repair services for home furniture, furnishings, and accessories, except curtain and drape
cleaning services (Include parts and materials used in repair. Include value of service contracts.)
$
,000.00
7000770000
26. Maintenance and repair services for household and personal goods, not elsewhere classified (Include parts and
materials used in repair. Include value of service contracts.)
$
,000.00
7000800000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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30
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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31
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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32
Item 28: Special Items - Used Merchandise
ITEM 28: SPECIAL ITEMS - USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than 75% of the total sales and receipts reported in Item 5?
Yes
No
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
33
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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34
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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35
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
36
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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37
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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38
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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39
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
40
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
41
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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42
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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43
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
1000
characters remaining
44
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RT-44211_su.pdf Generated 2022-02-23 16:22:27
,000.00
45
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Convenience food store
445120 001
Convenience store selling gasoline
447110 002
Grocery store
445110 001
Food supermarket
445110 003
Liquor store
445310 001
Beer, wine, liquor store
445310 002
Wine and/or beer store
445310 003
Cigarette, pipe, and tobacco store
453991 002
Meat market or ham store
445210 003
Delicatessen, primarily selling meats and a range of grocery items
445110 002
Delicatessen, primarily selling fresh and prepared meats
445210 001
Delicatessen, primarily preparing sandwiches and meals for immediate consumption
722513 004
Pizza take and bake store
445299 005
Ice cream/soft serve shop
722515 101
Candy, nut, confectionery store, little or no preparing on premises
445292 001
Coffee shop
722515 501
Fast food restaurant
722513 002
Full-service restaurant, patrons order through waiter/waitress service and pay after eating
722511 001
Bar with limited gaming operations (e.g., video poker, keno, pull tabs)
722410 002
Other primary business or activity
779000 001
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total sales of merchandise and other operating receipts?
(Include excise taxes. Exclude sales taxes or other taxes collected.)
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RT-44512_su.pdf Generated 2022-02-23 16:43:57
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
2022
%
1. Household consumers and individuals
2. Retailers for resale
%
3. Wholesalers/distributors for resale
%
%
4. Repair shops for use in repair work
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Restaurants, hotels, food services, and contract feeding
%
7. Businesses for end use in their own operation, not for resale or production
%
8. Building contractors, heavy construction, and special trade contractors
%
9. Farmers for use in farm production
%
10. Governmental bodies (Federal, state, and local)
%
11. Export sales
%
12. Other
%
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20
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
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%
21
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
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22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
1. Retail sales of fresh meat and poultry
(Report deli meats on line 6a and meats sold in a frozen state on line 7a.)
5000025000
2. Retail sales of fresh fish and seafood
(Report fish and seafood sold in a frozen state on line 7a.)
5000050000
3. Retail sales of fresh fruit and vegetables
(Report frozen fruits and vegetables on line 7a.)
5000075000
4. Retail sales of eggs and dairy (except ice cream)
(Report deli cheeses on line 6a and ice cream and other frozen dairy products on line 7b.)
5000100000
5. Retail sales of baked goods packaged for future consumption (Include breads, doughnuts, pastries, and pies.)
(Report candy and prepackaged cookies on line 8 and frozen baked goods on line 7a.)
5000125000
6. Retail sales of perishable prepared foods packaged for future consumption
a. Retail sales of delicatessen items, including deli meats and other service delicatessen items (except prepared sandwiches,
dishes, and entrees)
5000150000
5000150003
5000150006
b. Retail sales of soup and salad bars
c. Retail sales of all other perishable prepared foods, including prepared sandwiches, dishes, and entrees
7. Retail sales of frozen foods
(Report hand-dipped ice cream and yogurt on line 11.)
5000150009
5000175000
a. Retail sales of frozen foods, excluding ice cream and other frozen dairy products
b. Retail sales of ice cream and other frozen dairy products
8. Retail sales of candy, prepackaged cookies, and snack foods
9. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy milk, and egg
and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies, pasta, and crackers.)
10. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
2022_RT-44512_su.pdf Generated 2022-02-23 16:43:57
5000175003
5000175006
5000200000
5000225000
5000250000
7000025000
23
12. Meals, snacks, other food items, and beverages prepared for catered events
13. Alcoholic beverages, prepared and served or dispensed for immediate consumption
7000060000
7000050000
5000300000
14. Retail sales of packaged alcoholic beverages
a. Retail sales of distilled spirits, including liquor, brandy, and liqueurs
5000300003
5000300006
b. Retail sales of wine
5000300009
c. Retail sales of beer and ale
15. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids, and other
smoking supplies
a. Retail sales of tobacco products, electronic cigarettes, and other smoking supplies (excluding cannabis/marijuana)
b. Retail sales of cannabis/marijuana dried buds (pre-rolled or loose) and cannabis-based vapor cartridges and liquids, for medical
and non-medical use
5000325000
5000325003
5000325006
5000275000
16. Retail sales of ice
5000775000
17. Retail sales of household cleaning supplies
a. Retail sales of household soaps, detergents, and cleaners
b. Retail sales of household cleaning supplies, including mops, sponges, brooms, and brushes
5000775003
5000775006
18. Retail sales of household paper and plastic products, except tableware (Include paper towels, napkins, etc.)
(Report toilet paper, facial tissues, and sanitary napkins on line 22.)
5000825000
19. Retail sales of tableware, kitchenware, cookware, glassware (Include flatware, cutlery, paper and plastic tableware, and pots and
pans.)
5000750000
20. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements
5001350000
5001350003
a. Retail sales of prescriptions
5001350006
b. Retail sales of nonprescription medicines
c. Retail sales of vitamins, minerals, and other dietary supplements
21. Retail sales of cosmetics and fragrances (Include face cream, makeup, cologne, and perfume.)
(Report hair care products and nail polish on line 22.)
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5001350009
5001450000
24
22. Retail sales of personal hygiene supplies (Include hand and foot care products, eye/contact lens care products, oral hygiene
products, deodorants, hair care products, nail polish, toilet paper, facial tissues, sanitary napkins, and disposable diapers.)
23. Retail sales of home health care equipment and supplies (Include first aid products and surgical and medical masks.)
5001425000
5001375000
5001250000
24. Retail sales of pet foods and supplies
25. Retail sales of books (Include audio books and e-books.)
26. Retail sales of magazines and newspapers, including issue format comic books
27. Retail sales of other publications, including greeting cards and calendars
5000925000
5000950000
5000975000
5001725000
28. Retail sales of automotive fuels
29. Retail sales of household fuels, including oil, LP gas, wood, coal
5001750000
5001950000
30. Retail sales of automotive parts and supplies
31. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
5001930000
5000375000
32. Retail sales of women's clothing
5000350000
33. Retail sales of men's clothing
34. Retail sales of men's and women's clothing accessories (Include hats, gloves, neckwear, rain accessories, etc.)
(Report costume jewelry on line 38.)
35. Retail sales of costumes, vestments, and unisex clothing
5000450000
5000425000
5000475000
36. Retail sales of footwear and footwear accessories
37. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including school uniforms
5000400000
5000455000
38. Retail sales of costume and novelty jewelry
39. Retail sales of toys, games, and hobby and craft supplies
5001125000
5001400000
40. Retail sales of glasses and contact lenses
41. Retail sales of hunting, fishing, hiking, and camping equipment
42. Retail sales of household goods, not elsewhere classified
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5001075000
5000860000
25
5000860003
a. Retail sales of nonautomotive batteries
5000860006
b. Retail sales of religious goods (except books)
5000860009
c. Retail sales of souvenirs and novelty items
d. Retail sales of baby goods, not elsewhere classified, including bottles, monitors, carriers, swings, collapsible playpens, infant and
booster car seats, etc.
5000860012
5000860015
e. Retail sales of gift cards
43. Retail sales of office and school supplies, packaging and packing materials and supplies, and other general industry and
miscellaneous materials and supplies
5001935000
5001935003
a. Retail sales of office, school, and packaging supplies
b. Retail sales of stationery products, including stationery, pads, looseleaf paper, and related products
c. Retail sales of office paper, including computer printer, copier, and fax paper
5001935006
5001935009
5001935012
d. Retail sales of artists' materials and supplies
5001935015
e. Retail sales of gift wrap, gift bags, and tissue paper
f. Retail sales of other general industry and miscellaneous materials and supplies
44. Document payment services, such as money order and check cashing services (Exclude traveler's check services.)
5001935018
7005543000
Add product/service not listed
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26
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Retail sales of fresh meat and poultry
(Report deli meats on line 6a and meats sold in a frozen state on line 7a.)
$
,000.00
5000025000
2. Retail sales of fresh fish and seafood
(Report fish and seafood sold in a frozen state on line 7a.)
$
,000.00
5000050000
3. Retail sales of fresh fruit and vegetables
(Report frozen fruits and vegetables on line 7a.)
$
,000.00
5000075000
4. Retail sales of eggs and dairy (except ice cream)
(Report deli cheeses on line 6a and ice cream and other frozen dairy products on line 7b.)
$
,000.00
5000100000
5. Retail sales of baked goods packaged for future consumption (Include breads, doughnuts, pastries, and pies.)
(Report candy and prepackaged cookies on line 8 and frozen baked goods on line 7a.)
$
,000.00
5000125000
a. Retail sales of delicatessen items, including deli meats and other service delicatessen items (except prepared
sandwiches, dishes, and entrees)
$
,000.00
5000150003
b. Retail sales of soup and salad bars
$
,000.00
5000150006
c. Retail sales of all other perishable prepared foods, including prepared sandwiches, dishes, and entrees
$
,000.00
5000150009
Subtotal
$
,000.00
5000150000
a. Retail sales of frozen foods, excluding ice cream and other frozen dairy products
$
,000.00
5000175003
b. Retail sales of ice cream and other frozen dairy products
$
,000.00
5000175006
Subtotal
$
,000.00
5000175000
8. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
9. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy
milk, and egg and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies, pasta, and
crackers.)
$
,000.00
5000225000
$
,000.00
5000250000
6. Retail sales of perishable prepared foods packaged for future consumption
7. Retail sales of frozen foods
(Report hand-dipped ice cream and yogurt on line 11.)
10. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
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27
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
12. Meals, snacks, other food items, and beverages prepared for catered events
$
,000.00
7000060000
13. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
a. Retail sales of distilled spirits, including liquor, brandy, and liqueurs
$
,000.00
5000300003
b. Retail sales of wine
$
,000.00
5000300006
$
,000.00
5000300009
$
,000.00
5000300000
a. Retail sales of tobacco products, electronic cigarettes, and other smoking supplies (excluding cannabis/marijuana)
$
,000.00
5000325003
b. Retail sales of cannabis/marijuana dried buds (pre-rolled or loose) and cannabis-based vapor cartridges and
liquids, for medical and non-medical use
$
,000.00
5000325006
Subtotal
$
,000.00
5000325000
$
,000.00
5000275000
a. Retail sales of household soaps, detergents, and cleaners
$
,000.00
5000775003
b. Retail sales of household cleaning supplies, including mops, sponges, brooms, and brushes
$
,000.00
5000775006
$
,000.00
5000775000
18. Retail sales of household paper and plastic products, except tableware (Include paper towels, napkins, etc.)
(Report toilet paper, facial tissues, and sanitary napkins on line 22.)
$
,000.00
5000825000
19. Retail sales of tableware, kitchenware, cookware, glassware (Include flatware, cutlery, paper and plastic tableware,
and pots and pans.)
$
,000.00
5000750000
$
,000.00
5001350003
14. Retail sales of packaged alcoholic beverages
c. Retail sales of beer and ale
Subtotal
15. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids,
and other smoking supplies
16. Retail sales of ice
17. Retail sales of household cleaning supplies
Subtotal
20. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements
a. Retail sales of prescriptions
2022_RT-44512_su.pdf Generated 2022-02-23 16:43:57
28
$
,000.00
5001350006
$
,000.00
5001350009
$
,000.00
5001350000
21. Retail sales of cosmetics and fragrances (Include face cream, makeup, cologne, and perfume.)
(Report hair care products and nail polish on line 22.)
$
,000.00
5001450000
22. Retail sales of personal hygiene supplies (Include hand and foot care products, eye/contact lens care products, oral
hygiene products, deodorants, hair care products, nail polish, toilet paper, facial tissues, sanitary napkins, and
disposable diapers.)
$
,000.00
5001425000
23. Retail sales of home health care equipment and supplies (Include first aid products and surgical and medical
masks.)
$
,000.00
5001375000
24. Retail sales of pet foods and supplies
$
,000.00
5001250000
25. Retail sales of books (Include audio books and e-books.)
$
,000.00
5000925000
$
,000.00
5000950000
27. Retail sales of other publications, including greeting cards and calendars
$
,000.00
5000975000
28. Retail sales of automotive fuels
$
,000.00
5001725000
29. Retail sales of household fuels, including oil, LP gas, wood, coal
$
,000.00
5001750000
30. Retail sales of automotive parts and supplies
$
,000.00
5001950000
31. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
$
,000.00
5001930000
32. Retail sales of women's clothing
$
,000.00
5000375000
33. Retail sales of men's clothing
$
,000.00
5000350000
34. Retail sales of men's and women's clothing accessories (Include hats, gloves, neckwear, rain accessories, etc.)
(Report costume jewelry on line 38.)
$
,000.00
5000450000
35. Retail sales of costumes, vestments, and unisex clothing
$
,000.00
5000425000
36. Retail sales of footwear and footwear accessories
$
,000.00
5000475000
37. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including
school uniforms
$
,000.00
5000400000
b. Retail sales of nonprescription medicines
c. Retail sales of vitamins, minerals, and other dietary supplements
Subtotal
26. Retail sales of magazines and newspapers, including issue format comic books
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29
38. Retail sales of costume and novelty jewelry
$
,000.00
5000455000
39. Retail sales of toys, games, and hobby and craft supplies
$
,000.00
5001125000
$
,000.00
5001400000
$
,000.00
5001075000
a. Retail sales of nonautomotive batteries
$
,000.00
5000860003
b. Retail sales of religious goods (except books)
$
,000.00
5000860006
c. Retail sales of souvenirs and novelty items
$
,000.00
5000860009
d. Retail sales of baby goods, not elsewhere classified, including bottles, monitors, carriers, swings, collapsible
playpens, infant and booster car seats, etc.
$
,000.00
5000860012
e. Retail sales of gift cards
$
,000.00
5000860015
Subtotal
$
,000.00
5000860000
$
,000.00
5001935003
b. Retail sales of stationery products, including stationery, pads, looseleaf paper, and related products
$
,000.00
5001935006
c. Retail sales of office paper, including computer printer, copier, and fax paper
$
,000.00
5001935009
d. Retail sales of artists' materials and supplies
$
,000.00
5001935012
e. Retail sales of gift wrap, gift bags, and tissue paper
$
,000.00
5001935015
$
,000.00
5001935018
$
,000.00
5001935000
44. Document payment services, such as money order and check cashing services (Exclude traveler's check services.)
$
,000.00
7005543000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
40. Retail sales of glasses and contact lenses
41. Retail sales of hunting, fishing, hiking, and camping equipment
42. Retail sales of household goods, not elsewhere classified
43. Retail sales of office and school supplies, packaging and packing materials and supplies, and other general industry
and miscellaneous materials and supplies
a. Retail sales of office, school, and packaging supplies
f. Retail sales of other general industry and miscellaneous materials and supplies
Subtotal
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30
Add product/service not listed
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31
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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32
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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33
Item 28: Special Items - Floor Space
ITEM 28: SPECIAL ITEMS - FLOOR SPACE
Include:
Only the floor space used/controlled by this company.
All space occupied by this establishment on every floor of multi-story buildings.
1. What was the total under-roof selling space?
(Enter the square footage of in-store selling space at the end of 2022. Include all store areas open to customers, including aisles,
elevators, etc. Exclude display windows fronting onto streets or walks, outdoor entrance ways, or other outdoor space.)
2. What was the total under-roof floor space?
(Enter the total square footage of all under-roof selling space plus all other space available at the end of 2022. Include dry storage,
refrigerated space, offices, workrooms, display windows, and enclosed entrance ways. Exclude outdoor space, even if covered.)
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Square feet as of
December 31,
2022
Square feet as of
December 31,
2022
34
Item 28: Special Items - Self-Checkout
ITEM 28: SPECIAL ITEMS - SELF-CHECKOUT
Did this establishment offer a way for customers to self-checkout, with no or minimal assistance, in 2022?
Yes
No
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35
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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36
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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37
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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38
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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39
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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40
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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41
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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42
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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43
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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44
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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45
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_RT-44512_su.pdf Generated 2022-02-23 16:43:57
1000
characters remaining
46
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RT-44512_su.pdf Generated 2022-02-23 16:43:57
,000.00
47
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Jewelry store
448310 001
Costume jewelry/accessory store
448150 002
Watch store
448310 002
Clock store
448310 003
Jewelry, watch, and clock repair
811490 101
Collectors' items and supplies store, including philatelist, numismatist, etc.
453998 102
Gift, novelty, souvenir store, including crafts
453220 003
Pawn shop
522298 101
Other primary business or activity
779000 001
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total sales of merchandise and other operating receipts?
(Exclude sales taxes or other taxes collected.)
2022_RT-44831_su.pdf Generated 2022-02-23 16:27:04
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RT-44831_su.pdf Generated 2022-02-23 16:27:04
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
2022
%
1. Household consumers and individuals
2. Retailers for resale
%
3. Wholesalers/distributors for resale
%
%
4. Repair shops for use in repair work
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Restaurants, hotels, food services, and contract feeding
%
7. Businesses for end use in their own operation, not for resale or production
%
8. Building contractors, heavy construction, and special trade contractors
%
9. Farmers for use in farm production
%
10. Governmental bodies (Federal, state, and local)
%
11. Export sales
%
12. Other
%
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20
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_RT-44831_su.pdf Generated 2022-02-23 16:27:04
%
21
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
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22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Retail sales of fine jewelry and watches
(Report estate/antique jewelry on line 4f and receipts from watch, clock, and jewelry repair on line 10.)
a. Retail sales of diamond jewelry (except estate/ antique jewelry and watches)
(Report all watches on line 1g and loose diamonds on line 1f.)
b. Retail sales of pearl jewelry (except estate/ antique jewelry and watches)
c. Retail sales of other gemstone jewelry (except estate/ antique jewelry and watches)
(Report loose gemstones on line 1f.)
d. Retail sales of karat gold jewelry (except estate/antique jewelry and watches)
e. Retail sales of platinum jewelry (except estate/ antique jewelry and watches)
f. Retail sales of loose gemstones, including diamonds and colored gemstones
g. Retail sales of watches, watchbands, and parts (except batteries)
Product Code
5000500000
5000500003
5000500006
5000500009
5000500012
5000500015
5000500018
5000500021
2. Retail sales of costume and novelty jewelry (Include sterling silver jewelry.)
(Report used costume and novelty jewelry on line 4g.)
5000455000
3. Retail sales of luggage and leather goods, including briefcases
(Report men's and women's small leather apparel accessories on line 6.)
5001325000
4. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
5000850000
5000850003
a. Retail sales of antiques, items over 100 years old
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
c. Retail sales of art goods, including original pictures and sculptures
d. Retail sales of precious metals, coins, medals, and other numismatic items
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
5000850006
5000850009
5000850012
5000850015
5000850018
f. Retail sales of estate/antique jewelry
2022_RT-44831_su.pdf Generated 2022-02-23 16:27:04
23
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and garden goods
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical instruments, etc.
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
k. Retail sales of used household and personal goods, not elsewhere classified
5000850021
5000850024
5000850027
5000850031
5000850033
5000680000
5. Retail sales of other home furnishings and accessories
a. Retail sales of decorative accessories and home furnishings (Include lamps, lampshades, decorative glassware, vases, giftware,
mirrors, pictures, picture frames, clocks, magazine racks, desk sets, closet and bathroom accessories, etc.)
5000680003
5000680006
b. Retail sales of artificial/silk flowers, plants, and trees
c. Retail sales of seasonal decorations (except decorative plates, napkins, and cups)
6. Retail sales of men's and women's clothing accessories (except costume jewelry)
7. Retail sales of glasses and contact lenses (Include sunglasses.)
8. Retail sales of tableware, kitchenware, cookware, glassware
9. Retail sales of household goods, not elsewhere classified
10. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry
5000680009
5000450000
5001400000
5000750000
5000860000
7000200000
Add product/service not listed
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24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Retail sales of fine jewelry and watches
(Report estate/antique jewelry on line 4f and receipts from watch, clock, and jewelry repair on line 10.)
a. Retail sales of diamond jewelry (except estate/ antique jewelry and watches)
(Report all watches on line 1g and loose diamonds on line 1f.)
$
,000.00
5000500003
b. Retail sales of pearl jewelry (except estate/ antique jewelry and watches)
$
,000.00
5000500006
c. Retail sales of other gemstone jewelry (except estate/ antique jewelry and watches)
(Report loose gemstones on line 1f.)
$
,000.00
5000500009
d. Retail sales of karat gold jewelry (except estate/antique jewelry and watches)
$
,000.00
5000500012
e. Retail sales of platinum jewelry (except estate/ antique jewelry and watches)
$
,000.00
5000500015
f. Retail sales of loose gemstones, including diamonds and colored gemstones
$
,000.00
5000500018
$
,000.00
5000500021
$
,000.00
5000500000
2. Retail sales of costume and novelty jewelry (Include sterling silver jewelry.)
(Report used costume and novelty jewelry on line 4g.)
$
,000.00
5000455000
3. Retail sales of luggage and leather goods, including briefcases
(Report men's and women's small leather apparel accessories on line 6.)
$
,000.00
5001325000
$
,000.00
5000850003
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
$
,000.00
5000850006
c. Retail sales of art goods, including original pictures and sculptures
$
,000.00
5000850009
d. Retail sales of precious metals, coins, medals, and other numismatic items
$
,000.00
5000850012
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
$
,000.00
5000850015
g. Retail sales of watches, watchbands, and parts (except batteries)
Subtotal
4. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
a. Retail sales of antiques, items over 100 years old
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25
f. Retail sales of estate/antique jewelry
$
,000.00
5000850018
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
$
,000.00
5000850021
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and
garden goods
$
,000.00
5000850024
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical
instruments, etc.
$
,000.00
5000850027
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
$
,000.00
5000850031
k. Retail sales of used household and personal goods, not elsewhere classified
$
,000.00
5000850033
Subtotal
$
,000.00
5000850000
$
,000.00
5000680003
b. Retail sales of artificial/silk flowers, plants, and trees
$
,000.00
5000680006
c. Retail sales of seasonal decorations (except decorative plates, napkins, and cups)
$
,000.00
5000680009
Subtotal
$
,000.00
5000680000
6. Retail sales of men's and women's clothing accessories (except costume jewelry)
$
,000.00
5000450000
7. Retail sales of glasses and contact lenses (Include sunglasses.)
$
,000.00
5001400000
8. Retail sales of tableware, kitchenware, cookware, glassware
$
,000.00
5000750000
9. Retail sales of household goods, not elsewhere classified
$
,000.00
5000860000
10. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry
$
,000.00
7000200000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
5. Retail sales of other home furnishings and accessories
a. Retail sales of decorative accessories and home furnishings (Include lamps, lampshades, decorative glassware,
vases, giftware, mirrors, pictures, picture frames, clocks, magazine racks, desk sets, closet and bathroom
accessories, etc.)
Add product/service not listed
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26
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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27
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Used Merchandise
ITEM 28: SPECIAL ITEMS - USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than 75% of the total sales and receipts reported in Item 5?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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32
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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38
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
40
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RT-44831_su.pdf Generated 2022-02-23 16:27:04
,000.00
41
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Bicycle shop
451110 211
Golf specialty shop
451110 221
Gun shop
451110 231
Fishing tackle shop
451110 272
Ski and/or snowboard shop
451110 271
Fitness equipment specialty store
451110 273
Children's play equipment store, including swing sets, trampolines, etc.
451110 27A
Backpacking/camping/outfitter shop
451110 279
Scuba shop
451110 275
Surfing and/or skateboarding shop
451110 276
Pool/billiards store
451110 274
Tack store (saddlery)
451110 277
Tack store (feed)
444220 203
Other specialty sporting goods store, specializing in a maximum of four (4) lines, such as archery, bowling, tennis, swimming, hunting/fishing,
etc.
451110 278
General (full-line) sporting goods store
451110 102
Team athletic supply store, including equipment and uniforms
451110 104
Sports apparel store, including golf, tennis, riding, etc.
448190 301
Athletic footwear store
448210 501
Boat/marine dealer
441222 001
All-terrain vehicle (ATV) dealer, including motor bikes, motor scooters, and mopeds
441228 104
Other primary business or activity
779000 001
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total sales of merchandise and other operating receipts?
(Exclude sales taxes or other taxes collected.)
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. What was the estimated percentage of this establishment's total sales by class of customer in 2022?
2022
%
1. Household consumers and individuals
2. Retailers for resale
%
3. Wholesalers/distributors for resale
%
%
4. Repair shops for use in repair work
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Restaurants, hotels, food services, and contract feeding
%
7. Businesses for end use in their own operation, not for resale or production
%
8. Building contractors, heavy construction, and special trade contractors
%
9. Farmers for use in farm production
%
10. Governmental bodies (Federal, state, and local)
%
11. Export sales
%
12. Other
%
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
20
Describe
13. TOTAL (Sum of lines 1 through 12 should equal 100%.)
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
%
21
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Retail sales of hunting, fishing, hiking, and camping equipment
(Report used clothing on line 36g.)
a. Retail sales of firearms, hunting equipment, and supplies
Product Code
5001075000
5001075003
5001075006
b. Retail sales of fishing tackle, including bait
c. Retail sales of camping and backpacking equipment and supplies
2. Retail sales of golf equipment
(Report used golf equipment on line 36i.)
5001075009
5001050000
3. Retail sales of new and used exercise/fitness equipment
5001700000
4. Retail sales of bicycles and other cycles, all types, except children's sidewalk bikes, and parts and accessories
(Report used bicycles and other cycles on line 36i. Report maintenance and repair services and parts used in repair on line 38.)
5001025000
5. Retail sales of other sporting goods and equipment, excluding sport vehicles
(Report all other used sporting goods on line 36i and all sports vehicles under 12.)
5001105000
5001105003
a. Retail sales of tennis equipment
b. Retail sales of snow-skiing and snowboarding equipment
5001105006
5001105009
c. Retail sales of scuba and skin diving equipment
d. Retail sales of water skiing, surfing, and sail boarding equipment
5001105012
5001105015
e. Retail sales of billiards equipment and supplies
f. Retail sales of hockey equipment, except team hockey equipment
5001105018
5001105021
g. Retail sales of team sporting goods
h. Retail sales of all other sporting goods, including archery equipment, badminton sets, bowling equipment, ice skates,
skateboards, saddlery, cleated and other specialized athletic footwear, etc.
(Report men's athletic footwear (excluding cleats and other specialized athletic footwear) on line 6d and women's athletic footwear
(excluding cleats and other specialized athletic footwear) on line 6e.)
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
5001105024
23
6. Retail sales of footwear and footwear accessories
(Report used footwear on line 36g.)
5000475000
a. Retail sales of men's nonathletic footwear, including dress and casual footwear
b. Retail sales of women's nonathletic footwear, including dress and casual footwear
c. Retail sales of children's nonathletic footwear, including boys', girls', infants', and toddlers' dress and casual footwear
d. Retail sales of men's athletic footwear, including tennis shoes/sneakers
e. Retail sales of women's athletic footwear, including tennis shoes/sneakers
f. Retail sales of children's athletic footwear, including boys', girls', infants', and toddlers'
g. Retail sales of men's and women's outdoor hiking/sports boots
h. Retail sales of footwear accessories, including polishes, laces, trees, storage bags, etc.
7. Retail sales of men's clothing
(Report used clothing on line 36g.)
5000475003
5000475006
5000475009
5000475012
5000475015
5000475018
5000475021
5000475024
5000350000
a. Retail sales of men's outerwear coats, jackets, windbreakers, and similar
5000350003
5000350006
b. Retail sales of men's suits and formal wear
5000350009
c. Retail sales of men's sport coats and blazers
5000350012
d. Retail sales of men's tailored and dress slacks
e. Retail sales of men's casual slacks and jeans, walking shorts, etc.
5000350015
5000350018
f. Retail sales of men's dress shirts
g. Retail sales of men's sport shirts, including t-shirts, knit and woven shirts, etc.
5000350021
5000350024
h. Retail sales of men's sweaters
i. Retail sales of men's sweat tops, pants, and warm-ups
j. Retail sales of men's underwear, nightwear, and hosiery
5000350027
5000350031
5000350034
k. Retail sales of men's career and work uniforms
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
24
l. Retail sales of men's sports apparel, including tennis, golf, jogging, swimming, skiing, camping, fishing, hiking, and other rugged
outer and exercise apparel
5000350037
5000350041
m. Retail sales of other men's wear
8. Retail sales of women's clothing
(Report used clothing on line 36g.)
5000375000
a. Retail sales of women's, juniors', and misses' furs and fur garments
b. Retail sales of women's, juniors', and misses' dressy and tailored coats, outer jackets, and rainwear
c. Retail sales of women's, juniors', and misses' dresses, including all types
d. Retail sales of women's, juniors', and misses' suits, pantsuits, sport jackets, and blazers
e. Retail sales of women's, juniors', and misses' slacks/pants, jeans, walking shorts, and skirts
f. Retail sales of women's, juniors', and misses' tops, including t-shirts, knit and woven shirts, blouses, and sweaters
g. Retail sales of women's sweat tops, pants, and warm-ups
5000375003
5000375006
5000375009
5000375012
5000375015
5000375018
5000375021
5000375024
h. Retail sales of bras, girdles, and corsets
i. Retail sales of women's, juniors', and misses' lingerie, sleepwear, and loungewear
j. Retail sales of women's hosiery, including pantyhose, socks, and tights
k. Retail sales of women's sports apparel, including tennis, golf, jogging, swimming, skiing, camping, fishing, hiking, and other
rugged outer and exercise apparel
l. Retail sales of other women's apparel, including uniforms, smocks, and other apparel items
9. Retail sales of men's and women's clothing accessories (except costume jewelry)
(Report used accessories on line 36g.)
a. Retail sales of men's accessories, including hats, gloves, neckwear, handkerchiefs, belts, rain accessories, etc.
5000375027
5000375031
5000375034
5000375037
5000450000
5000450003
5000450006
b. Retail sales of women's hats, wigs, and hairpieces
c. Retail sales of women's accessories, including handbags, wallets, neckwear, gloves, belts, rain accessories, etc.
10. Retail sales of costumes, vestments, and unisex clothing
(Report used costumes, vestments, and unisex clothing on line 36g.)
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
5000450009
5000425000
25
11. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including school uniforms
(Report used clothing on line 36g.)
5000400000
5001175000
12. Retail sales of boats and other sports vehicles
a. Retail sales of new boats, canoes, kayaks, motors, and parts and accessories
b. Retail sales of used boats, canoes, kayaks, motors, and parts and accessories
c. Retail sales of utility trailers, including horse/livestock trailers
d. Retail sales of all-terrain vehicles (ATVs) and personal watercraft
e. Retail sales of other sports vehicles, including snowmobiles, golf cars, go-carts, parts and accessories, etc.
13. Retail sales of candy, prepackaged cookies, and snack foods
14. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy milk, and egg
and cheese substitutes
15. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
16. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
17. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids, and other
smoking supplies
5001175003
5001175006
5001175009
5001175012
5001175015
5000200000
5000225000
5000250000
7000025000
5000325000
5000300000
18. Retail sales of packaged alcoholic beverages
19. Retail sales of glasses and contact lenses (Include sunglasses.)
(Report binoculars on line 22.)
20. Retail sales of fine jewelry and watches (Include sport watches.)
21. Retail sales of luggage and leather goods, including briefcases
22. Retail sales of toys, games, and hobby and craft supplies
5001400000
5000500000
5001325000
5001125000
5000925000
23. Retail sales of books
24. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers; frypans; personal
care appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
25. Retail sales of tableware, kitchenware, cookware, glassware
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
5000725000
5000750000
26
5000575000
26. Retail sales of outdoor/patio furniture
27. Retail sales of other home furnishings and accessories (Include decorative accessories and home furnishings; artificial/silk flowers,
plants, and trees; and seasonal decorations.)
28. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants
29. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
5000680000
5000805000
5001930000
5000900000
30. Retail sales of photographic equipment and supplies
31. Retail sales of computers and peripheral equipment, communications equipment, and related products
5001550000
5001250000
32. Retail sales of pet foods and supplies
5001710000
33. Retail sales of safes and vaults
5001110000
34. Retail sales of fireworks
35. Retail sales of household goods, not elsewhere classified
36. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
5000860000
5000850000
5000850003
a. Retail sales of antiques, items over 100 years old
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
c. Retail sales of art goods, including original pictures and sculptures
d. Retail sales of precious metals, coins, medals, and other numismatic items
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
5000850006
5000850009
5000850012
5000850015
5000850018
f. Retail sales of estate/antique jewelry
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and garden goods
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical instruments, etc.
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
5000850021
5000850024
5000850027
5000850031
27
k. Retail sales of used household and personal goods, not elsewhere classified
5000850033
37. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles, and musical
instruments)
7001800000
38. Maintenance and repair services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports
vehicles, and musical instruments)
7001825000
39. Leisure, recreational, and athletic instructional programs
7002500000
Add product/service not listed
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
28
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Retail sales of hunting, fishing, hiking, and camping equipment
(Report used clothing on line 36g.)
a. Retail sales of firearms, hunting equipment, and supplies
$
,000.00
5001075003
b. Retail sales of fishing tackle, including bait
$
,000.00
5001075006
c. Retail sales of camping and backpacking equipment and supplies
$
,000.00
5001075009
Subtotal
$
,000.00
5001075000
2. Retail sales of golf equipment
(Report used golf equipment on line 36i.)
$
,000.00
5001050000
3. Retail sales of new and used exercise/fitness equipment
$
,000.00
5001700000
4. Retail sales of bicycles and other cycles, all types, except children's sidewalk bikes, and parts and accessories
(Report used bicycles and other cycles on line 36i. Report maintenance and repair services and parts used in repair
on line 38.)
$
,000.00
5001025000
a. Retail sales of tennis equipment
$
,000.00
5001105003
b. Retail sales of snow-skiing and snowboarding equipment
$
,000.00
5001105006
c. Retail sales of scuba and skin diving equipment
$
,000.00
5001105009
d. Retail sales of water skiing, surfing, and sail boarding equipment
$
,000.00
5001105012
e. Retail sales of billiards equipment and supplies
$
,000.00
5001105015
f. Retail sales of hockey equipment, except team hockey equipment
$
,000.00
5001105018
g. Retail sales of team sporting goods
$
,000.00
5001105021
5. Retail sales of other sporting goods and equipment, excluding sport vehicles
(Report all other used sporting goods on line 36i and all sports vehicles under 12.)
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
29
h. Retail sales of all other sporting goods, including archery equipment, badminton sets, bowling equipment, ice
skates, skateboards, saddlery, cleated and other specialized athletic footwear, etc.
(Report men's athletic footwear (excluding cleats and other specialized athletic footwear) on line 6d and women's
athletic footwear (excluding cleats and other specialized athletic footwear) on line 6e.)
$
,000.00
5001105024
Subtotal
$
,000.00
5001105000
a. Retail sales of men's nonathletic footwear, including dress and casual footwear
$
,000.00
5000475003
b. Retail sales of women's nonathletic footwear, including dress and casual footwear
$
,000.00
5000475006
c. Retail sales of children's nonathletic footwear, including boys', girls', infants', and toddlers' dress and casual
footwear
$
,000.00
5000475009
d. Retail sales of men's athletic footwear, including tennis shoes/sneakers
$
,000.00
5000475012
e. Retail sales of women's athletic footwear, including tennis shoes/sneakers
$
,000.00
5000475015
f. Retail sales of children's athletic footwear, including boys', girls', infants', and toddlers'
$
,000.00
5000475018
g. Retail sales of men's and women's outdoor hiking/sports boots
$
,000.00
5000475021
h. Retail sales of footwear accessories, including polishes, laces, trees, storage bags, etc.
$
,000.00
5000475024
$
,000.00
5000475000
a. Retail sales of men's outerwear coats, jackets, windbreakers, and similar
$
,000.00
5000350003
b. Retail sales of men's suits and formal wear
$
,000.00
5000350006
$
,000.00
5000350009
d. Retail sales of men's tailored and dress slacks
$
,000.00
5000350012
e. Retail sales of men's casual slacks and jeans, walking shorts, etc.
$
,000.00
5000350015
f. Retail sales of men's dress shirts
$
,000.00
5000350018
g. Retail sales of men's sport shirts, including t-shirts, knit and woven shirts, etc.
$
,000.00
5000350021
6. Retail sales of footwear and footwear accessories
(Report used footwear on line 36g.)
Subtotal
7. Retail sales of men's clothing
(Report used clothing on line 36g.)
c. Retail sales of men's sport coats and blazers
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
30
h. Retail sales of men's sweaters
$
,000.00
5000350024
i. Retail sales of men's sweat tops, pants, and warm-ups
$
,000.00
5000350027
j. Retail sales of men's underwear, nightwear, and hosiery
$
,000.00
5000350031
$
,000.00
5000350034
l. Retail sales of men's sports apparel, including tennis, golf, jogging, swimming, skiing, camping, fishing, hiking, and
other rugged outer and exercise apparel
$
,000.00
5000350037
m. Retail sales of other men's wear
$
,000.00
5000350041
Subtotal
$
,000.00
5000350000
a. Retail sales of women's, juniors', and misses' furs and fur garments
$
,000.00
5000375003
b. Retail sales of women's, juniors', and misses' dressy and tailored coats, outer jackets, and rainwear
$
,000.00
5000375006
c. Retail sales of women's, juniors', and misses' dresses, including all types
$
,000.00
5000375009
$
,000.00
5000375012
e. Retail sales of women's, juniors', and misses' slacks/pants, jeans, walking shorts, and skirts
$
,000.00
5000375015
f. Retail sales of women's, juniors', and misses' tops, including t-shirts, knit and woven shirts, blouses, and sweaters
$
,000.00
5000375018
g. Retail sales of women's sweat tops, pants, and warm-ups
$
,000.00
5000375021
h. Retail sales of bras, girdles, and corsets
$
,000.00
5000375024
$
,000.00
5000375027
j. Retail sales of women's hosiery, including pantyhose, socks, and tights
$
,000.00
5000375031
k. Retail sales of women's sports apparel, including tennis, golf, jogging, swimming, skiing, camping, fishing, hiking,
and other rugged outer and exercise apparel
$
,000.00
5000375034
l. Retail sales of other women's apparel, including uniforms, smocks, and other apparel items
$
,000.00
5000375037
$
,000.00
5000375000
k. Retail sales of men's career and work uniforms
8. Retail sales of women's clothing
(Report used clothing on line 36g.)
d. Retail sales of women's, juniors', and misses' suits, pantsuits, sport jackets, and blazers
i. Retail sales of women's, juniors', and misses' lingerie, sleepwear, and loungewear
Subtotal
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
31
9. Retail sales of men's and women's clothing accessories (except costume jewelry)
(Report used accessories on line 36g.)
a. Retail sales of men's accessories, including hats, gloves, neckwear, handkerchiefs, belts, rain accessories, etc.
$
,000.00
5000450003
b. Retail sales of women's hats, wigs, and hairpieces
$
,000.00
5000450006
c. Retail sales of women's accessories, including handbags, wallets, neckwear, gloves, belts, rain accessories, etc.
$
,000.00
5000450009
Subtotal
$
,000.00
5000450000
10. Retail sales of costumes, vestments, and unisex clothing
(Report used costumes, vestments, and unisex clothing on line 36g.)
$
,000.00
5000425000
11. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including
school uniforms
(Report used clothing on line 36g.)
$
,000.00
5000400000
$
,000.00
5001175003
b. Retail sales of used boats, canoes, kayaks, motors, and parts and accessories
$
,000.00
5001175006
c. Retail sales of utility trailers, including horse/livestock trailers
$
,000.00
5001175009
d. Retail sales of all-terrain vehicles (ATVs) and personal watercraft
$
,000.00
5001175012
e. Retail sales of other sports vehicles, including snowmobiles, golf cars, go-carts, parts and accessories, etc.
$
,000.00
5001175015
Subtotal
$
,000.00
5001175000
13. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
14. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt,
nondairy milk, and egg and cheese substitutes
$
,000.00
5000225000
15. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
$
,000.00
5000250000
16. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
17. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids,
and other smoking supplies
$
,000.00
5000325000
18. Retail sales of packaged alcoholic beverages
$
,000.00
5000300000
12. Retail sales of boats and other sports vehicles
a. Retail sales of new boats, canoes, kayaks, motors, and parts and accessories
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
32
19. Retail sales of glasses and contact lenses (Include sunglasses.)
(Report binoculars on line 22.)
$
,000.00
5001400000
20. Retail sales of fine jewelry and watches (Include sport watches.)
$
,000.00
5000500000
21. Retail sales of luggage and leather goods, including briefcases
$
,000.00
5001325000
22. Retail sales of toys, games, and hobby and craft supplies
$
,000.00
5001125000
23. Retail sales of books
$
,000.00
5000925000
24. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers;
frypans; personal care appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
$
,000.00
5000725000
25. Retail sales of tableware, kitchenware, cookware, glassware
$
,000.00
5000750000
26. Retail sales of outdoor/patio furniture
$
,000.00
5000575000
27. Retail sales of other home furnishings and accessories (Include decorative accessories and home furnishings;
artificial/silk flowers, plants, and trees; and seasonal decorations.)
$
,000.00
5000680000
28. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants
$
,000.00
5000805000
29. Retail sales of hardware, nonpower hand tools, and other building materials and supplies
$
,000.00
5001930000
30. Retail sales of photographic equipment and supplies
$
,000.00
5000900000
31. Retail sales of computers and peripheral equipment, communications equipment, and related products
$
,000.00
5001550000
32. Retail sales of pet foods and supplies
$
,000.00
5001250000
33. Retail sales of safes and vaults
$
,000.00
5001710000
34. Retail sales of fireworks
$
,000.00
5001110000
35. Retail sales of household goods, not elsewhere classified
$
,000.00
5000860000
$
,000.00
5000850003
$
,000.00
5000850006
$
,000.00
5000850009
36. Retail sales of antiques, collectibles, art works, and other used goods (except transportation and machinery goods)
a. Retail sales of antiques, items over 100 years old
b. Retail sales of collectibles, including items which are old, but less than 100 years old, and limited in supply
c. Retail sales of art goods, including original pictures and sculptures
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
33
d. Retail sales of precious metals, coins, medals, and other numismatic items
$
,000.00
5000850012
e. Retail sales of stamps, autographs, and other philatelic materials and supplies
$
,000.00
5000850015
f. Retail sales of estate/antique jewelry
$
,000.00
5000850018
g. Retail sales of used clothing, footwear, personal accessories, jewelry, and related products
$
,000.00
5000850021
h. Retail sales of used home furniture, household appliances, kitchenware, home furnishings, and home lawn and
garden goods
$
,000.00
5000850024
i. Retail sales of used home entertainment, recreation, and culture products, including books, CDs, musical
instruments, etc.
$
,000.00
5000850027
j. Retail sales of used hardware, tools, plumbing and electrical supplies, and building materials
$
,000.00
5000850031
k. Retail sales of used household and personal goods, not elsewhere classified
$
,000.00
5000850033
Subtotal
$
,000.00
5000850000
37. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles,
and musical instruments)
$
,000.00
7001800000
38. Maintenance and repair services for recreational, sports, and fitness equipment (including boats, motorcycles, other
sports vehicles, and musical instruments)
$
,000.00
7001825000
39. Leisure, recreational, and athletic instructional programs
$
,000.00
7002500000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
34
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
35
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
36
Item 28: Special Items - Used Merchandise
ITEM 28: SPECIAL ITEMS - USED MERCHANDISE
Did the sale of used or secondhand merchandise account for more than 75% of the total sales and receipts reported in Item 5?
Yes
No
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37
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
38
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
39
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
40
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
41
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
42
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
43
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
44
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
45
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
46
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
47
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
1000
characters remaining
48
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RT-45111_su.pdf Generated 2022-02-23 15:52:18
,000.00
49
Attachment D-8
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 48-49
Attachment Sector
D-8
48-49
Instrument
Path
Instrument Path Title
48100
48400
48700
4930X
Air Transportation
Truck Transportation
Scenic and Sightseeing Transportation
Warehousing and Storage (Enterprise Support)
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Scheduled air transportation
Scheduled passenger carrier, including commuter
481111 001
Scheduled air freight carrier
481112 001
Courier service, including delivery of parcels weighing 100 pounds or less
Air courier service
492110 201
Courier service - local, except by air
492210 002
Courier service - intercity, except by air
492110 102
Nonscheduled air transportation - no regular routes or regular schedules
Nonscheduled passenger service, including air taxi and charters
481211 001
Nonscheduled freight service without passengers
481212 001
Sightseeing by airplane, helicopter, or hot air balloon
487990 003
Ambulance or emergency rescue services, air or ground
621910 003
Variety of specialized flying services - performing a variety of specialized flying services, e.g., crop dusting, aerial forest fire fighting, aerial
advertising and photography, aerial surveying - Describe
481219 001
Describe
Aviation clubs providing a variety of nonscheduled air transportation activities to the general public (except primarily operating public flying
fields)
481219 002
Aviation clubs, primary operating public flying fields
488119 003
Airport and aircraft services
Air traffic control, except military
488111 001
Airport operation and terminal services, including fixed base operators (FBOs), airfreight handling, hangar operations, runway maintenance,
airport terminal services, aircraft storage, baggage handling, airports and flying fields, etc.
488119 001
Aircraft maintenance and repair (except factory conversion, factory overhaul, factory rebuilding)
488190 001
Aircraft fueling service, except on contract basis
424720 006
Airplane cleaning and janitorial services
561720 005
Limousine or luxury sedan with drivers, except scheduled airport shuttle and taxi service
485320 001
Bus or motor vehicle transit system - with regular routes and schedules within a metropolitan area and its adjacent nonurban areas
485113 002
Taxi or ridesharing service by automobile or van
485310 001
Scheduled airport shuttle service
485999 101
Aircraft rental or leasing without crew and/or pilot
532411 901
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
15
Other airport and aircraft transportation services - Describe
488190 002
Describe
Arrangement of transportation for passengers
Travel agency
561510 001
Tour operator - assembling tour packages and selling directly to travelers or through other travel agencies
561520 001
Arrangement of transportation for freight and cargo
Freight forwarding service
488510 101
Freight/shipping agent or broker, except freight forwarding
488510 203
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue?
For further clarification, click the "Additional Information" link above.
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Domestic, scheduled passenger transportation by air, first class and business class
2. Domestic, scheduled passenger transportation by air, coach class
3. International, scheduled passenger transportation by air, first class and business
4. International, scheduled passenger transportation by air, coach class
Product Code
7002975000
7003000000
7003025000
7003050000
7003075000
5. Domestic non-scheduled passenger transportation by air
6. International non-scheduled passenger transportation by air
7. Transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
a. Domestic, scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
b. International, scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
c. Domestic, non-scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
d. International, non-scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
8. Transportation of non-perishable/not climate-controlled boxed, palletized, and other packed goods, by air
a. Domestic, scheduled transportation of bundled postal mail by air
b. Domestic, scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other packed goods, by air
c. International, scheduled transportation of bundled postal mail by air
7003100000
7011425000
7011425003
7011425006
7011425009
7011425012
7011500000
7011500003
7011500006
7011500009
d. International, scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other packed general
freight, by air
7011500012
e. Domestic, non-scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other packed general
freight, by air
7011500015
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
21
f. International, non-scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other packed general
freight, by air
7011500018
7011300000
9. Transportation of bulk liquids and gases by air
7011675000
10. Transportation of automobiles and light trucks by air
7011850000
11. Transportation of other goods by air
12. Rental of air (Dry Leasing), rail, and water transportation equipment
13. Rental of aircraft with crew for air carrier use (Wet Leasing)
7009300000
7009325000
7015025000
14. Air traffic control services
7015050000
15. Fixed-base-operator (FBO) services
7015075000
16. Airport operation and administration services
7015075003
a. Parking services for aircraft
7015075006
b. Other airport operation and administration services
17. Other air transportation support services, not elsewhere classified
7015100000
7012375000
18. Leased display advertising media space
7012375003
a. Leased display advertising media space, large format
7012375006
b. Leased display advertising media space, transit
c. Leased display advertising media space, street furniture and other urban fixtures
7012375009
7012375012
d. Other leased display advertising media space
7017000000
19. Aerial support services, not elsewhere classified
7017000003
a. Aerial crop dusting services
7017000006
b. Other air specialty services, not elsewhere classified
7002025000
20. All other recreation, sports, and fitness services
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
22
7002025003
a. Air-based recreational services
b. All other recreation, sports, and fitness services, not elsewhere classified
7002025006
7004275000
21. Air ambulance emergency services
22. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
7000025000
7009400000
23. Maintenance and repair and related services for aircraft
24. Manufacturing of radio station equipment, including space-based (satellite) stations, airborne and marine-based stations, and earth
fixed-based and mobile-based systems (excluding transmission equipment)
25. Manufacturing of complete guided missiles and complete space vehicles (excluding propulsion systems, parts, and prototypes)
26. Manufacturing of complete missiles, space vehicle engines, propulsion units, and related parts and accessories (excluding
complete guided missiles and prototypes)
2011825000
2012380000
2012480000
Add product/service not listed
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Domestic, scheduled passenger transportation by air, first class and business class
$
,000.00
7002975000
2. Domestic, scheduled passenger transportation by air, coach class
$
,000.00
7003000000
3. International, scheduled passenger transportation by air, first class and business
$
,000.00
7003025000
4. International, scheduled passenger transportation by air, coach class
$
,000.00
7003050000
5. Domestic non-scheduled passenger transportation by air
$
,000.00
7003075000
6. International non-scheduled passenger transportation by air
$
,000.00
7003100000
a. Domestic, scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by
air
$
,000.00
7011425003
b. International, scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed goods,
by air
$
,000.00
7011425006
c. Domestic, non-scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed
goods, by air
$
,000.00
7011425009
d. International, non-scheduled transportation of perishable/climate-controlled boxed, palletized, and other packed
goods, by air
$
,000.00
7011425012
Subtotal
$
,000.00
7011425000
a. Domestic, scheduled transportation of bundled postal mail by air
$
,000.00
7011500003
b. Domestic, scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other packed
goods, by air
$
,000.00
7011500006
c. International, scheduled transportation of bundled postal mail by air
$
,000.00
7011500009
d. International, scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other
packed general freight, by air
$
,000.00
7011500012
7. Transportation of perishable/climate-controlled boxed, palletized, and other packed goods, by air
8. Transportation of non-perishable/not climate-controlled boxed, palletized, and other packed goods, by air
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
24
e. Domestic, non-scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other
packed general freight, by air
$
,000.00
7011500015
f. International, non-scheduled transportation of non-perishable/not climate-controlled boxed, palletized, and other
packed general freight, by air
$
,000.00
7011500018
Subtotal
$
,000.00
7011500000
9. Transportation of bulk liquids and gases by air
$
,000.00
7011300000
10. Transportation of automobiles and light trucks by air
$
,000.00
7011675000
11. Transportation of other goods by air
$
,000.00
7011850000
12. Rental of air (Dry Leasing), rail, and water transportation equipment
$
,000.00
7009300000
13. Rental of aircraft with crew for air carrier use (Wet Leasing)
$
,000.00
7009325000
14. Air traffic control services
$
,000.00
7015025000
15. Fixed-base-operator (FBO) services
$
,000.00
7015050000
$
,000.00
7015075003
$
,000.00
7015075006
$
,000.00
7015075000
$
,000.00
7015100000
a. Leased display advertising media space, large format
$
,000.00
7012375003
b. Leased display advertising media space, transit
$
,000.00
7012375006
c. Leased display advertising media space, street furniture and other urban fixtures
$
,000.00
7012375009
d. Other leased display advertising media space
$
,000.00
7012375012
Subtotal
$
,000.00
7012375000
16. Airport operation and administration services
a. Parking services for aircraft
b. Other airport operation and administration services
Subtotal
17. Other air transportation support services, not elsewhere classified
18. Leased display advertising media space
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
25
19. Aerial support services, not elsewhere classified
a. Aerial crop dusting services
$
,000.00
7017000003
b. Other air specialty services, not elsewhere classified
$
,000.00
7017000006
Subtotal
$
,000.00
7017000000
a. Air-based recreational services
$
,000.00
7002025003
b. All other recreation, sports, and fitness services, not elsewhere classified
$
,000.00
7002025006
$
,000.00
7002025000
21. Air ambulance emergency services
$
,000.00
7004275000
22. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
23. Maintenance and repair and related services for aircraft
$
,000.00
7009400000
24. Manufacturing of radio station equipment, including space-based (satellite) stations, airborne and marine-based
stations, and earth fixed-based and mobile-based systems (excluding transmission equipment)
$
,000.00
2011825000
25. Manufacturing of complete guided missiles and complete space vehicles (excluding propulsion systems, parts, and
prototypes)
$
,000.00
2012380000
26. Manufacturing of complete missiles, space vehicle engines, propulsion units, and related parts and accessories
(excluding complete guided missiles and prototypes)
$
,000.00
2012480000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
20. All other recreation, sports, and fitness services
Subtotal
Add product/service not listed
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
26
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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27
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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28
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
29
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
30
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
31
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
33
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
34
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
35
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
1000
characters remaining
38
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_TW-48100_su.pdf Generated 2022-02-23 17:09:01
,000.00
39
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Local trucking - goods carried within a single metropolitan area and its adjacent nonurban areas; generally same-day return trips
Local used household goods moving (without storage)
484210 101
Local used household goods moving (with storage)
484210 301
Local general freight trucking, truckload (TL)
484110 501
Local general freight trucking, less than truckload (LTL)
484110 601
Dump trucking, including coal, gravel, and sand hauling
484220 301
Solid waste, recyclables, and yard waste (exclude hazardous waste) collection services, local
562111 001
Hazardous waste collection services
562112 001
Local hazardous materials trucking, except waste
484220 101
Local agricultural products trucking (without storage), including log hauling
484220 201
Local specialized trucking without storage, including auto transport, boat transport, manufactured (mobile) home transport, water transport,
and refrigerated transport - Describe
484220 401
Describe
484220 501
Local specialized trucking with storage - Describe
Describe
Long-distance trucking - goods carried between metropolitan areas
Long-distance used household goods moving
484210 201
Long-distance general freight, truckload (TL)
484121 001
Long-distance general freight, less-than-truckload (LTL)
484122 001
Long-distance hazardous materials trucking, except waste
484230 101
Long-distance agricultural products trucking, including log hauling
484230 201
Long-distance specialized trucking, including auto transport, boat transport, water transport, refrigerated transport, and coal hauling Describe
484230 301
Describe
Courier and messenger service, including delivery of parcels weighing 100 pounds or less, except by means of air transportation
Local messenger and delivery services, including bicycles
492210 001
Intercity courier and delivery services
492110 101
Warehousing and storage facilities
Cotton and linters storage
493130 001
Grain elevators, storage only
493130 002
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
15
Other farm products, except cold storage
493130 003
Refrigerated products, including fur storage
493120 002
Lessor of self-service storage or miniwarehouses
531130 001
Household goods storage
493190 101
General warehousing and storage, contract and public (except self-storage)
493110 002
Paper document warehousing and storage
493190 202
Distribution warehouse/center - Describe
493110 003
Describe
Specialized goods (except refrigerated), including bulk petroleum, chemicals, automobile dead storage, and other products requiring special
storage - Describe
493190 201
Describe
Other transportation-related activities
Physical distribution and logistics consulting services
541614 001
Freight/shipping agent or broker, except freight forwarding
488510 203
Freight forwarding service
488510 101
Motor freight terminal and joint terminal maintenance facility
488490 007
Truck rental, without drivers
532120 102
Truck leasing, without drivers, except finance leasing
532120 202
Driver leasing, without trucks
561330 003
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
What was the total operating revenue?
(Establishments which use purchased transportation and/or commissioned agents should include gross revenue
regardless of amount retained by this establishment. Exclude sales of used equipment.)
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
Check
if
None
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7000450000
1. Household moving services
7011050000
2. Commercial moving
7011075000
3. Moving of other goods requiring special handling
4. Local transportation and delivery of purchased or serviced items
5. Transportation services for small packages, documents, and letters
a. Station-to-station transportation of documents and parcels
b. Other transportation services for small packages, documents, and letters
6. Transportation of bulk liquids and gases in intermodal tank containers by road
7. Transportation of bulk liquids and gases, except in intermodal tank containers, by road
8. Transportation of dry bulks, except in intermodal containers, by road
9. Transportation of climate-controlled boxed, palletized, and other packed goods, except in intermodal containers, by road
10. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal containers, by road
7011125000
7011100000
7011100003
7011100006
7011200000
7011225000
7011325000
7011375000
7011450000
a. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal containers, by road,
truckload service
7011450003
b. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal containers, by road,
less-than-truckload service
7011450006
11. Transportation of climate-controlled intermodal containers, not elsewhere classified, by road
12. Transportation of other intermodal containers, not climate-controlled, not elsewhere classified, by road
7011525000
7011575000
7011625000
13. Transportation of automobiles and light trucks by road
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
21
7011700000
14. Transportation of livestock by road
7011750000
15. Transportation of waste by road
7011750003
a. Transportation of non-hazardous waste by road
b. Transportation of non-hazardous recyclable material by road
7011750006
7011750009
c. Transportation of hazardous waste by road
7011800000
16. Transportation of other goods by road
7015325000
17. Drayage services
7011900000
18. Warehousing and storage services
7011975000
19. Handling services for goods
7012000000
20. Packing services for goods
21. Freight transportation arrangement and customs brokering services
7011925000
7015300000
22. Towing services
7009275000
23. Rental of heavy trucks, truck trailers, and buses
24. Operations and supply chain management consulting and implementation services
7014650000
Add product/service not listed
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Household moving services
$
,000.00
7000450000
2. Commercial moving
$
,000.00
7011050000
3. Moving of other goods requiring special handling
$
,000.00
7011075000
4. Local transportation and delivery of purchased or serviced items
$
,000.00
7011125000
a. Station-to-station transportation of documents and parcels
$
,000.00
7011100003
b. Other transportation services for small packages, documents, and letters
$
,000.00
7011100006
$
,000.00
7011100000
6. Transportation of bulk liquids and gases in intermodal tank containers by road
$
,000.00
7011200000
7. Transportation of bulk liquids and gases, except in intermodal tank containers, by road
$
,000.00
7011225000
8. Transportation of dry bulks, except in intermodal containers, by road
$
,000.00
7011325000
9. Transportation of climate-controlled boxed, palletized, and other packed goods, except in intermodal containers, by
road
$
,000.00
7011375000
a. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal
containers, by road, truckload service
$
,000.00
7011450003
b. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal
containers, by road, less-than-truckload service
$
,000.00
7011450006
Subtotal
$
,000.00
7011450000
$
,000.00
7011525000
5. Transportation services for small packages, documents, and letters
Subtotal
10. Transportation of boxed, palletized, and other packed goods, not climate-controlled and not in intermodal containers,
by road
11. Transportation of climate-controlled intermodal containers, not elsewhere classified, by road
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
23
$
,000.00
7011575000
$
,000.00
7011625000
$
,000.00
7011700000
a. Transportation of non-hazardous waste by road
$
,000.00
7011750003
b. Transportation of non-hazardous recyclable material by road
$
,000.00
7011750006
c. Transportation of hazardous waste by road
$
,000.00
7011750009
Subtotal
$
,000.00
7011750000
16. Transportation of other goods by road
$
,000.00
7011800000
17. Drayage services
$
,000.00
7015325000
18. Warehousing and storage services
$
,000.00
7011900000
19. Handling services for goods
$
,000.00
7011975000
20. Packing services for goods
$
,000.00
7012000000
21. Freight transportation arrangement and customs brokering services
$
,000.00
7011925000
22. Towing services
$
,000.00
7015300000
$
,000.00
7009275000
24. Operations and supply chain management consulting and implementation services
$
,000.00
7014650000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
12. Transportation of other intermodal containers, not climate-controlled, not elsewhere classified, by road
13. Transportation of automobiles and light trucks by road
14. Transportation of livestock by road
15. Transportation of waste by road
23. Rental of heavy trucks, truck trailers, and buses
Add product/service not listed
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
24
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
25
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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26
Item 28: Special Items - Analysis of Operating (Trucking) Revenue
ITEM 28: SPECIAL ITEMS - ANALYSIS OF OPERATING (TRUCKING) REVENUE
What percentage of motor carrier revenue was from the following?
Check
if
None
2022 Percent
1. LOCAL (motor carrier service within a single metropolitan area and its adjacent nonurban areas, which may cross state
lines)
%
2. LONG-DISTANCE (motor carrier service between metropolitan areas which may cross North American borders)
%
3. TOTAL (Sum of lines 1 and 2 should equal 100%.)
%
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27
Item 28: Special Items - Purchased Transportation
ITEM 28: SPECIAL ITEMS - PURCHASED TRANSPORTATION
What was the cost of transportation purchased for each of the following uses?
Check
if
None
2022
$
,000.00
2. Lease and rental payments for trucks and other motor vehicles without drivers
$
,000.00
3. Purchased transportation from other motor carriers
$
,000.00
4. All other purchased transportation
(Include allowances to shippers less credits for equipment rents to others.)
$
,000.00
5. TOTAL (Add lines 1 through 4.)
$
,000.00
1. Lease and rental payments for trucks and other motor vehicles with drivers
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28
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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29
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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30
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
31
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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32
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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38
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
1000
characters remaining
39
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_TW-48400_su.pdf Generated 2022-02-23 17:16:32
,000.00
40
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Scenic and sightseeing transportation
Sightseeing bus excursions
487110 004
Horse-drawn cabs or carriages, for hire
487110 003
Aerial tramway and cable lift, scenic or sightseeing
487990 002
Scenic railroad or steam train
487110 002
Sightseeing by airplane, helicopter, or hot air balloon
487990 003
Scenic and sightseeing transportation by water, including dinner cruises, excursions, and harbor tours
487210 103
Charter fishing boat
487210 202
Other scenic or sightseeing transportation - Describe
487990 004
Describe
Charter bus services
Bus charter services - local
485510 004
Bus charter services - interstate or interurban
485510 005
Other arrangement of passenger transportation NOT operated by a transportation company
Travel agency
561510 001
Tour operator - assembling tour packages and selling directly to travelers or through other travel agencies
561520 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total operating revenue?
For further clarification, click the "Additional Information" link above.
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7003200000
1. Sightseeing services by air
7003135000
2. Sightseeing services by rail
7003150000
3. Sightseeing services by ground vehicles, except rail
4. Sightseeing services by water (Include dinner cruises, excursions, and harbor tours)
5. Short-term access to communications services (Internet cafe, cruise ship, conference, etc.)
7003175000
7014175000
7015350000
6. Vanpool and carpool coordination services
7. Other road transportation support services and road transportation intermediation services, including taxi dispatch services and
ridesharing arrangement services
8. Coastal and Great Lakes fixed-route, passenger transportation by water
7015375000
7003125000
7002850000
9. Local passenger transportation by water
7003250000
10. Cruises (Deep sea)
11. Long-distance, fixed-route passenger transportation by road
12. Local, fixed-route, passenger transportation by road and transit rail
13. Long-distance passenger transportation by road, except fixed-route
14. Local passenger transportation by road (except fixed-route)
15. Packaged tours with accommodation, except cruises and academic trips and tours
16. Customized tours with accommodation, except cruises and academic trips and tours
7002925000
7002800000
7002950000
7002825000
7003275000
7003285000
7001750000
17. Academic trips and tours
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20
18. Retail sales of candy, prepackaged cookies, and snack foods
5000200000
5000250000
19. Retail sales of soft drinks and nonalcoholic beverages
20. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
7000025000
Add product/service not listed
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21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Sightseeing services by air
$
,000.00
7003200000
2. Sightseeing services by rail
$
,000.00
7003135000
3. Sightseeing services by ground vehicles, except rail
$
,000.00
7003150000
4. Sightseeing services by water (Include dinner cruises, excursions, and harbor tours)
$
,000.00
7003175000
5. Short-term access to communications services (Internet cafe, cruise ship, conference, etc.)
$
,000.00
7014175000
6. Vanpool and carpool coordination services
$
,000.00
7015350000
7. Other road transportation support services and road transportation intermediation services, including taxi dispatch
services and ridesharing arrangement services
$
,000.00
7015375000
8. Coastal and Great Lakes fixed-route, passenger transportation by water
$
,000.00
7003125000
9. Local passenger transportation by water
$
,000.00
7002850000
10. Cruises (Deep sea)
$
,000.00
7003250000
11. Long-distance, fixed-route passenger transportation by road
$
,000.00
7002925000
12. Local, fixed-route, passenger transportation by road and transit rail
$
,000.00
7002800000
13. Long-distance passenger transportation by road, except fixed-route
$
,000.00
7002950000
$
,000.00
7002825000
15. Packaged tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003275000
16. Customized tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003285000
17. Academic trips and tours
$
,000.00
7001750000
14. Local passenger transportation by road (except fixed-route)
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
22
$
,000.00
5000200000
19. Retail sales of soft drinks and nonalcoholic beverages
$
,000.00
5000250000
20. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
18. Retail sales of candy, prepackaged cookies, and snack foods
Add product/service not listed
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
23
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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24
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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26
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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30
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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31
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
1000
characters remaining
36
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_TW-48700_su.pdf Generated 2022-02-23 17:20:11
,000.00
37
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all selling and service
locations of a company and any other facilities such as warehouses, administrative offices, terminals, etc., that were in operation at any time during 2022. Permanent (or temporary)
locations with no paid employees (such as unmanned warehouses) are not considered separate establishments.
DEFINITION OF AN ENTERPRISE
An enterprise or company is a business, service, or membership organization consisting of one or more establishments within the United States under common ownership or control. It
includes all establishments of subsidiary companies, where there is more than 50 percent ownership, as well as establishments of firms which the enterprise has the power to direct or
cause the direction of management and policies.
DEFINITION OF AN ENTERPRISE SUPPORT ESTABLISHMENT
An enterprise support establishment is an establishment that is primarily engaged in performing management, supervision, general administrative functions, and supporting services
such as trucking and warehousing for other establishments of the same enterprise, rather than for the general public or other business firms.
PHYSICAL ADDRESS
Please update the location's physical address if needed.
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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7
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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8
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Warehousing and storage facilities
Cotton and linters storage
493130 001
Grain elevators, storage only
493130 002
Other farm products, except cold storage
493130 003
Refrigerated products, including fur storage
493120 002
Lessor of self-service storage or miniwarehouses
531130 001
Household goods storage
493190 101
General warehousing and storage, contract and public (except self-storage)
493110 002
Paper document warehousing and storage
493190 202
Distribution warehouse/center - Describe
493110 003
Describe
Specialized goods (except refrigerated), including bulk petroleum, chemicals, automobile dead storage, and other products requiring special
storage - Describe
493190 201
Describe
Other transportation-related activities
Physical distribution and logistics consulting services
541614 001
Freight/shipping agent or broker, except freight forwarding
488510 203
Freight forwarding service
488510 101
Motor freight terminal and joint terminal maintenance facility
488490 007
Truck rental, without drivers
532120 102
Truck leasing, without drivers, except finance leasing
532120 202
Driver leasing, without trucks
561330 003
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
10
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
For further clarification, click the "Additional Information" link above.
Check
if
None
What were the sales to, or receipts or revenue from, customers outside your enterprise?
(Exclude billings, sales, receipts, or revenue from establishments of your own enterprise.)
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
2022
$
,000.00
11
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
2022
$
,000.00
$
,000.00
12
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
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Item 8: Support Services - Continued
ITEM 8: SUPPORT SERVICES - PRIMARY BUSINESS OR ACTIVITY OF THE OPERATING ESTABLISHMENTS SERVICED
What primary kind of business or activity is performed by the establishments of your enterprise that are managed or serviced by this establishment?
Example: If this establishment is a corporate, subsidiary, or regional managing office, data processing service center, or administrative/support office to a chain of clothing stores, please
describe "clothing stores" below.
Describe
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Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES
Report the payment of selected expenses allocated by category
Report payments for expenses directly incurred by this establishment in column 1.
Report payments made by this establishment for expenses incurred by other establishments of your enterprise in column 2 (where applicable).
Exclude:
Transfers made within the company
Capitalized expenses
Impairment
Interest
Bad debt
Income tax
Taxes collected from customers (e.g., sales and excise)
Cost of merchandise for resale
Personnel costs, except payroll
1. Employer's cost for employer paid insurance premiums,
pension plans, payroll taxes, and other employee
benefits More
Check
if
None
2022 Expenses of this
establishment ONLY
$
,000.00
$
,000.00
3. Expensed computer hardware and other equipment More
$
,000.00
4. Expensed purchases of other materials, parts, and
supplies More
$
,000.00
5. Purchased transportation More
$
,000.00
6. Expensed purchases of computer software More
$
,000.00
7. Purchased electricity More
$
,000.00
8. Purchased fuels for transportation More
$
,000.00
9. Purchased fuels (exclude motor fuels.) More
$
,000.00
2. Temporary staff and leased employee expense More
Expensed equipment and materials
Expensed purchased services
2022 Payments made by
this establishment on
behalf of other
establishments of your
enterprise
Check
if
None
10. Data processing and other purchased computer
services More
$
,000.00
$
,000.00
11. Purchased communication services More
$
,000.00
$
,000.00
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15
12. Purchased repairs and maintenance to transportation
equipment More
$
,000.00
$
,000.00
13. Purchased repairs and maintenance to machinery and
equipment More
$
,000.00
$
,000.00
14. Purchased repairs and maintenance to buildings,
structures, and offices More
$
,000.00
$
,000.00
15. Water, sewer, refuse removal, and other utility
payments More
$
,000.00
$
,000.00
16. Purchased advertising and promotional services More
$
,000.00
$
,000.00
17. Purchased professional and technical services More
$
,000.00
$
,000.00
18. Lease and rental payments for machinery, equipment,
and other tangible items More
$
,000.00
$
,000.00
19. Lease and rental payments for land, buildings,
structures, store spaces, and offices More
$
,000.00
$
,000.00
20. Governmental taxes and license fees (Exclude sales,
excise, and income taxes.) More
$
,000.00
$
,000.00
21. Cost of insurance More
$
,000.00
22. Depreciation and amortization charges More
$
,000.00
23. All other selected expenses
(Describe - If more than 50% of TOTAL reported on line
24) More
$
,000.00
$
,000.00
Other selected expenses
Describe
24. TOTAL SELECTED EXPENSES of this establishment
ONLY, excluding payroll (Add lines 1 through 23.)
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16
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7011900000
1. Warehousing and storage services
7011975000
2. Handling services for goods
7012000000
3. Packing services for goods
4. Freight transportation arrangement and customs brokering services
5. Operations and supply chain management consulting and implementation services
7011925000
7014650000
Add product/service not listed
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17
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Warehousing and storage services
$
,000.00
7011900000
2. Handling services for goods
$
,000.00
7011975000
$
,000.00
7012000000
4. Freight transportation arrangement and customs brokering services
$
,000.00
7011925000
5. Operations and supply chain management consulting and implementation services
$
,000.00
7014650000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
3. Packing services for goods
Add product/service not listed
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18
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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20
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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21
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
22
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
23
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
24
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_TW-4930X_mu.pdf Generated 2022-02-23 17:29:53
25
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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26
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
27
Attachment D-9
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 51
Attachment Sector
D-9
51
Instrument
Path
Instrument Path Title
5160C
51213
51224
51314
Motion Picture and Video Production and Distribution and
Broadcasting Services (Classification)
Motion Picture and Video Exhibition
Sound Recording Studios and Other Sound Recording Industries
Directory and Mailing List Publishing
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
99999-9999
EIN
99-9999999
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Motion picture, television, and video production, including distribution of productions by own company and distribution of productions by other companies
Producer of television shows, including commercials, infomercials, and music videos
512110 002
Producer of educational, training, corporate, religious, direct-to-home videos/DVDs, or other non-theatrical films and videos/DVDs
512110 003
Producer of motion pictures
512110 001
Producer of animated or computer animated films or videos/DVDs, including commercials and music videos
512110 004
Other film, video, or digital media productions
512110 005
Describe
Motion picture, television, and video distribution exclusively for other companies
Motion picture or television distributor - acquiring distribution rights and distributing film, video, or digital productions to theaters, television
networks and stations, and other exhibitors, including commercials, infomercials, and music videos
512120 001
Distributor of educational, training, corporate, religious, direct-to-home videos/DVDs, or other non-theatrical films and videos/DVDs
512120 002
Other film, video, or digital media distribution
512120 005
Describe
Services allied to film and video production and distribution
Author, writer, or composer
711510 004
Audio postproduction services
512240 003
Actor, actress, comedian, or other independent entertainer
711510 001
Independent film director or other motion picture artist or technician
711510 002
Postproduction services for film, video, or digital media
512191 002
Motion picture theater, excluding drive-in
512131 001
Radio broadcasting
Public radio broadcast station
515112 003
Independent radio station, except Internet only
515112 002
Radio network
515111 002
Radio network affiliated station, except Internet only
515112 001
Radio program syndication
515111 001
Television broadcasting
Television network affiliated station, except Internet only
515120 101
Television network, excluding cable programming network
515120 201
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Cable television network
515210 003
Independent television station, except Internet only
515120 102
Public access television producer
515210 002
Internet broadcasting and news syndicates
Internet broadcasting
519130 401
News syndicates
519110 002
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
8
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Motion picture theater, excluding drive-in
512131 001
Drive-in motion picture theater
512132 001
Film festival exhibitor
512131 002
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001575000
1. Admissions to film exhibitions
7001575003
a. Admissions to domestic films
7001575006
b. Admissions to foreign films
2. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption More
3. Retail sales of candy, prepackaged cookies, and snack foods
4. Alcoholic beverages, prepared and served or dispensed for immediate consumption
7000025000
5000200000
7000050000
7012410000
5. Other advertising space, time, and similar services More
7002325000
6. Video and other coin-operated games and rides More
7006375000
7. Rental and leasing of commercial space
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to film exhibitions
a. Admissions to domestic films
$
,000.00
7001575003
b. Admissions to foreign films
$
,000.00
7001575006
Subtotal
$
,000.00
7001575000
2. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption More
$
,000.00
7000025000
3. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
4. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
5. Other advertising space, time, and similar services More
$
,000.00
7012410000
6. Video and other coin-operated games and rides More
$
,000.00
7002325000
$
,000.00
7006375000
$
,000.00
9900000000
7. Rental and leasing of commercial space
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
33
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IN-51213_su.pdf Generated 2022-02-24 06:42:30
,000.00
34
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Sound recording industries
Sound recording studio, including independent establishments recording musical performances, but not engaged in production or distribution
512240 001
Audio postproduction services
512240 003
Music production for commercials
512240 002
Audio taping services, including meetings, conferences, etc.
512290 901
Producer of taped radio programs
512290 201
Record production - contracting with musical artists, arranging, and financing the production of original master recordings
512250 101
Stock music library
512290 902
Background recorded music provider
512290 903
Integrated record production/distribution (Primarily engaged in releasing, promoting, and distributing sound recordings, including audio tapes
and compact discs.)
512250 201
Music publishing, excluding sheet music and music books
512230 901
Other primary business or activity
Musical group or artist
711130 902
Songwriter
711510 006
Other primary business or activity
779000 001
Select Sector
Describe
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7013450000
1. Studio recording services for music clients More
a. Studio recording, excluding mixing of musical recordings More
b. Studio recording, including mixing of musical recordings More
7013450003
7013450006
7013450009
c. Mixing of musical recordings More
7013450012
d. Mastering of musical recordings More
7013450015
e. Mixing and mastering of musical recordings More
f. Remixing and remastering of musical recordings More
2. Studio recording services for spoken word clients that are primarily non-musical in nature, such as audio books and comedic
routines that are done inside a sound recording studio More
7013450018
7013475000
7013500000
3. Studio recording services for radio material More
7013500003
a. Radio spots More
7013500006
b. Radio programs More
4. Sound editing and design services for audiovisual works More
a. Original music produced under contract for audiovisual works More
7013525000
7013525003
7013525006
b. Orchestration More
7013525009
c. Foley stage More
7013525012
d. Additional dialogue recording (ADR) More
7013525015
e. Foreign language dubbing More
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
20
7013525018
f. Sound integration and synchronization More
7013525021
g. Other sound services for audiovisual works
7013550000
5. Live recording services
a. Audio recording of meetings, conferences, and seminars More
7013550003
7013550006
b. Audio recording of other events More
6. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines
7006575000
7006575003
a. Rental and leasing of recording studio facilities More
b. Rental and leasing of motion picture and video production studios
c. Rental and leasing of other nonresidential space in buildings or other facilities, not elsewhere classified
7. Licensing of rights to use musical compositions protected by copyright More
8. Licensing of international rights to publish domestic musical compositions protected by copyright (i.e., international sub-publishing
rights)
9. Licensing of rights to use musical recordings protected by copyright
7006575006
7006575009
7009578000
7009579000
7009580000
7013575000
10. Support services for sound recording by others More
7013600000
11. Audio transfer services More
12. Other artistic and literary intellectual property protected by copyright produced under contract, except live performances and
audiovisual works More
7010125000
Add product/service not listed
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Studio recording services for music clients More
a. Studio recording, excluding mixing of musical recordings More
$
,000.00
7013450003
b. Studio recording, including mixing of musical recordings More
$
,000.00
7013450006
c. Mixing of musical recordings More
$
,000.00
7013450009
d. Mastering of musical recordings More
$
,000.00
7013450012
e. Mixing and mastering of musical recordings More
$
,000.00
7013450015
$
,000.00
7013450018
$
,000.00
7013450000
$
,000.00
7013475000
a. Radio spots More
$
,000.00
7013500003
b. Radio programs More
$
,000.00
7013500006
$
,000.00
7013500000
$
,000.00
7013525003
b. Orchestration More
$
,000.00
7013525006
c. Foley stage More
$
,000.00
7013525009
d. Additional dialogue recording (ADR) More
$
,000.00
7013525012
f. Remixing and remastering of musical recordings More
Subtotal
2. Studio recording services for spoken word clients that are primarily non-musical in nature, such as audio books and
comedic routines that are done inside a sound recording studio More
3. Studio recording services for radio material More
Subtotal
4. Sound editing and design services for audiovisual works More
a. Original music produced under contract for audiovisual works More
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
22
$
,000.00
7013525015
f. Sound integration and synchronization More
$
,000.00
7013525018
g. Other sound services for audiovisual works
$
,000.00
7013525021
Subtotal
$
,000.00
7013525000
a. Audio recording of meetings, conferences, and seminars More
$
,000.00
7013550003
b. Audio recording of other events More
$
,000.00
7013550006
Subtotal
$
,000.00
7013550000
a. Rental and leasing of recording studio facilities More
$
,000.00
7006575003
b. Rental and leasing of motion picture and video production studios
$
,000.00
7006575006
$
,000.00
7006575009
$
,000.00
7006575000
7. Licensing of rights to use musical compositions protected by copyright More
$
,000.00
7009578000
8. Licensing of international rights to publish domestic musical compositions protected by copyright (i.e., international
sub-publishing rights)
$
,000.00
7009579000
$
,000.00
7009580000
10. Support services for sound recording by others More
$
,000.00
7013575000
11. Audio transfer services More
$
,000.00
7013600000
12. Other artistic and literary intellectual property protected by copyright produced under contract, except live
performances and audiovisual works More
$
,000.00
7010125000
$
,000.00
9900000000
e. Foreign language dubbing More
5. Live recording services
6. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service
gambling machines
c. Rental and leasing of other nonresidential space in buildings or other facilities, not elsewhere classified
Subtotal
9. Licensing of rights to use musical recordings protected by copyright
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
23
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
24
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
2022
$
,000.00
27
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
29
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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30
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
33
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
37
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IN-51224_su.pdf Generated 2022-02-24 06:44:40
,000.00
38
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Directory, database, and mailing list publishing, excluding Internet publishing
Advertising sales offices of directory and database publishing companies
511140 004
Directory and database publishers, including publishing and printing combined (Exclude publishing exclusively on the Internet.)
511140 002
Mailing list publishers, including publishing and printing combined (Exclude publishing exclusively on the Internet.)
511140 003
Other publishing and Internet publishing
Internet Directory and mailing list publishing, publishing exclusively on the Internet
519130 341
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included? Select ALL that apply.
Description
Select
Product Code
7014505000
1. Directories More
7014505003
a. Directories, online
7014505006
b. Directories, except online
7014515000
2. Databases and other collections of information More
7014515003
a. Databases and other collections of information, online
b. Databases and other collections of information, except online
7014515006
7002525000
3. Library and archive services
7012275000
4. Advertising space in printed publications
7012275003
a. Advertising space in printed general daily newspapers
b. Advertising space in printed newspapers other than general daily
7012275006
7012275009
c. Advertising space in printed specialized newspapers
d. Advertising space in printed arts, culture, leisure, and entertainment periodicals
e. Advertising space in printed home and living periodicals
f. Advertising space in printed political, social, and business news periodicals
g. Advertising space in other printed general interest periodicals
h. Advertising space in printed business (including farming), professional and academic periodicals
i. Advertising space in printed periodicals, not elsewhere classified
7012275012
7012275015
7012275018
7012275021
7012275024
7012275027
7012275031
j. Advertising space in printed telephone directories
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
20
7012275033
k. Advertising space in other printed directories
l. Advertising space in printed databases and other printed collections of information
7012275036
7012275039
m. Advertising space in books
7012350000
5. Internet advertising
7012350003
a. Advertising space in online general daily newspapers
b. Advertising space in online newspapers other than general daily
7012350006
7012350009
c. Advertising space in online specialized newspapers
d. Advertising space in online arts, culture, leisure, and entertainment periodicals
e. Advertising space in online home and living periodicals
f. Advertising space in online political, social, and business news periodicals
g. Advertising space in online general interest periodicals
h. Advertising space in online business (including farming), professional and academic periodicals
i. Advertising space in online periodicals, not elsewhere classified
7012350012
7012350015
7012350018
7012350021
7012350024
7012350027
7012350031
j. Advertising space in online directories
k. Advertising space in online databases and other online collections of information
6. Advertising space in publications on electronic and other media, except online
7012350033
7012400000
2052875000
7. Quick printing More
2052900000
8. Digital printing (excluding books) More
7012600000
9. Mailing list services
10. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings More
7009581000
Add product/service not listed
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
21
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Directories More
a. Directories, online
$
,000.00
7014505003
b. Directories, except online
$
,000.00
7014505006
Subtotal
$
,000.00
7014505000
a. Databases and other collections of information, online
$
,000.00
7014515003
b. Databases and other collections of information, except online
$
,000.00
7014515006
Subtotal
$
,000.00
7014515000
$
,000.00
7002525000
$
,000.00
7012275003
$
,000.00
7012275006
c. Advertising space in printed specialized newspapers
$
,000.00
7012275009
d. Advertising space in printed arts, culture, leisure, and entertainment periodicals
$
,000.00
7012275012
e. Advertising space in printed home and living periodicals
$
,000.00
7012275015
f. Advertising space in printed political, social, and business news periodicals
$
,000.00
7012275018
g. Advertising space in other printed general interest periodicals
$
,000.00
7012275021
h. Advertising space in printed business (including farming), professional and academic periodicals
$
,000.00
7012275024
2. Databases and other collections of information More
3. Library and archive services
4. Advertising space in printed publications
a. Advertising space in printed general daily newspapers
b. Advertising space in printed newspapers other than general daily
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
23
$
,000.00
7012275027
$
,000.00
7012275031
k. Advertising space in other printed directories
$
,000.00
7012275033
l. Advertising space in printed databases and other printed collections of information
$
,000.00
7012275036
m. Advertising space in books
$
,000.00
7012275039
Subtotal
$
,000.00
7012275000
a. Advertising space in online general daily newspapers
$
,000.00
7012350003
b. Advertising space in online newspapers other than general daily
$
,000.00
7012350006
c. Advertising space in online specialized newspapers
$
,000.00
7012350009
d. Advertising space in online arts, culture, leisure, and entertainment periodicals
$
,000.00
7012350012
e. Advertising space in online home and living periodicals
$
,000.00
7012350015
f. Advertising space in online political, social, and business news periodicals
$
,000.00
7012350018
g. Advertising space in online general interest periodicals
$
,000.00
7012350021
h. Advertising space in online business (including farming), professional and academic periodicals
$
,000.00
7012350024
$
,000.00
7012350027
j. Advertising space in online directories
$
,000.00
7012350031
k. Advertising space in online databases and other online collections of information
$
,000.00
7012350033
Subtotal
$
,000.00
7012350000
$
,000.00
7012400000
$
,000.00
2052875000
i. Advertising space in printed periodicals, not elsewhere classified
j. Advertising space in printed telephone directories
5. Internet advertising
i. Advertising space in online periodicals, not elsewhere classified
6. Advertising space in publications on electronic and other media, except online
7. Quick printing More
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
24
8. Digital printing (excluding books) More
$
,000.00
2052900000
9. Mailing list services
$
,000.00
7012600000
10. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings More
$
,000.00
7009581000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
25
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Media
ITEM 28: SPECIAL ITEMS - MEDIA
Estimate the percent of receipts from subscriptions and sales reported in Item 22 by type of dissemination media used to deliver product to client:
2022
%
1. Print
2. Internet
%
3. Other media, including CD-ROM/DVD-ROM, diskette or cassette, and
microform
%
4. TOTAL - Sum should equal 100%
%
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
27
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
28
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
2022
$
,000.00
29
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
30
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
31
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
32
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
33
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
34
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
35
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
36
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
37
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
38
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
1000
characters remaining
39
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IN-51314_su.pdf Generated 2022-02-24 06:37:02
,000.00
40
Attachment D-10
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 52
Attachment Sector
D-10
52
Instrument
Path
Instrument Path Title
52111
52230
52321
52410
Monetary Authorities - Central Bank
Financial Transactions Processing and Other Activities Related to
Credit Intermediation
Securities and Commodity Exchanges
Health and Medical Insurance Carriers
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Federal Reserve bank or branch
521110 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total revenue?
For further clarification, click the "Additional Information" link above.
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Loans to financial businesses - include federal funds More
2. Trading securities and commodity contracts on own account - net gains (losses) More
Product Code
8000075000
8000150000
8000150003
a. Trading debt instruments on own account
b. Trading equities on own account, including private equity
8000150006
8000150009
c. Trading derivatives contracts on own account
8000150012
d. Trading foreign currency (wholesale) on own account
e. Trading other securities and commodity contracts on own account
8000150015
7005546000
3. Automated Clearing House (ACH) services More
4. Cash handling and management services for business More
5. Support services for financial and commodity markets More
7005542000
7005545000
7017475000
6. Regulation of credit markets
7. Other products supporting financial services, including electronic payment services and loan administration services (excluding credit
card, wire transfer, and automated clearing house (ACH) services)
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
b. Other products supporting financial services, including loan administration services and ATM services to customers other than a
financial institution's own deposit holders More
7005547000
7005547003
7005547006
Add product/service not listed
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
$
,000.00
8000075000
a. Trading debt instruments on own account
$
,000.00
8000150003
b. Trading equities on own account, including private equity
$
,000.00
8000150006
c. Trading derivatives contracts on own account
$
,000.00
8000150009
$
,000.00
8000150012
e. Trading other securities and commodity contracts on own account
$
,000.00
8000150015
Subtotal
$
,000.00
8000150000
3. Automated Clearing House (ACH) services More
$
,000.00
7005546000
4. Cash handling and management services for business More
$
,000.00
7005542000
$
,000.00
7005545000
$
,000.00
7017475000
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
$
,000.00
7005547003
b. Other products supporting financial services, including loan administration services and ATM services to
customers other than a financial institution's own deposit holders More
$
,000.00
7005547006
Subtotal
$
,000.00
7005547000
$
,000.00
9900000002
1. Loans to financial businesses - include federal funds More
2. Trading securities and commodity contracts on own account - net gains (losses) More
d. Trading foreign currency (wholesale) on own account
5. Support services for financial and commodity markets More
6. Regulation of credit markets
7. Other products supporting financial services, including electronic payment services and loan administration services
(excluding credit card, wire transfer, and automated clearing house (ACH) services)
TOTAL - Sum of lines should equal total Revenue reported in Item 5
Add product/service not listed
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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26
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
1000
characters remaining
34
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_FI-52111_su.pdf Generated 2022-02-24 08:16:02
,000.00
35
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Financial transaction processing
Electronic funds transfer network
522320 201
Money transfer or wire transmission
522390 006
Electronic payment service
522320 202
Automated Teller Machine (ATM) or Automated Loan Machine (ALM) network
522320 203
Clearinghouse, bank or check
522320 204
Credit card service by business credit institutions
522320 301
Credit and/or debit card processing service
522320 902
Cryptocurrency financial payment services
522320 205
Other credit related services
Check cashing agency
522390 004
Payday loans
522390 005
Foreign currency exchange
523130 007
Mortgage broker
522310 002
Mortgage banker, mortgage company, or loan correspondent
522292 901
Mortgage and non-mortgage loan servicing
522390 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total revenue?
For further clarification, click the "Additional Information" link above.
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7000300000
1. Residential mortgage loans More
7005425000
2. Unsecured loans to consumers More
7005526000
3. Credit card services More
a. Credit card services for cardholders, business and government
7005526003
7005526006
b. Credit card services for cardholders, consumer
7005526009
c. Credit card services for merchants More
7005526012
d. Credit card association products
4. Cash handling and management services for business More
7005542000
7005546000
5. Automated Clearing House (ACH) services More
6. Other products supporting financial services, including electronic payment services and loan administration services (excluding credit
card, wire transfer, and automated clearing house (ACH) services)
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
b. Other products supporting financial services, including loan administration services and ATM services to customers other than a
financial institution's own deposit holders More
7005547000
7005547003
7005547006
Add product/service not listed
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Residential mortgage loans More
$
,000.00
7000300000
2. Unsecured loans to consumers More
$
,000.00
7005425000
a. Credit card services for cardholders, business and government
$
,000.00
7005526003
b. Credit card services for cardholders, consumer
$
,000.00
7005526006
$
,000.00
7005526009
d. Credit card association products
$
,000.00
7005526012
Subtotal
$
,000.00
7005526000
4. Cash handling and management services for business More
$
,000.00
7005542000
5. Automated Clearing House (ACH) services More
$
,000.00
7005546000
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
$
,000.00
7005547003
b. Other products supporting financial services, including loan administration services and ATM services to
customers other than a financial institution's own deposit holders More
$
,000.00
7005547006
$
,000.00
7005547000
$
,000.00
9900000000
3. Credit card services More
c. Credit card services for merchants More
6. Other products supporting financial services, including electronic payment services and loan administration services
(excluding credit card, wire transfer, and automated clearing house (ACH) services)
Subtotal
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
21
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
22
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
23
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
24
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
2022
$
,000.00
25
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
26
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
27
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
28
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
29
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
30
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
31
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
32
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
33
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
34
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
1000
characters remaining
35
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_FI-52230_su.pdf Generated 2022-02-24 08:22:35
,000.00
36
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Securities exchange
523210 001
Commodities exchange
523210 002
Securities/commodities exchange clearinghouse
523999 002
Other primary business or activity
779000 001
Select Sector
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total revenue?
For further clarification, click the "Additional Information" link above.
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Support services for financial and commodity markets More
a. Payment clearing and settlement services for financial transactions, except trades of securities and commodity contracts
b. Trade execution, clearing, and settlement services for security and commodity contracts, excluding virtual
currency/cryptocurrency
c. Trading and clearing system services for security and commodity contracts, excluding virtual currency/cryptocurrency
d. Trading and clearing system services for virtual currency/cryptocurrency
Product Code
7005545000
7005545003
7005545006
7005545009
7005545011
7005545012
e. Listing services for security and commodity contracts
f. Support services for financial market and clearing products, not elsewhere classified
7005545016
7017450000
2. Regulation of securities markets
3. Other products supporting financial services, including electronic payment services and loan administration services (excluding credit
card, wire transfer, and automated clearing house (ACH) services)
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
b. Other products supporting financial services, including loan administration services and ATM services to customers other than a
financial institution's own deposit holders More
7005547000
7005547003
7005547006
Add product/service not listed
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Support services for financial and commodity markets More
a. Payment clearing and settlement services for financial transactions, except trades of securities and commodity
contracts
$
,000.00
7005545003
b. Trade execution, clearing, and settlement services for security and commodity contracts, excluding virtual
currency/cryptocurrency
$
,000.00
7005545006
c. Trading and clearing system services for security and commodity contracts, excluding virtual
currency/cryptocurrency
$
,000.00
7005545009
d. Trading and clearing system services for virtual currency/cryptocurrency
$
,000.00
7005545011
$
,000.00
7005545012
f. Support services for financial market and clearing products, not elsewhere classified
$
,000.00
7005545016
Subtotal
$
,000.00
7005545000
$
,000.00
7017450000
a. Electronic payment services (excluding credit card, wire transfer, and automated clearing house (ACH) services)
$
,000.00
7005547003
b. Other products supporting financial services, including loan administration services and ATM services to
customers other than a financial institution's own deposit holders More
$
,000.00
7005547006
Subtotal
$
,000.00
7005547000
$
,000.00
9900000000
e. Listing services for security and commodity contracts
2. Regulation of securities markets
3. Other products supporting financial services, including electronic payment services and loan administration services
(excluding credit card, wire transfer, and automated clearing house (ACH) services)
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
21
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
22
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
23
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
2022
$
,000.00
24
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
25
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
26
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:55
27
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
28
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
29
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
30
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
31
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
32
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
33
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
1000
characters remaining
34
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_FI-52321_su.pdf Generated 2022-02-24 08:25:56
,000.00
35
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Health insurance carrier
524114 005
Accident and disability income insurance carrier
524113 003
Dental and/or vision insurance carrier
524114 001
Health maintenance organization office - NOT providing hospital, medical, and/or dental services
524114 002
Preferred provider organization office - NOT providing hospital, medical, and/or dental services
524114 003
Dental insurance plan office - NOT providing hospital, medical, and/or dental services
524114 004
Property and casualty insurance carrier
524126 101
Life insurance carrier
524113 001
Reinsurance carrier including life, accident and health, property and casualty, surety, fidelity and liability, title or other reinsurance carrier
524130 005
Insurance agent or broker
524210 006
Other primary business or activity
779000 001
Select Sector
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total revenue?
For further clarification, click the "Additional Information" link above.
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Heath and accident insurance underwriting services - net premiums earned
a. Dental service plans for groups and individuals - underwriting services
b. Individual medical service plans - underwriting services
c. Supplemental Medicare insurance plans - underwriting services
d. Supplemental CHAMPUS/TRICARE insurance plans - underwriting services
e. Group managed care medical service plans - underwriting services
f. Group fee-for-service medical service plans - underwriting services
g. Accidental death and dismemberment, and disability income insurance plans - underwriting services
h. Other health and medical insurance - underwriting services
2. Life insurance underwriting services - net premiums earned
3. Reinsurance services for life and health insurance and annuities - premiums assumed
Product Code
7005000000
7005000003
7005000006
7005000009
7005000012
7005000015
7005000018
7005000021
7005000024
7004975000
7005555000
7005561000
4. Claims adjustment services More
5. Insurance support services, not elsewhere classified, including third party administration
6. Trading securities and commodity contracts on own account - net gains (losses) More
7005563000
8000150000
Add product/service not listed
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Heath and accident insurance underwriting services - net premiums earned
a. Dental service plans for groups and individuals - underwriting services
$
,000.00
7005000003
b. Individual medical service plans - underwriting services
$
,000.00
7005000006
c. Supplemental Medicare insurance plans - underwriting services
$
,000.00
7005000009
d. Supplemental CHAMPUS/TRICARE insurance plans - underwriting services
$
,000.00
7005000012
$
,000.00
7005000015
f. Group fee-for-service medical service plans - underwriting services
$
,000.00
7005000018
g. Accidental death and dismemberment, and disability income insurance plans - underwriting services
$
,000.00
7005000021
h. Other health and medical insurance - underwriting services
$
,000.00
7005000024
Subtotal
$
,000.00
7005000000
$
,000.00
7004975000
3. Reinsurance services for life and health insurance and annuities - premiums assumed
$
,000.00
7005555000
4. Claims adjustment services More
$
,000.00
7005561000
5. Insurance support services, not elsewhere classified, including third party administration
$
,000.00
7005563000
6. Trading securities and commodity contracts on own account - net gains (losses) More
$
,000.00
8000150000
TOTAL - Sum of lines should equal total Revenue reported in Item 5
$
,000.00
9900000002
e. Group managed care medical service plans - underwriting services
2. Life insurance underwriting services - net premiums earned
Add product/service not listed
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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22
Item 28: Special Items - Administrative Expenses and Benefits Paid (Losses)
ITEM 28: SPECIAL ITEMS - ADMINISTRATIVE EXPENSES AND BENEFITS PAID (LOSSES)
What were the benefits paid to policy holders (losses) and administrative expenses from providing insurance by this establishment in 2022?
INSTRUCTIONS FOR ADMINISTRATIVE EXPENSES
Include:
Commissions paid to salespersons on premiums and annuity considerations, including commissions and expense allowances on reinsurance assumed (net of commissions
received on reinsurance ceded)
Wages, salaries, and other compensation
Insurance taxes, licenses, and fees
Increase in loading on, and cost of collection in excess of loading on, deferred and uncollected premiums
Aggregate write-ins for deductions
Investment expenses, including investment taxes, licenses, and fees, depreciation on real estate and other invested assets. Assign real estate investment expenses to line 8 (all
other activities); assign all other investment expenses according to the distribution of reserves.
Other general insurance expenses
Exclude:
Federal income taxes
Activity
Benefits Paid (Losses)
Administrative Expenses
$
,000.00
$
,000.00
2. Health and medical reinsurance
$
,000.00
$
,000.00
3. Life insurance and annuities
$
,000.00
$
,000.00
4. Life reinsurance
$
,000.00
$
,000.00
5. Accident insurance
$
,000.00
$
,000.00
6. Accident reinsurance
$
,000.00
$
,000.00
$
,000.00
1. Health insurance and hospital and medical service plans
7. Providing claims processing and other administrative services for other parties
8. All other activities (i.e., property and casualty, including reinsurance, etc.)
$
,000.00
$
,000.00
9. TOTAL (Add lines 1 through 8.)
$
,000.00
$
,000.00
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
23
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
24
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
26
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
27
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
28
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
29
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
30
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
31
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
32
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
33
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
1000
characters remaining
34
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_FI-52410_su.pdf Generated 2022-02-24 08:28:09
,000.00
35
Attachment D-11
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 53
Attachment Sector
D-11
53
Instrument
Path
Instrument Path Title
53100
53110
53210
53300
Offices of Real Estate Agents and Brokers and Activities Related to
Real Estate
Real Estate Lessors
Automotive Equipment Rental and Leasing (Without Drivers)
Lessors of Nonfinancial Intangible Assets (except Copyrighted
Works)
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_RE-53100_su.pdf Generated 2022-02-24 08:16:17
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_RE-53100_su.pdf Generated 2022-02-24 08:16:17
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Individual rental properties in which a permanent leasing or property management office is not maintained
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Real estate agents/brokers
Agent or broker - residential real estate
531210 101
Agent or broker - nonresidential real estate
531210 901
Time share sales or resales by agent or broker
531210 102
Resort/vacation property rental and leasing by agent or broker
531210 103
Real estate property management (primarily engaged in managing property for others)
Property manager - residential real estate
531311 005
Property manager - nonresidential real estate
531312 002
Property owners' association, including home owners', condominium owners', and cooperative owners' associations (Not strictly providing
property management.)
813990 401
Resort/vacation property management
531311 003
Time share property management
531311 002
Activities related to real estate
Appraiser - real estate
531320 002
Listing service - real estate (excluding agents and brokers)
531390 001
Real estate consultant (excluding agents and brokers)
531390 004
Escrow agent - real estate
531390 003
Real estate relocation services
531390 006
Mortgage broker
522310 002
Landman, right of way leasing
531390 005
Lessors of real estate (property owned by you)
Lessor of apartment buildings with 5 or more housing units per building
531110 101
Lessor of residential space, excluding apartments with 5 or more housing units per building
531110 905
Lessor of office/professional space
531120 101
Lessor of shopping centers, retail shops
531120 303
Lessor of industrial buildings
531120 201
Other primary business or activity
Hotel management services (providing management and operating staff to run hotel)
721110 004
Vacation time share exchange services (except by offices of real estate agents)
561599 605
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779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Commissions and fees for managing, listing, selling, or renting property owned by others - not gross rents or gross sale price
Commissions and fees received on behalf of, and paid to, sales agents and to other brokers
Commissions and fees received from other brokers (co-brokerage fees)
Gross rents from properties owned by this establishment and leased to others
Reimbursements from property owners for miscellaneous expenditures
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
$
What was the total revenue?
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,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RE-53100_su.pdf Generated 2022-02-24 08:16:18
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Agent and brokerage services for the sale and rental of residential real estate - including real estate auction, relocation, and online
residential intermediary services More
a. Agent and brokerage services for the sale of residential real estate
b. Agent and brokerage services for the rental of residential real estate
2. Agent and brokerage services for the sale and rental of nonresidential real estate - includes real estate auction services More
a. Agent and brokerage services for the sale of nonresidential real estate
b. Agent and brokerage services for the rental of nonresidential real estate
3. Agent and brokerage services for the sale and rental of land - includes real estate auction services More
Product Code
7000250000
7000250003
7000250006
7007300000
7007300003
7007300006
7008200000
7008200003
a. Agent and brokerage services for the sale of land
7008200006
b. Agent and brokerage services for the rental of land
4. Real estate consulting services - includes real estate escrow, landman, and real estate asset management services
7008225000
7008250000
5. Real estate appraisal services
7008250003
a. Urban real estate appraisal services
7008250006
b. Rural real estate appraisal services
6. Property management services - includes payroll and repair reimbursements More
7008550000
7008550003
a. Residential building property management
7008550006
b. Nonresidential building property management
7008550009
c. Land property management
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7008275000
7. Real estate listing services
7012850000
8. Marketing research services
9. Home, apartment, rooming house, and other residential space rental and leasing More
10. Rental and leasing of office and professional space More
7000275000
7006325000
7006375000
11. Rental and leasing of commercial space More
12. Rental and leasing of industrial and manufacturing space More
7006400000
7003825000
13. Room or unit accommodation for travelers
14. Insurance brokerage and agency services - commissions and related fees
7005560000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Agent and brokerage services for the sale and rental of residential real estate - including real estate auction,
relocation, and online residential intermediary services More
a. Agent and brokerage services for the sale of residential real estate
$
,000.00
7000250003
b. Agent and brokerage services for the rental of residential real estate
$
,000.00
7000250006
Subtotal
$
,000.00
7000250000
a. Agent and brokerage services for the sale of nonresidential real estate
$
,000.00
7007300003
b. Agent and brokerage services for the rental of nonresidential real estate
$
,000.00
7007300006
Subtotal
$
,000.00
7007300000
a. Agent and brokerage services for the sale of land
$
,000.00
7008200003
b. Agent and brokerage services for the rental of land
$
,000.00
7008200006
Subtotal
$
,000.00
7008200000
$
,000.00
7008225000
a. Urban real estate appraisal services
$
,000.00
7008250003
b. Rural real estate appraisal services
$
,000.00
7008250006
Subtotal
$
,000.00
7008250000
2. Agent and brokerage services for the sale and rental of nonresidential real estate - includes real estate auction
services More
3. Agent and brokerage services for the sale and rental of land - includes real estate auction services More
4. Real estate consulting services - includes real estate escrow, landman, and real estate asset management services
5. Real estate appraisal services
6. Property management services - includes payroll and repair reimbursements More
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$
,000.00
7008550003
$
,000.00
7008550006
c. Land property management
$
,000.00
7008550009
Subtotal
$
,000.00
7008550000
7. Real estate listing services
$
,000.00
7008275000
8. Marketing research services
$
,000.00
7012850000
$
,000.00
7000275000
10. Rental and leasing of office and professional space More
$
,000.00
7006325000
11. Rental and leasing of commercial space More
$
,000.00
7006375000
12. Rental and leasing of industrial and manufacturing space More
$
,000.00
7006400000
13. Room or unit accommodation for travelers
$
,000.00
7003825000
14. Insurance brokerage and agency services - commissions and related fees
$
,000.00
7005560000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
a. Residential building property management
b. Nonresidential building property management
9. Home, apartment, rooming house, and other residential space rental and leasing More
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
37
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
38
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
Exclude:
Individual rental properties in which a permanent leasing or property management office is not maintained
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Lessors of residential properties (property owned by you)
Lessor of apartment buildings with 5 or more housing units per building
531110 101
Lessor of retirement housing with 5 or more housing units per building (without nursing care)
531110 102
Lessor of apartment buildings with 2 to 4 housing units per building
531110 901
Lessor of single-family houses, including townhouses
531110 902
Lessor of manufactured and/or mobile homes, on site
531110 904
Lessor of home sites for manufactured and/or mobile homes - land only
531190 101
Real estate investment trust - equity REIT - apartment buildings with 5 or more housing units per building
531110 103
Real estate investment trust - equity REIT - manufactured (mobile) home sites
531190 103
Real estate investment trust - equity REIT - dwellings other than apartment buildings
531110 903
Operator of trailer park or recreational vehicle park, overnight or short-term site rentals
721211 002
Nursing care facility, providing nursing and rehabilitative services, including inpatient hospice facility
623110 004
Lessors of nonresidential properties (property owned by you)
Lessor of self-service storage or miniwarehouses
531130 001
Lessor of office/professional buildings
531120 102
Lessor of shopping centers, retail shops - property operation only
531120 301
Lessor of industrial buildings
531120 201
Lessor of flea market spaces - under roof
531120 903
Lessor of flea market spaces, excluding under roof
531190 901
Lessor of hotel or motel buildings - property ownership and leasing
531120 902
Lessor of piers, docks, and associated buildings and facilities
531120 901
Real estate investment trust - equity REIT - miniwarehouses and self-storage units
531130 003
Real estate investment trust - equity REIT - shopping centers and retail stores
531120 302
Real estate investment trust - equity REIT - professional and office buildings
531120 103
Real estate investment trust - equity REIT - manufacturing and industrial buildings
531120 202
Real estate investment trust - equity REIT - other nonresidential buildings and facilities
531120 904
Real estate investment trust - equity REIT - other real property
531190 902
Other real estate activities
Property manager (primarily engaged in managing property for others) - residential real estate
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531311 001
15
Property manager (primarily engaged in managing property for others) - nonresidential real estate
531312 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Other primary business or activity
Hotel management services (providing management and operating staff to run hotel)
721110 004
Vacation time share exchange services (except by offices of real estate agents)
561599 605
Other primary business or activity
779000 001
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Gross rents from properties owned by this establishment and leased to others
Gross sales of real property subdivided or buildings built for sale by this establishment
Commissions and fees for managing, listing, selling, or renting property owned by others - not gross rents or gross sale price
Commissions and fees received on behalf of, and paid to, sales agents and to other brokers
Commissions and fees received from other brokers (co-brokerage fees)
Net gains (losses) on sale of investment or rental property owned by this establishment
Other investment income
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
$
What was the total revenue?
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,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RE-53110_su.pdf Generated 2022-02-24 08:17:30
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Home, apartment, rooming house, and other residential space rental and leasing More
a. Rental and leasing of residential space in houses for principal residence
b. Rental and leasing of residential space in apartments for principal residence
c. Rental and leasing of other residential space for principal use
Product Code
7000275000
7000275006
7000275009
7000275012
7000275003
d. Rental and leasing of land for residential use
7006300000
2. Rental and leasing of land for nonresidential use More
3. Rental and leasing of office and professional space More
7006325000
7006375000
4. Rental and leasing of commercial space More
7006375003
a. Rental and leasing of retail space in shopping malls
b. Rental and leasing of food service space in shopping malls
c. Rental and leasing of retail space in free-standing locations
d. Rental and leasing of food service space in free-standing locations
e. Rental and leasing of booths and chairs in beauty and personal care establishments
7006375006
7006375009
7006375012
7006375015
7006375018
f. Rental and leasing of other commercial space
5. Rental and leasing of industrial and manufacturing space More
7006400000
7006400003
a. Rental and leasing of space in industrial parks
b. Rental and leasing of industrial space, except in industrial parks
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7006400006
21
6. Rental of space for meetings, conventions, and similar short-term business uses More
7. Rental of mini-warehouses and self-storage units space More
8. Rental of space for weddings, banquets, parties, and similar short-term social uses More
9. Rental of space for sporting, entertainment, and other events More
10. Rental and leasing of nonresidential space in buildings or other facilities, not elsewhere specified, excluding hosting of coinoperated self-service gambling machines More
11. Property management services - includes payroll and repair reimbursements More
7006425000
7006450000
7006475000
7006500000
7006575000
7008550000
7008550003
a. Residential building property management
7008550006
b. Nonresidential building property management
7008550009
c. Land property management
7003825000
12. Room or unit accommodation for travelers
a. Room or unit accommodation for travelers, with maid service
b. Room or unit accommodation for travelers, without maid service
7003825003
7003825006
7003825009
c. Shared-room accommodation for travelers
13. Trading securities and commodity contracts on own account - includes interest income and other investment income - net
8000150000
8000175000
14. Gains (losses) from non-financial assets sold More
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Home, apartment, rooming house, and other residential space rental and leasing More
a. Rental and leasing of residential space in houses for principal residence
$
,000.00
7000275006
b. Rental and leasing of residential space in apartments for principal residence
$
,000.00
7000275009
c. Rental and leasing of other residential space for principal use
$
,000.00
7000275012
d. Rental and leasing of land for residential use
$
,000.00
7000275003
Subtotal
$
,000.00
7000275000
$
,000.00
7006300000
$
,000.00
7006325000
$
,000.00
7006375003
b. Rental and leasing of food service space in shopping malls
$
,000.00
7006375006
c. Rental and leasing of retail space in free-standing locations
$
,000.00
7006375009
d. Rental and leasing of food service space in free-standing locations
$
,000.00
7006375012
e. Rental and leasing of booths and chairs in beauty and personal care establishments
$
,000.00
7006375015
f. Rental and leasing of other commercial space
$
,000.00
7006375018
Subtotal
$
,000.00
7006375000
$
,000.00
7006400003
2. Rental and leasing of land for nonresidential use More
3. Rental and leasing of office and professional space More
4. Rental and leasing of commercial space More
a. Rental and leasing of retail space in shopping malls
5. Rental and leasing of industrial and manufacturing space More
a. Rental and leasing of space in industrial parks
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23
$
,000.00
7006400006
$
,000.00
7006400000
6. Rental of space for meetings, conventions, and similar short-term business uses More
$
,000.00
7006425000
7. Rental of mini-warehouses and self-storage units space More
$
,000.00
7006450000
8. Rental of space for weddings, banquets, parties, and similar short-term social uses More
$
,000.00
7006475000
9. Rental of space for sporting, entertainment, and other events More
$
,000.00
7006500000
10. Rental and leasing of nonresidential space in buildings or other facilities, not elsewhere specified, excluding hosting
of coin-operated self-service gambling machines More
$
,000.00
7006575000
a. Residential building property management
$
,000.00
7008550003
b. Nonresidential building property management
$
,000.00
7008550006
c. Land property management
$
,000.00
7008550009
Subtotal
$
,000.00
7008550000
a. Room or unit accommodation for travelers, with maid service
$
,000.00
7003825003
b. Room or unit accommodation for travelers, without maid service
$
,000.00
7003825006
c. Shared-room accommodation for travelers
$
,000.00
7003825009
Subtotal
$
,000.00
7003825000
13. Trading securities and commodity contracts on own account - includes interest income and other investment income
- net
$
,000.00
8000150000
14. Gains (losses) from non-financial assets sold More
$
,000.00
8000175000
TOTAL - Sum of lines should equal total Revenue reported in Item 5
$
,000.00
9900000002
b. Rental and leasing of industrial space, except in industrial parks
Subtotal
11. Property management services - includes payroll and repair reimbursements More
12. Room or unit accommodation for travelers
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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25
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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29
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
37
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
38
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
If more than one establishment:
Separate automotive rental offices or concessions (for example, airport locations) in the same metropolitan area, for which a common fleet is maintained, should not be considered
separate locations for the purpose of this report. Data for offices that share a common fleet should be included with the controlling main or branch location for that metropolitan area.
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Passenger car rental and leasing
Renting passenger cars, passenger vans, and sport utility vehicles without drivers on a short-term basis
532111 001
Leasing passenger cars, passenger vans, and sport utility vehicles without drivers
532112 001
Third party financing of passenger car, passenger van, and sport utility vehicle leases
522220 903
Truck rental and leasing
Renting trucks, including nonpassenger vans, buses, truck tractors, truck trailers, semitrailers, and storage semitrailers without drivers on a
short-term basis
532120 101
Leasing trucks, including nonpassenger vans, buses, truck tractors, truck trailers, semitrailers, and storage semitrailers without drivers
532120 201
Renting or leasing trucks with drivers (truckload) - local
484110 502
Renting or leasing trucks with drivers (truckload) - excluding local
484121 002
Third party financing of trucks, including nonpassenger van, truck tractor, truck trailer, semitrailer, and storage semitrailer leases
522220 904
Other automotive rental and leasing
Renting and/or leasing utility trailers
532120 901
Renting motor homes, travel trailers, and RV's
532120 902
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Include:
Revenue derived from rentals and operating leases
If you hold the leases, interest from capital, finance, and full-payout leases
If you do not hold the leases, the fair sales value of merchandise marketed by your firm under capital, finance, or full-payout leases
Exclude:
Revenue from sales of used equipment previously rented or leased to customers
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
$
What was the total revenue?
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total revenue (reported in Item 5) by class of customer?
2022
%
1. Individuals
2. Federal, state, and local governments
%
3. Businesses and all other
%
%
4. TOTAL - Sum should equal 100%
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20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7003800000
1. Rental of automobiles and light-duty trucks
a. Rental of automobiles and light-duty trucks, nonelectric
b. Rental of automobiles and light-duty trucks, electric and hybrid
7003800003
7003800006
7005528000
2. Automobile and light-duty truck leasing services
a. Automobile and light-duty truck leasing services, nonelectric
b. Automobile and light-duty truck leasing services, electric and hybrid
3. Rental and leasing, excluding financial, of heavy trucks, truck trailers, and buses More
a. Rental, excluding leasing, of heavy trucks, truck trailers, and buses
b. Leasing, excluding financial, of heavy trucks, truck trailers, and buses
4. Rental and leasing services, excluding financial, for motor homes, travel trailers, campers, and utility trailers More
5. Finance leasing services, except automobile and light-duty truck leasing services
6. Protection plans, damage waivers, warranty programs, and liability insurance - Insurance brokerage and agency services
7. Maintenance and repair services for automobiles and light-duty trucks
8. Maintenance and repair and related services for motor homes, travel trailers, and campers
9. Maintenance and repair services for heavy trucks and buses
7005528003
7005528006
7009275000
7009275003
7009275006
7002875000
7005529000
7005560000
7002625000
7002900000
7009375000
Add product/service not listed
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21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Rental of automobiles and light-duty trucks
a. Rental of automobiles and light-duty trucks, nonelectric
$
,000.00
7003800003
b. Rental of automobiles and light-duty trucks, electric and hybrid
$
,000.00
7003800006
Subtotal
$
,000.00
7003800000
a. Automobile and light-duty truck leasing services, nonelectric
$
,000.00
7005528003
b. Automobile and light-duty truck leasing services, electric and hybrid
$
,000.00
7005528006
Subtotal
$
,000.00
7005528000
$
,000.00
7009275003
$
,000.00
7009275006
$
,000.00
7009275000
4. Rental and leasing services, excluding financial, for motor homes, travel trailers, campers, and utility trailers More
$
,000.00
7002875000
5. Finance leasing services, except automobile and light-duty truck leasing services
$
,000.00
7005529000
6. Protection plans, damage waivers, warranty programs, and liability insurance - Insurance brokerage and agency
services
$
,000.00
7005560000
7. Maintenance and repair services for automobiles and light-duty trucks
$
,000.00
7002625000
8. Maintenance and repair and related services for motor homes, travel trailers, and campers
$
,000.00
7002900000
9. Maintenance and repair services for heavy trucks and buses
$
,000.00
7009375000
2. Automobile and light-duty truck leasing services
3. Rental and leasing, excluding financial, of heavy trucks, truck trailers, and buses More
a. Rental, excluding leasing, of heavy trucks, truck trailers, and buses
b. Leasing, excluding financial, of heavy trucks, truck trailers, and buses
Subtotal
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22
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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23
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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24
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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28
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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30
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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31
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
1000
characters remaining
36
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RE-53210_su.pdf Generated 2022-02-24 08:15:10
,000.00
37
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Franchise leasing/licensing, without primarily selling products to the franchisee
533110 901
Patent leasing/licensing of products designed or invented by other companies
533110 902
Trademark leasing/licensing of products designed or invented by other companies
533110 903
Music publishing, excluding sheet music and music books
512230 901
Other copyright leasing/licensing - Describe type of works copyrighted
777530 005
Describe
Patent leasing/licensing of products designed or invented by this company - Describe products
777530 003
Describe
Oil royalty company
533110 101
Other primary business or activity
779000 001
Select Sector
Describe
2022_RE-53300_su.pdf Generated 2022-02-24 08:21:23
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_RE-53300_su.pdf Generated 2022-02-24 08:21:23
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What was the total revenue?
For further clarification, click the "Additional Information" link above.
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Licensing of rights to use intellectual property protected by patent
2. Licensing of rights to use intellectual property protected by trademark
3. Licensing of rights to use intellectual property protected as industrial property, not elsewhere classified
4. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
5. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings
6. Leasing of rights to explore for and exploit natural resources
7. Leasing of other rights related to intellectual property, not elsewhere classified
Product Code
7009600000
7009625000
7009650000
7009576000
7009581000
7010200000
7010250000
7010260000
8. Franchising agreements
9. Trading securities and commodity contracts on own account - includes interest income and other investment income - net
8000150000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Licensing of rights to use intellectual property protected by patent
$
,000.00
7009600000
2. Licensing of rights to use intellectual property protected by trademark
$
,000.00
7009625000
3. Licensing of rights to use intellectual property protected as industrial property, not elsewhere classified
$
,000.00
7009650000
4. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
$
,000.00
7009576000
5. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings
$
,000.00
7009581000
6. Leasing of rights to explore for and exploit natural resources
$
,000.00
7010200000
7. Leasing of other rights related to intellectual property, not elsewhere classified
$
,000.00
7010250000
8. Franchising agreements
$
,000.00
7010260000
9. Trading securities and commodity contracts on own account - includes interest income and other investment income net
$
,000.00
8000150000
TOTAL - Sum of lines should equal total Revenue reported in Item 5
$
,000.00
9900000002
Add product/service not listed
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
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2022
$
,000.00
24
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
34
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_RE-53300_su.pdf Generated 2022-02-24 08:21:23
,000.00
35
Attachment D-12
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 54
Attachment Sector
Instrument
Path
Instrument Path Title
D-12
5403X
54
54140
5415C
54162
Architectural and Landscape Architectural Services (Enterprise
Support)
Specialized Design Services
Computer Systems Design and Related Services and Management,
Scientific, and Technical Consulting Services (Classification)
Environmental Consulting and Other Scientific and Technical
Consulting Services
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all locations of a company or
organization, including administrative offices, warehouses, etc., that were in operation at any time during 2022. Report activity for each establishment on a separate form.
DEFINITION OF AN ENTERPRISE
An enterprise or company is a business, service, or membership organization consisting of one or more establishments within the United States under common ownership or control. It
includes all establishments of subsidiary companies, where there is more than 50 percent ownership, as well as establishments of firms which the enterprise has the power to direct or
cause the direction of management and policies.
DEFINITION OF AN ENTERPRISE SUPPORT ESTABLISHMENT
An enterprise support establishment is an establishment that is primarily engaged in performing management, supervision, general administrative functions, and supporting services for
other establishments of the same enterprise, rather than for the general public or other business firms.
PHYSICAL ADDRESS
Please update the location's physical address if needed.
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Architectural and engineering services
Architectural services, excluding landscape architectural services
541310 003
Landscape architectural services, excluding landscaping and landscape construction
541320 005
Engineering services, including construction engineering services
541330 00B
Design services
Interior design services
541410 001
Graphic design services
541430 001
Administrative services
Corporate, subsidiary, or regional managing office engaged in management of, or providing more than one centralized administrative support
functions to, other establishments of the company (Offices engaged in only one type of specific activity should select another kind of
business or activity.)
551114 001
Other primary business or activity
Urban/city/regional planning and design services
541320 00A
Landscape maintenance and installation services
561730 003
Drafting services, including CAD (Computer Aided Design) drafting and steel detailing
541340 006
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
10
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Sales, Receipts, or Revenue
Include:
Sales, receipts, or revenue from customers outside your enterprise originating from this location.
Exclude:
Sales, receipts, or revenue from other establishments within your own enterprise.
For further clarification, click "Additional Information" link above.
Check
if
None
What were the sales, receipts, or revenue (exclude billings) from customers outside your enterprise originating from
this location?
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
2022
$
,000.00
11
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
2022
$
,000.00
$
,000.00
12
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
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Item 8: Support Services - Continued
ITEM 8: SUPPORT SERVICES - PRIMARY BUSINESS OR ACTIVITY OF THE OPERATING ESTABLISHMENTS SERVICED
What primary kind of business or activity is performed by the establishments of your enterprise that are managed or serviced by this establishment?
Example: If this establishment is a corporate, subsidiary, or regional managing office, data processing service center, or administrative/support office to a chain of clothing stores, please
describe "clothing stores" below.
Describe
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Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES
Report the payment of selected expenses allocated by category
Report payments for expenses directly incurred by this establishment in column 1.
Report payments made by this establishment for expenses incurred by other establishments of your enterprise in column 2 (where applicable).
Exclude:
Transfers made within the company
Capitalized expenses
Impairment
Interest
Bad debt
Income tax
Taxes collected from customers (e.g., sales and excise)
Cost of merchandise for resale
Personnel costs, except payroll
1. Employer's cost for employer paid insurance premiums,
pension plans, payroll taxes, and other employee
benefits More
Check
if
None
2022 Expenses of this
establishment ONLY
$
,000.00
$
,000.00
3. Expensed computer hardware and other equipment More
$
,000.00
4. Expensed purchases of other materials, parts, and
supplies More
$
,000.00
5. Expensed purchases of software More
$
,000.00
6. Purchased electricity More
$
,000.00
7. Purchased fuels (Exclude motor fuels.) More
$
,000.00
2. Temporary staff and leased employee expense More
Expensed equipment and materials
Expensed purchased services
2022 Payments made by
this establishment on
behalf of other
establishments of your
enterprise
Check
if
None
8. Data processing and other purchased computer
services More
$
,000.00
$
,000.00
9. Purchased communication services More
$
,000.00
$
,000.00
10. Purchased repairs and maintenance to machinery,
vehicles, and equipment More
$
,000.00
$
,000.00
11. Purchased repairs and maintenance to buildings,
structures, and offices More
$
,000.00
$
,000.00
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12. Water, sewer, refuse removal, and other utility
payments More
$
,000.00
$
,000.00
13. Purchased advertising and promotional services More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
15. Lease and rental payments for machinery, equipment,
and other tangible items More
$
,000.00
$
,000.00
16. Lease and rental payments for land, buildings,
structures, store spaces, and offices More
$
,000.00
$
,000.00
17. Governmental taxes and license fees (Exclude sales,
excise, and income taxes.) More
$
,000.00
$
,000.00
18. Depreciation and amortization charges More
$
,000.00
19. All other selected expenses
(Describe - If more than 50% of TOTAL reported on line
20.) More
$
,000.00
$
,000.00
14. Purchased professional and technical services More
Other selected expenses
Describe
20. TOTAL SELECTED EXPENSES of this establishment
ONLY, excluding payroll (Add lines 1 through 19.)
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Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the estimated percentage of receipts (reported in Item 5) from services provided to clients outside your enterprise by class of customer?
2022
%
1. Federal government
%
2. State and local governments, including public authorities
3. Construction firms
%
4. Architectural firms
%
5. Engineering firms
%
6. All other business firms and organizations
(Manufacturing, utilities, mining, shopping centers, office buildings, etc.)
%
7. Not-for-profit organizations
(Include religious organizations.)
%
8. Household consumers and individuals
(Report fees from individually owned businesses on lines 3, 4, 5, or 6 as appropriate.)
%
9. TOTAL (Sum of lines 1 through 8 should equal 100%.)
%
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Architectural services for apartment building and other nonresidential building projects More
2. Architectural services for residential building projects, excluding apartment building projects More
3. Architectural services for historical restoration projects More
Product Code
7006775000
7000625000
7006800000
7007525000
4. Architectural consulting services More
5. Landscape architectural services for residential building projects, excluding apartment building projects More
6. Landscape architectural services for nonresidential building projects, including apartment building projects More
7. Landscape architectural services for recreational and open space projects More
8. Landscape architectural services, specific elements More
7000650000
7006825000
7006850000
7007550000
7007575000
9. Landscape architectural consulting services More
7006925000
10. Development of comprehensive urban plans More
7006950000
11. Development of community urban plans More
7006975000
12. Development of urban plan elements
7007000000
13. Urban planning consulting services More
7007600000
14. Project site master planning services More
15. Construction project management services, excluding at-risk More
16. Project management services, except construction More
3004800000
7014925000
7000645000
17. Residential landscaping services More
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
18
7006750000
18. Exterior commercial landscaping services More
7008000000
19. Full-service interior design services More
7008025000
20. Interior design services, excluding full-service More
21. Engineering services for residential building projects, excluding apartment building projects More
22. Engineering services for commercial, public and institutional building projects, including apartment building projects More
7000640000
7007025000
Add product/service not listed
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Architectural services for apartment building and other nonresidential building projects More
$
,000.00
7006775000
2. Architectural services for residential building projects, excluding apartment building projects More
$
,000.00
7000625000
3. Architectural services for historical restoration projects More
$
,000.00
7006800000
4. Architectural consulting services More
$
,000.00
7007525000
$
,000.00
7000650000
6. Landscape architectural services for nonresidential building projects, including apartment building projects More
$
,000.00
7006825000
7. Landscape architectural services for recreational and open space projects More
$
,000.00
7006850000
8. Landscape architectural services, specific elements More
$
,000.00
7007550000
9. Landscape architectural consulting services More
$
,000.00
7007575000
10. Development of comprehensive urban plans More
$
,000.00
7006925000
$
,000.00
7006950000
12. Development of urban plan elements
$
,000.00
7006975000
13. Urban planning consulting services More
$
,000.00
7007000000
14. Project site master planning services More
$
,000.00
7007600000
15. Construction project management services, excluding at-risk More
$
,000.00
3004800000
16. Project management services, except construction More
$
,000.00
7014925000
17. Residential landscaping services More
$
,000.00
7000645000
18. Exterior commercial landscaping services More
$
,000.00
7006750000
5. Landscape architectural services for residential building projects, excluding apartment building projects More
11. Development of community urban plans More
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
20
19. Full-service interior design services More
$
,000.00
7008000000
20. Interior design services, excluding full-service More
$
,000.00
7008025000
21. Engineering services for residential building projects, excluding apartment building projects More
$
,000.00
7000640000
22. Engineering services for commercial, public and institutional building projects, including apartment building
projects More
$
,000.00
7007025000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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21
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
22
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
2022
$
,000.00
23
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
24
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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25
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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26
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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27
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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28
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-5403X_mu.pdf Generated 2022-02-24 06:25:40
29
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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30
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
32
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Design services
Graphic design services
541430 001
Communication design services
541430 005
Interior design services - planning, designing, and administering projects in interior spaces to meet the physical and aesthetic needs of
people using the spaces
541410 002
Interior decorating consultant - advising on interior decorating
541410 003
Advertising agency - creating advertising campaigns and placing advertising with media
541810 001
Industrial design services - developing designs that optimize the use, value, and appearance of products
541420 001
Engineering design services - applying principles of engineering in the design and development of machines and products
541330 00C
Fashion design services
541490 001
Commercial art services
541430 002
Display advertising
541850 004
Architectural services, excluding landscape
541310 001
Furniture store, except custom
442110 501
Other primary business or activity
Commercial photography services
541922 001
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
2022
$
,000.00
$
,000.00
19
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
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Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating receipts (reported in Item 5) by class of customer?
2022
%
1. Business firms and farms
2. Not-for-profit organizations (Include religious organizations.)
%
%
3. Federal government
4. State and local governments
%
5. Household consumers and individuals (Report receipts from individually owned businesses on line 1.)
%
6. TOTAL (Sum of lines 1 through 5 should equal 100%.)
%
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7008000000
1. Full-service interior design services More
a. Full-service interior design services for residential buildings, except historical restoration
b. Full-service interior design services for nonresidential buildings, except historical restoration
c. Full-service interior design services for restoration of historic buildings
7008000003
7008000006
7008000009
7008025000
2. Interior design services, except full-service More
7000630000
3. Interior decorating services More
7012050000
4. Industrial design services More
7012050003
a. Industrial design services for products
7012050006
b. Model design and fabrication services More
c. Consulting services for industrial design and other industrial design services
5. Developing and making prototypes of other goods (excluding aircraft, aircraft engines and parts, guided missiles, space vehicles,
space vehicle engines, propulsion units, and missile and space vehicle parts and components)
6. Graphic design services, except advertising graphic design
7012050009
2019365000
7012075000
7012075003
a. Graphic design services for corporate identity More
7012075009
b. Graphic design services for publications
7012075012
c. Graphic design services for commercial illustrations
d. Graphic interface and interaction design services More
7012075015
7012075018
e. Graphic design services, not elsewhere classified
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
22
7012028000
7. Integrated website design and development services
8. Advertising creative services, including advertising and promotional graphic design services
7012475000
7014500000
9. Information and document transformation services
7014500003
a. Imaging and other data capture services
b. Data plotting, printing, conversion, and migration services
10. Other printing and related contract manufacturing services, performed using materials owned by others (i.e., the customer)
11. Clothing and other specialized design services, not elsewhere classified
7014500006
2053415000
7012100000
7012100003
a. Clothing design services
b. Other specialized design services, not elsewhere classified
7012100006
Add product/service not listed
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Full-service interior design services More
a. Full-service interior design services for residential buildings, except historical restoration
$
,000.00
7008000003
b. Full-service interior design services for nonresidential buildings, except historical restoration
$
,000.00
7008000006
c. Full-service interior design services for restoration of historic buildings
$
,000.00
7008000009
Subtotal
$
,000.00
7008000000
2. Interior design services, except full-service More
$
,000.00
7008025000
3. Interior decorating services More
$
,000.00
7000630000
a. Industrial design services for products
$
,000.00
7012050003
b. Model design and fabrication services More
$
,000.00
7012050006
$
,000.00
7012050009
$
,000.00
7012050000
$
,000.00
2019365000
a. Graphic design services for corporate identity More
$
,000.00
7012075003
b. Graphic design services for publications
$
,000.00
7012075009
c. Graphic design services for commercial illustrations
$
,000.00
7012075012
d. Graphic interface and interaction design services More
$
,000.00
7012075015
4. Industrial design services More
c. Consulting services for industrial design and other industrial design services
Subtotal
5. Developing and making prototypes of other goods (excluding aircraft, aircraft engines and parts, guided missiles,
space vehicles, space vehicle engines, propulsion units, and missile and space vehicle parts and components)
6. Graphic design services, except advertising graphic design
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
24
e. Graphic design services, not elsewhere classified
$
,000.00
7012075018
Subtotal
$
,000.00
7012075000
$
,000.00
7012028000
$
,000.00
7012475000
a. Imaging and other data capture services
$
,000.00
7014500003
b. Data plotting, printing, conversion, and migration services
$
,000.00
7014500006
Subtotal
$
,000.00
7014500000
$
,000.00
2053415000
$
,000.00
7012100003
b. Other specialized design services, not elsewhere classified
$
,000.00
7012100006
Subtotal
$
,000.00
7012100000
$
,000.00
9900000000
7. Integrated website design and development services
8. Advertising creative services, including advertising and promotional graphic design services
9. Information and document transformation services
10. Other printing and related contract manufacturing services, performed using materials owned by others (i.e., the
customer)
11. Clothing and other specialized design services, not elsewhere classified
a. Clothing design services
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
28
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
2022
$
,000.00
29
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
30
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
31
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
32
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
33
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
34
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
35
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
36
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
37
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
38
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
1000
characters remaining
39
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_PS-54140_su.pdf Generated 2022-02-24 06:59:49
,000.00
40
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
3
Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
4
Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
5
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Management and consulting services
Administrative and general management consulting services, including strategic planning and organizational change
541611 002
Marketing consulting services, including sales management, customer service, and marketing planning/strategy
541613 001
Management and administrative services - providing day-to-day administrative services such as personnel management, bookkeeping,
billing, etc., for a client's business or operation (Exclude administrative activities provided for own company.)
561110 001
Environmental consulting services, excluding engineering
541620 005
Human resources and personnel management consulting services
541612 301
Financial management consulting services, excluding investment advice
541611 003
Manufacturing operations management consulting services
541614 004
Physical distribution and logistics consulting services
541614 001
Actuarial consulting services
541612 101
Employee benefit consulting services
541612 302
Transportation management consulting services
541614 006
Outplacement consulting services
561312 002
Agricultural consulting services
541690 902
Other management consulting services
541618 001
Computer services
Data processing service center - providing data entry, image processing, database management, record conversion, and other computer
processing services from central processing centers and cloud services
518210 009
Data storage services, including remote backup and storage of computer data
518210 002
Cloud computing and cloud storage
518210 00B
Custom computer programming services - writing, modifying, testing, and supporting software to meet the needs of a particular customer,
including web design and network software
541511 001
Custom software development services
541511 002
Computer systems integrator services - analyzing a client's computer needs and bundling software and hardware to deliver an integrated
system to meet those specialized needs
541512 101
Computer systems design services, excluding software development
541512 203
Computer systems facilities support services - on-site management and operation of a client's computer systems
541513 003
Computer-related consulting, including domain registration and software/hardware installation services (exclude computer systems
consulting or design services)
541519 001
Software publishers, including developing and publishing or publishing only, packaged software, including cloud-based
511210 001
Computer software/hardware consulting services
541512 206
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
6
Other primary business or activity
Executive search services
561312 001
Engineering services, including construction engineering services
541330 00B
Certified public accountant (CPA)
541211 001
Accountant, excluding CPA
541219 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
7
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_PS-5415C_su.pdf Generated 2022-02-24 06:23:54
1000
characters remaining
8
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Scientific and technical consulting services
Environmental consulting services, excluding engineering
541620 005
Consulting engineering services, including environmental engineering
541330 00D
Safety or security consulting services
541690 901
Scientific consulting services, such as geological, chemical, and biological (except economic, meteorological, environmental, and
engineering consulting services)
541690 905
Computer systems design services
541512 205
Economic consulting services
541690 101
Pharmaceutical or clinical consulting services
541690 906
Energy management consulting services
541690 904
Educational consulting services, excluding management consulting
611710 104
Industrial design consulting services
541420 002
Other primary business or activity
Management consulting services
541611 004
Other primary business or activity
779000 001
Select Sector
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
2022
$
,000.00
$
,000.00
19
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
20
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating receipts (reported in Item 5) by class of customer?
2022
%
1. Business firms and farms
2. Not-for-profit organizations (Include religious organizations.)
%
%
3. Federal government
4. State and local governments
%
5. Household consumers and individuals (Report receipts from individually owned businesses on line 1.)
%
6. TOTAL (Sum of lines 1 through 5 should equal 100%.)
%
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
6000800000
1. Environmental assessment services More
6000800003
a. Environmental assessment services, integrated More
6000800006
b. Environmental assessment services, air
6000800009
c. Environmental assessment services, water
6000800012
d. Environmental assessment services, soil
6000800015
e. Environmental assessment services, noise
6000850000
2. Site remediation planning services More
6000850003
a. Site remediation planning services, integrated More
6000850006
b. Site remediation planning services, air
6000850009
c. Site remediation planning services, water
6000850012
d. Site remediation planning services, soil
6000850015
e. Site remediation planning services, noise
6000825000
3. Environmental audit services More
6000825003
a. Environmental audit services, integrated More
6000825006
b. Environmental audit services, air
6000825009
c. Environmental audit services, water
6000825012
d. Environmental audit services, soil
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
22
6000825015
e. Environmental audit services, noise
6000875000
4. Evaluation of environmental studies
6000900000
5. Natural resource management consulting services More
6000925000
6. Waste management consulting services
6000925003
a. Hazardous waste management consulting services
b. Non-hazardous waste management consulting services
6000925006
6000950000
7. Environmental policy development consulting services
8. Environmental consulting services, except environmental litigation support
6000980000
6001000000
9. Environmental licensing and permitting services
7012265000
10. Economic consulting services
11. Information technology (IT) technical consulting services
12. Scientific and technical consulting services, not elsewhere classified
a. Agricultural, fisheries, and biological consulting services
7014225000
7012270000
7012270003
7012270006
b. Occupational health and safety consulting services
7012270009
c. Public safety and security consulting services
7012270012
d. Energy, mining, and geological consulting services
7012270015
e. Geophysical consulting services
7012270018
f. Consulting services for research and development
g. Other scientific and technical consulting services, not elsewhere classified
13. Strategic management consulting and implementation services
14. Marketing management consulting and implementation services
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
7012270021
7014550000
7014600000
23
15. Human resources management consulting and implementation services
16. Operations and supply chain management consulting and implementation services
17. Construction project management services, excluding at-risk
7014625000
7014650000
3004800000
7014675000
18. Other facility support services
Add product/service not listed
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Environmental assessment services More
a. Environmental assessment services, integrated More
$
,000.00
6000800003
b. Environmental assessment services, air
$
,000.00
6000800006
c. Environmental assessment services, water
$
,000.00
6000800009
d. Environmental assessment services, soil
$
,000.00
6000800012
e. Environmental assessment services, noise
$
,000.00
6000800015
Subtotal
$
,000.00
6000800000
a. Site remediation planning services, integrated More
$
,000.00
6000850003
b. Site remediation planning services, air
$
,000.00
6000850006
c. Site remediation planning services, water
$
,000.00
6000850009
$
,000.00
6000850012
e. Site remediation planning services, noise
$
,000.00
6000850015
Subtotal
$
,000.00
6000850000
a. Environmental audit services, integrated More
$
,000.00
6000825003
b. Environmental audit services, air
$
,000.00
6000825006
c. Environmental audit services, water
$
,000.00
6000825009
2. Site remediation planning services More
d. Site remediation planning services, soil
3. Environmental audit services More
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
25
d. Environmental audit services, soil
$
,000.00
6000825012
e. Environmental audit services, noise
$
,000.00
6000825015
Subtotal
$
,000.00
6000825000
$
,000.00
6000875000
$
,000.00
6000900000
a. Hazardous waste management consulting services
$
,000.00
6000925003
b. Non-hazardous waste management consulting services
$
,000.00
6000925006
Subtotal
$
,000.00
6000925000
7. Environmental policy development consulting services
$
,000.00
6000950000
8. Environmental consulting services, except environmental litigation support
$
,000.00
6000980000
9. Environmental licensing and permitting services
$
,000.00
6001000000
10. Economic consulting services
$
,000.00
7012265000
11. Information technology (IT) technical consulting services
$
,000.00
7014225000
a. Agricultural, fisheries, and biological consulting services
$
,000.00
7012270003
b. Occupational health and safety consulting services
$
,000.00
7012270006
c. Public safety and security consulting services
$
,000.00
7012270009
d. Energy, mining, and geological consulting services
$
,000.00
7012270012
$
,000.00
7012270015
$
,000.00
7012270018
4. Evaluation of environmental studies
5. Natural resource management consulting services More
6. Waste management consulting services
12. Scientific and technical consulting services, not elsewhere classified
e. Geophysical consulting services
f. Consulting services for research and development
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
26
g. Other scientific and technical consulting services, not elsewhere classified
$
,000.00
7012270021
Subtotal
$
,000.00
7012270000
13. Strategic management consulting and implementation services
$
,000.00
7014550000
14. Marketing management consulting and implementation services
$
,000.00
7014600000
$
,000.00
7014625000
16. Operations and supply chain management consulting and implementation services
$
,000.00
7014650000
17. Construction project management services, excluding at-risk
$
,000.00
3004800000
18. Other facility support services
$
,000.00
7014675000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
15. Human resources management consulting and implementation services
Add product/service not listed
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
27
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
28
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
29
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
2022
$
,000.00
30
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
31
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
32
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
33
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
34
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
35
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
36
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
37
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
38
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
39
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
1000
characters remaining
40
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_PS-54162_su.pdf Generated 2022-02-24 06:55:24
,000.00
41
Attachment D-13
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 55
Attachment Sector
Instrument
Path
Instrument Path Title
D-13
5511X
55
55111
Corporate, Subsidiary, and Regional Managing Offices (Enterprise
Support)
Holding Companies
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all locations of a company or
organization, including administrative offices, warehouses, etc., that were in operation at any time during 2022. Report activity for each establishment on a separate form.
DEFINITION OF AN ENTERPRISE
An enterprise or company is a business, service, or membership organization consisting of one or more establishments within the United States under common ownership or control. It
includes all establishments of subsidiary companies, where there is more than 50 percent ownership, as well as establishments of firms which the enterprise has the power to direct or
cause the direction of management and policies.
DEFINITION OF AN ENTERPRISE SUPPORT ESTABLISHMENT
An enterprise support establishment is an establishment that is primarily engaged in performing management, supervision, general administrative functions, and supporting services for
other establishments of the same enterprise, rather than for the general public or other business firms.
PHYSICAL ADDRESS
Please update the location's physical address if needed.
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
4
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
5
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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6
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
7
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
8
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Corporate, subsidiary, or regional managing offices
Corporate, subsidiary, or regional managing office engaged in management of, or providing more than one centralized administrative support
functions to, other establishments of the company (Offices engaged in only one type of specific activity should select another kind of
business or activity.)
551114 001
Holding companies, excluding bank and financial holding companies
Holding company NOT engaged in direct management of held company(ies)
551112 001
Holding company engaged in direct management of held company(ies)
551114 003
Bank and financial holding companies (Registered with the Board of Governors of the Federal Reserve.)
Bank holding company
551111 001
Financial holding company
551112 002
Other kind of support service or activity
Data processing center or facility
518210 008
Other primary business or activity
779000 001
Select Sector
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
9
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
%
10
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Sales, Receipts, or Revenue
Include:
Sales, receipts, or revenue from customers outside your enterprise originating from this location.
Exclude:
Sales, receipts, or revenue from other establishments within your own enterprise.
For further clarification, click "Additional Information" link above.
Check
if
None
What were the sales, receipts, or revenue (exclude billings) from customers outside your enterprise originating from
this location?
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
2022
$
,000.00
11
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
2022
$
,000.00
$
,000.00
12
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
13
Item 8: Support Services - Continued
ITEM 8: SUPPORT SERVICES - PRIMARY BUSINESS OR ACTIVITY OF THE OPERATING ESTABLISHMENTS SERVICED
What primary kind of business or activity is performed by the establishments of your enterprise that are managed or serviced by this establishment?
Example: If this establishment is a corporate, subsidiary, or regional managing office, data processing service center, or administrative/support office to a chain of clothing stores, please
describe "clothing stores" below.
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
14
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES
Report the payment of selected expenses allocated by category
Report payments for expenses directly incurred by this establishment in column 1.
Report payments made by this establishment for expenses incurred by other establishments of your enterprise in column 2 (where applicable).
Exclude:
Transfers made within the company
Capitalized expenses
Impairment
Interest
Bad debt
Income tax
Taxes collected from customers (e.g., sales and excise)
Cost of merchandise for resale
Personnel costs, except payroll
1. Employer's cost for employer paid insurance premiums,
pension plans, payroll taxes, and other employee
benefits More
Check
if
None
2022 Expenses of this
establishment ONLY
$
,000.00
$
,000.00
3. Expensed computer hardware and other equipment More
$
,000.00
4. Expensed purchases of other materials, parts, and
supplies More
$
,000.00
5. Expensed purchases of software More
$
,000.00
6. Purchased electricity More
$
,000.00
7. Purchased fuels (Exclude motor fuels.) More
$
,000.00
2. Temporary staff and leased employee expense More
Expensed equipment and materials
Expensed purchased services
2022 Payments made by
this establishment on
behalf of other
establishments of your
enterprise
Check
if
None
8. Data processing and other purchased computer
services More
$
,000.00
$
,000.00
9. Purchased communication services More
$
,000.00
$
,000.00
10. Purchased repairs and maintenance to machinery,
vehicles, and equipment More
$
,000.00
$
,000.00
11. Purchased repairs and maintenance to buildings,
structures, and offices More
$
,000.00
$
,000.00
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
15
12. Water, sewer, refuse removal, and other utility
payments More
$
,000.00
$
,000.00
13. Purchased advertising and promotional services More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
15. Lease and rental payments for machinery, equipment,
and other tangible items More
$
,000.00
$
,000.00
16. Lease and rental payments for land, buildings,
structures, store spaces, and offices More
$
,000.00
$
,000.00
17. Governmental taxes and license fees (Exclude sales,
excise, and income taxes.) More
$
,000.00
$
,000.00
18. Depreciation and amortization charges More
$
,000.00
19. All other selected expenses
(Describe - If more than 50% of TOTAL reported on line
20.) More
$
,000.00
$
,000.00
14. Purchased professional and technical services More
Other selected expenses
Describe
20. TOTAL SELECTED EXPENSES of this establishment
ONLY, excluding payroll (Add lines 1 through 19.)
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
16
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Trading securities and commodity contracts on own account (Include interest and dividends.) More
Product Code
8000150000
8000175000
2. Gains (losses) from non-financial assets sold More
8000075000
3. Loans to financial businesses More
8000100000
4. Loans to non-financial businesses
8000125000
5. Loans to governments
7014900000
6. Bundled head-office services to the enterprise More
7. Financial management consulting and implementation services for businesses and government
8. Leasing of rights to explore for and exploit natural resources
7014575000
7010200000
7010260000
9. Franchising agreements More
10. Licensing of rights to use intellectual property protected by patent More
11. Licensing of rights to use intellectual property protected by trademark More
12. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings
7009600000
7009625000
7009581000
8000025000
13. Government contributions, gifts, and grants
8000050000
14. Private contributions, gifts, and grants
15. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines
16. Basic and applied research in engineering and technology More
7006575000
7009700000
Add product/service not listed
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
17
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Trading securities and commodity contracts on own account (Include interest and dividends.) More
$
,000.00
8000150000
2. Gains (losses) from non-financial assets sold More
$
,000.00
8000175000
$
,000.00
8000075000
4. Loans to non-financial businesses
$
,000.00
8000100000
5. Loans to governments
$
,000.00
8000125000
6. Bundled head-office services to the enterprise More
$
,000.00
7014900000
7. Financial management consulting and implementation services for businesses and government
$
,000.00
7014575000
$
,000.00
7010200000
$
,000.00
7010260000
10. Licensing of rights to use intellectual property protected by patent More
$
,000.00
7009600000
11. Licensing of rights to use intellectual property protected by trademark More
$
,000.00
7009625000
12. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings
$
,000.00
7009581000
$
,000.00
8000025000
14. Private contributions, gifts, and grants
$
,000.00
8000050000
15. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated selfservice gambling machines
$
,000.00
7006575000
$
,000.00
7009700000
3. Loans to financial businesses More
8. Leasing of rights to explore for and exploit natural resources
9. Franchising agreements More
13. Government contributions, gifts, and grants
16. Basic and applied research in engineering and technology More
17. All other nonoperating or tax-exempt revenue
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
18
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
19
Item 28: Special Items - Merchandise Sales
ITEM 28: SPECIAL ITEMS - MERCHANDISE SALES
NOTE - "Manufacturing" is transforming or otherwise processing materials or components into new products, including assembling of component parts, prototype development, blending,
and jobbing. Excludes packaging and minor assembly of manufactured goods incidental to distribution or sale.
Estimate the percent of merchandise sales, shipments, receipts, or revenues reported in Item 22 from:
2022
%
1. Products manufactured or assembled at this establishment
2. Products manufactured or assembled for this establishment by other domestic establishments of your company (i.e., within the 50
States and District of Columbia)
%
3. Products manufactured for this establishment by other companies on a contract basis OR manufactured by your company's foreign
plants
%
4. Product resales (products purchased by this establishment from others and sold without further processing or transformation; or sold on
a commission basis)
%
5. TOTAL (Sum of lines 1 through 4 should equal 100%.)
%
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
20
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
21
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
2022
$
,000.00
22
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
23
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
24
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
25
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
26
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
27
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
28
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
29
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
30
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MN-5511X_mu.pdf Generated 2022-02-18 07:36:31
1000
characters remaining
31
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all locations of a company or
organization, including administrative offices, warehouses, etc., that were in operation at any time during 2022. Report activity for each establishment on a separate form.
DEFINITION OF HOLDING COMPANY
A holding company is a company primarily engaged in holding securities of (or other equity interests in) companies and enterprises for the purpose of owning a controlling interest or
influencing the management decisions of these firms. They do not administer, oversee, or manage other establishments of the company or enterprise whose securities they hold.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
2
Legal Boundary and Municipality
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
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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3
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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4
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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5
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
6
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
7
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
8
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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9
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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13
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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15
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Holding companies, excluding bank and financial holding companies
Holding company NOT engaged in direct management of held company(ies)
551112 001
Bank and financial holding companies (Registered with the Board of Governors of the Federal Reserve.)
Bank holding company
551111 001
Financial holding company
551112 002
Corporate managing offices and other kind of business activity
Franchise leasing/licensing, without primarily selling products to the franchisee
533110 901
Other primary business or activity
779000 001
Select Sector
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
What was the income, earnings, or revenue of this establishment only?
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
$
Income, earnings, or revenue
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Trading securities and commodity contracts on own account (Include interest and dividends.) More
Product Code
8000150000
8000175000
2. Gains (losses) from non-financial assets sold More
8000075000
3. Loans to financial businesses More
8000100000
4. Loans to non-financial businesses
8000125000
5. Loans to governments
7014900000
6. Bundled head-office services to the enterprise More
7. Financial management consulting and implementation services for businesses and government
8. Leasing of rights to explore for and exploit natural resources
7014575000
7010200000
7010260000
9. Franchising agreements More
10. Licensing of rights to use intellectual property protected by patent More
11. Licensing of rights to use intellectual property protected by trademark More
12. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings
7009600000
7009625000
7009581000
8000025000
13. Government contributions, gifts, and grants
8000050000
14. Private contributions, gifts, and grants
15. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines
16. Basic and applied research in engineering and technology More
7006575000
7009700000
Add product/service not listed
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Trading securities and commodity contracts on own account (Include interest and dividends.) More
$
,000.00
8000150000
2. Gains (losses) from non-financial assets sold More
$
,000.00
8000175000
3. Loans to financial businesses More
$
,000.00
8000075000
4. Loans to non-financial businesses
$
,000.00
8000100000
5. Loans to governments
$
,000.00
8000125000
6. Bundled head-office services to the enterprise More
$
,000.00
7014900000
7. Financial management consulting and implementation services for businesses and government
$
,000.00
7014575000
8. Leasing of rights to explore for and exploit natural resources
$
,000.00
7010200000
9. Franchising agreements More
$
,000.00
7010260000
$
,000.00
7009600000
11. Licensing of rights to use intellectual property protected by trademark More
$
,000.00
7009625000
12. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings
$
,000.00
7009581000
13. Government contributions, gifts, and grants
$
,000.00
8000025000
$
,000.00
8000050000
15. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated selfservice gambling machines
$
,000.00
7006575000
16. Basic and applied research in engineering and technology More
$
,000.00
7009700000
10. Licensing of rights to use intellectual property protected by patent More
14. Private contributions, gifts, and grants
17. All other nonoperating or tax-exempt revenue
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
31
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
32
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
34
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
1000
characters remaining
35
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_MN-55111_su.pdf Generated 2022-02-18 07:35:53
,000.00
36
Attachment D-14
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 56
Attachment Sector
D-14
56
Instrument
Path
Instrument Path Title
5611C
56120
56150
5622X
Office Administrative Services (Classification)
Facilities Support Services
Travel Arrangement and Reservation Services
Waste Treatment and Disposal (Enterprise Support)
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Management services - providing management staff to direct or coordinate a client's business operation, but not providing staff for complete operation of the client's
business (Exclude management services provided to own establishments.)
Management and administrative services - providing day-to-day administrative services such as personnel management, bookkeeping,
billing, etc., for a client's business or operation (Exclude administrative activities provided for own company.)
561110 001
Hotel and restaurant management
561110 004
Medical office management
561110 005
Corrections management
561210 006
Facilities support services
Facilities support management (exclude computer facilities) - providing operating staff to perform a range of services to support operations
within the client's facilities, but not involved with or responsible for the core activities of the client's business operations
561210 001
Military base management
561210 005
Correctional facilities management and operation
561210 004
Computer systems facilities management and operation services
541513 002
Management consulting - providing advice and counsel to clients on various aspects of operating a business or other type of organization, but not providing
management services for day-to-day operations
Administrative and general management consulting services, including strategic planning and organizational change
541611 002
Human resources and personnel management consulting services
541612 301
Marketing consulting services, including sales management, customer service, and marketing planning/strategy
541613 001
Physical distribution and logistics consulting services
541614 001
Other primary business or activity
Medical case management - assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's
health care needs to provide quality and cost-effective outcomes
621999 101
Other primary business or activity
779000 001
Select Sector
Describe
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Item 28: Special Items - Merchandise Sales
ITEM 28: SPECIAL ITEMS - MERCHANDISE SALES
Did the sale of merchandise account for more than half of the total receipts of this establishment in 2022?
Yes - Describe merchandise sold
Describe
No
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AS-5611C_su.pdf Generated 2022-02-23 17:37:16
1000
characters remaining
8
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Facilities support services
Facilities support management (exclude computer facilities) - providing operating staff to perform a range of services to support operations
within the client's facilities, but not involved with or responsible for the core activities of the client's business operations
561210 001
Military base management
561210 005
Correctional facilities management and operation
561210 004
Computer systems facilities management and operation services
541513 002
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
2022
$
,000.00
$
,000.00
19
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
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Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating receipts (reported in Item 5) by class of customer?
2022
%
1. Business firms and farms
2. Not-for-profit organizations (Include religious organizations.)
%
%
3. Federal government
4. State and local governments
%
5. Household consumers and individuals (Report receipts from individually owned businesses on line 1.)
%
6. TOTAL (Sum of lines 1 through 5 should equal 100%.)
%
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Facilities support services (Exclude correctional facilities.)
Product Code
7014675000
7014670000
2. Correctional facilities contract operation services
3. Construction project management services, excluding at-risk
3004800000
7014925000
4. Project management services, except construction
7014450000
5. IT infrastructure and network management services
7014450003
a. Network management services
7014450006
b. Computer systems management services
6. Head office services to the enterprise including administering, overseeing, and managing other establishments for own company or
enterprise (e.g., corporate offices, head offices, regional managing offices, holding companies that manage)
7014900000
7012265000
7. Economic consulting services
7014225000
8. Information technology (IT) technical consulting services
9. Scientific and technical consulting services, not elsewhere classified
10. Operations and supply chain management consulting and implementation services
7012270000
7014650000
Add product/service not listed
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Facilities support services (Exclude correctional facilities.)
$
,000.00
7014675000
2. Correctional facilities contract operation services
$
,000.00
7014670000
3. Construction project management services, excluding at-risk
$
,000.00
3004800000
4. Project management services, except construction
$
,000.00
7014925000
a. Network management services
$
,000.00
7014450003
b. Computer systems management services
$
,000.00
7014450006
$
,000.00
7014450000
6. Head office services to the enterprise including administering, overseeing, and managing other establishments for
own company or enterprise (e.g., corporate offices, head offices, regional managing offices, holding companies that
manage)
$
,000.00
7014900000
7. Economic consulting services
$
,000.00
7012265000
8. Information technology (IT) technical consulting services
$
,000.00
7014225000
9. Scientific and technical consulting services, not elsewhere classified
$
,000.00
7012270000
10. Operations and supply chain management consulting and implementation services
$
,000.00
7014650000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
5. IT infrastructure and network management services
Subtotal
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
2022
$
,000.00
27
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
29
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
34
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
35
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
36
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
1000
characters remaining
37
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AS-56120_su.pdf Generated 2022-02-23 17:10:30
,000.00
38
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Travel agency and tour operator
Travel agency
561510 001
Tour operator - assembling tour packages and selling directly to travelers or through other travel agencies
561520 001
Other travel arrangement and reservation services
Ticket, reservation, and other travel arrangement services
561599 601
Ticket agency, including airline, railroad, bus, theatrical, sports, cruise ships, amusement, and recreation
561599 602
Automobile club, road and travel services
561599 201
Reservation system, including airlines, hotels, automobiles, and restaurants
561599 603
Convention and visitor/tourist information bureau
561591 001
Vacation time share exchange services
561599 604
Automobile travel clubs
561599 202
Transportation services
Limousine or luxury sedan with drivers, except scheduled airport shuttle and taxi service
485320 001
Bus charter services - local
485510 004
Bus charter services - interstate or interurban
485510 005
Sightseeing bus, trolley, or steam train excursions
487110 005
Scenic and sightseeing boat, including dinner cruises, excursions, and harbor tours
487210 102
Sightseeing airplane or helicopter
487990 001
Aerial tramway and cable lift, scenic or sightseeing
487990 002
Shipping agents or brokers
488510 202
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Report operating receipts of this establishment
Travel agents, ticket offices/agencies, and reservation systems should include commissions or fees, not gross sales.
Tour operators should include the difference between the selling price of their tours and the amount paid to suppliers.
Convention, visitor, and tourist information bureaus should report total revenue, including contributions, gifts, and grants.
For further clarification, click the "Additional Information" link above.
Check
if
None
2022
$
What were the total operating receipts?
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
2022
$
,000.00
$
,000.00
19
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
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20
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating receipts (reported in Item 5) by class of customer?
2022 Whole
percent of
receipts
1. Household consumers and individuals
(Report receipts from individually owned businesses on lines 2 and 3 as appropriate.)
%
2. Travel agencies and other resellers
%
3. All other business firms and farms
%
4. Not-for-profit organizations
(Include religious organizations.)
%
5. Federal government
%
6. State and local governments
%
7. TOTAL (Sum of lines 1 through 6 should equal 100%)
%
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7003575000
1. Trip planning services More
2. Packaged tours with accommodation, except cruises and academic trips and tours More
a. Domestic packaged tours with accommodation, except cruises and academic trips and tours
b. International packaged tours with accommodation, except cruises and academic trips and tours
7003275000
7003275003
7003275006
7003275009
c. Pre-packaged tour reselling services More
3. Customized tours with accommodation, except cruises and academic trips and tours More
a. Domestic customized tours with accommodation, except cruises and academic trips and tours
b. International customized tours with accommodation, except cruises and academic trips and tours
7003285000
7003285003
7003285006
7013050000
4. Public relations event management services More
a. Convention and trade show organization services More
b. Sports and performing arts event organization and management services
7013050003
7013050006
7013050009
c. All other public relations event management services
5. Visitor information and sightseeing tour information services More
7003903000
7003906000
6. Automobile club services More
7003900000
7. Condominium time-share exchange services More
7003909000
8. Travel document services
7003912000
9. Emergency travel services More
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
22
7003915000
10. Traveler's check services
11. Insurance brokerage and agency services for travel insurance
7003775000
7003325000
12. Reservation service for airline seats
7003325006
a. Reservation service for airline seats, domestic travel
b. Reservation service for airline seats, international travel
7003325003
7003425000
13. Reservation service for vehicle rental
7003450000
14. Reservation service for cruises
7003450003
a. Reservation service for cruises of one day or less
7003450006
b. Reservation service for cruises of more than one day
15. Reservation service for passenger transportation, not elsewhere classified
a. Reservation service for bus seats and airport shuttle services
7003465000
7003465003
7003465006
b. Reservation service for rail seats
7003465009
c. Reservation service for ferry transportation
7003475000
16. Lodging reservation service
7003475006
a. Lodging reservation service, domestic travel
7003475003
b. Lodging reservation service, international travel
7003500000
17. Reservation service for packaged tours More
a. Reservation service for packaged tours, domestic travel
b. Reservation service for packaged tours, international travel
7003500006
7003500003
7003550000
18. Event ticket sales and reservation services
7014275000
19. Application service provisioning
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23
a. Computerized reservation system application provisioning
b. Application service provisioning with integration services
c. Application service provisioning without integration services
7014275003
7014275006
7014275009
Add product/service not listed
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
$
,000.00
7003575000
a. Domestic packaged tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003275003
b. International packaged tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003275006
c. Pre-packaged tour reselling services More
$
,000.00
7003275009
Subtotal
$
,000.00
7003275000
a. Domestic customized tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003285003
b. International customized tours with accommodation, except cruises and academic trips and tours
$
,000.00
7003285006
Subtotal
$
,000.00
7003285000
a. Convention and trade show organization services More
$
,000.00
7013050003
b. Sports and performing arts event organization and management services
$
,000.00
7013050006
c. All other public relations event management services
$
,000.00
7013050009
Subtotal
$
,000.00
7013050000
5. Visitor information and sightseeing tour information services More
$
,000.00
7003903000
6. Automobile club services More
$
,000.00
7003906000
7. Condominium time-share exchange services More
$
,000.00
7003900000
1. Trip planning services More
2. Packaged tours with accommodation, except cruises and academic trips and tours More
3. Customized tours with accommodation, except cruises and academic trips and tours More
4. Public relations event management services More
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
25
8. Travel document services
$
,000.00
7003909000
9. Emergency travel services More
$
,000.00
7003912000
10. Traveler's check services
$
,000.00
7003915000
$
,000.00
7003775000
$
,000.00
7003325006
b. Reservation service for airline seats, international travel
$
,000.00
7003325003
Subtotal
$
,000.00
7003325000
$
,000.00
7003425000
a. Reservation service for cruises of one day or less
$
,000.00
7003450003
b. Reservation service for cruises of more than one day
$
,000.00
7003450006
Subtotal
$
,000.00
7003450000
a. Reservation service for bus seats and airport shuttle services
$
,000.00
7003465003
b. Reservation service for rail seats
$
,000.00
7003465006
$
,000.00
7003465009
$
,000.00
7003465000
a. Lodging reservation service, domestic travel
$
,000.00
7003475006
b. Lodging reservation service, international travel
$
,000.00
7003475003
Subtotal
$
,000.00
7003475000
11. Insurance brokerage and agency services for travel insurance
12. Reservation service for airline seats
a. Reservation service for airline seats, domestic travel
13. Reservation service for vehicle rental
14. Reservation service for cruises
15. Reservation service for passenger transportation, not elsewhere classified
c. Reservation service for ferry transportation
Subtotal
16. Lodging reservation service
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26
17. Reservation service for packaged tours More
$
,000.00
7003500006
b. Reservation service for packaged tours, international travel
$
,000.00
7003500003
Subtotal
$
,000.00
7003500000
$
,000.00
7003550000
a. Computerized reservation system application provisioning
$
,000.00
7014275003
b. Application service provisioning with integration services
$
,000.00
7014275006
c. Application service provisioning without integration services
$
,000.00
7014275009
Subtotal
$
,000.00
7014275000
$
,000.00
9900000000
a. Reservation service for packaged tours, domestic travel
18. Event ticket sales and reservation services
19. Application service provisioning
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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30
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
2022
$
,000.00
31
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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33
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
36
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
37
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
38
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
39
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
40
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
1000
characters remaining
41
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AS-56150_su.pdf Generated 2022-02-23 17:16:30
,000.00
42
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all locations of a company or
organization, including administrative offices, warehouses, etc., that were in operation at any time during 2022. Report activity for each establishment on a separate form.
DEFINITION OF AN ENTERPRISE
An enterprise or company is a business, service, or membership organization consisting of one or more establishments within the United States under common ownership or control. It
includes all establishments of subsidiary companies, where there is more than 50 percent ownership, as well as establishments of firms which the enterprise has the power to direct or
cause the direction of management and policies.
DEFINITION OF AN ENTERPRISE SUPPORT ESTABLISHMENT
An enterprise support establishment is an establishment that is primarily engaged in performing management, supervision, general administrative functions, and supporting services for
other establishments of the same enterprise, rather than for the general public or other business firms.
PHYSICAL ADDRESS
Please update the location's physical address if needed.
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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5
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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6
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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7
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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8
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Waste treatment and disposal services, including combined collection and disposal
Solid waste landfill
562212 001
Hazardous waste
562211 003
Medical waste
562211 001
Solid waste combustor and incinerator
562213 001
Septic tank cleaning services
562991 102
Waste collection services, without treatment or disposal
Solid waste, recyclables, and yard waste (exclude hazardous waste) collection services, local
562111 001
Solid waste transfer station
562111 002
Hazardous waste collection services
562112 001
Hazardous waste transfer station
562112 002
Other primary business or activity
Remediation services - remediating/cleaning up contaminated buildings, mine sites, soil, or ground water (excluding asbestos abatement
and/or lead removal)
562910 101
Other primary business or activity
779000 001
Select Sector
Describe
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
9
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
%
10
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Sales, Receipts, or Revenue
Include:
Sales, receipts, or revenue from customers outside your enterprise originating from this location.
Exclude:
Sales, receipts, or revenue from other establishments within your own enterprise.
For further clarification, click "Additional Information" link above.
Check
if
None
What were the sales, receipts, or revenue (exclude billings) from customers outside your enterprise originating from
this location?
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
2022
$
,000.00
11
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
2022
$
,000.00
$
,000.00
12
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
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13
Item 8: Support Services - Continued
ITEM 8: SUPPORT SERVICES - PRIMARY BUSINESS OR ACTIVITY OF THE OPERATING ESTABLISHMENTS SERVICED
What primary kind of business or activity is performed by the establishments of your enterprise that are managed or serviced by this establishment?
Example: If this establishment is a corporate, subsidiary, or regional managing office, data processing service center, or administrative/support office to a chain of clothing stores, please
describe "clothing stores" below.
Describe
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14
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES
Report the payment of selected expenses allocated by category
Report payments for expenses directly incurred by this establishment in column 1.
Report payments made by this establishment for expenses incurred by other establishments of your enterprise in column 2 (where applicable).
Exclude:
Transfers made within the company
Capitalized expenses
Impairment
Interest
Bad debt
Income tax
Taxes collected from customers (e.g., sales and excise)
Cost of merchandise for resale
Personnel costs, except payroll
1. Employer's cost for employer paid insurance premiums,
pension plans, payroll taxes, and other employee
benefits More
Check
if
None
2022 Expenses of this
establishment ONLY
$
,000.00
$
,000.00
3. Expensed computer hardware and other equipment More
$
,000.00
4. Expensed purchases of other materials, parts, and
supplies More
$
,000.00
5. Expensed purchases of software More
$
,000.00
6. Purchased electricity More
$
,000.00
7. Purchased fuels (Exclude motor fuels.) More
$
,000.00
2. Temporary staff and leased employee expense More
Expensed equipment and materials
Expensed purchased services
2022 Payments made by
this establishment on
behalf of other
establishments of your
enterprise
Check
if
None
8. Data processing and other purchased computer
services More
$
,000.00
$
,000.00
9. Purchased communication services More
$
,000.00
$
,000.00
10. Purchased repairs and maintenance to machinery,
vehicles, and equipment More
$
,000.00
$
,000.00
11. Purchased repairs and maintenance to buildings,
structures, and offices More
$
,000.00
$
,000.00
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
15
12. Water, sewer, refuse removal, and other utility
payments More
$
,000.00
$
,000.00
13. Purchased advertising and promotional services More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
15. Lease and rental payments for machinery, equipment,
and other tangible items More
$
,000.00
$
,000.00
16. Lease and rental payments for land, buildings,
structures, store spaces, and offices More
$
,000.00
$
,000.00
17. Governmental taxes and license fees (Exclude sales,
excise, and income taxes.) More
$
,000.00
$
,000.00
18. Depreciation and amortization charges More
$
,000.00
19. All other selected expenses
(Describe - If more than 50% of TOTAL reported on line
20.) More
$
,000.00
$
,000.00
14. Purchased professional and technical services More
Other selected expenses
Describe
20. TOTAL SELECTED EXPENSES of this establishment
ONLY, excluding payroll (Add lines 1 through 19.)
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16
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
What was the percentage of this establishment's total operating receipts (reported in Item 5) from services provided to clients outside your enterprise by class of customer?
2022 Whole
percent of
receipts
1. Household consumers and individuals
(Report receipts from individually owned businesses on lines 2, 3, 4, 5, or 6 as appropriate.)
%
2. Retailers
%
3. Banks, insurance companies, and other financial institutions
%
4. Hospitals and other health care services
%
5. Travel agencies and other resellers
%
6. All other business firms and farms
%
7. Not-for-profit organizations
(Include religious organizations.)
%
8. Federal government
%
%
9. State and local governments
%
10. TOTAL (Sum of lines 1 through 9 should equal 100%.)
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17
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
6000350000
1. Disposal services for non-hazardous waste
6000350003
a. Landfilling services for non-hazardous waste
b. Incineration disposal services for non-hazardous waste
6000350006
6000350009
c. Other disposal services for non-hazardous waste
6000525000
2. Disposal services for hazardous waste
a. Disposal services for hazardous waste, by controlled confinement by landfilling
b. Disposal services for hazardous waste, by controlled confinement other than landfilling
6000525003
6000525006
6000525009
c. Other disposal services for hazardous waste
6000575000
3. Hazardous waste brokerage services
6000500000
4. Treatment services for hazardous waste
a. Treatment services for hazardous waste (biological-infectious waste)
b. Treatment services for hazardous waste (radioactive waste)
c. Treatment services for other hazardous waste (except waste water)
5. Residential collection services for non-hazardous waste and recyclable material More
a. Residential collection services for non-hazardous waste
b. Residential collection services for non-hazardous recyclable material
6. Nonresidential collection services for non-hazardous waste and recyclable material More
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
6000500003
6000500006
6000500009
6000200000
6000200003
6000200006
6000225000
18
a. Nonresidential collection services for non-hazardous industrial waste
b. Nonresidential collection services for non-hazardous non-industrial waste
c. Nonresidential collection services for non-hazardous recyclable material
7. Collection services for non-hazardous construction and demolition waste
8. Consolidation, storage, and preparation services for non-hazardous waste and recyclable material
a. Transfer facility services for non-hazardous waste More
b. Recovery and preparation services for non-hazardous recyclable material More
6000225003
6000225006
6000225009
6000250000
6000325000
6000325003
6000325006
6000075000
9. Electricity generation
a. Electricity generation (except waste energy generation)
6000075003
6000075006
b. Non-hazardous waste energy generation services
6000075009
c. Hazardous waste energy generation services More
10. Other non-hazardous waste management services, not elsewhere classified
6000425000
6000450000
11. Collection services for hazardous waste More
6000450003
a. Residential collection services for hazardous waste
b. Nonresidential collection services for hazardous waste
c. Cleaning and removal services for hazardous waste holding facilities
12. Consolidation, storage, and preparation services for hazardous waste and recyclable material More
6000450006
6000450009
6000475000
7011750000
13. Transportation of waste by road
7011750003
a. Transportation of non-hazardous waste by road
b. Transportation of non-hazardous recyclable material by road
7011750006
7011750009
c. Transportation of hazardous waste by road
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
19
7011775000
14. Transportation of waste by water
6000400000
15. Non-hazardous waste brokerage services
16. Hazardous waste management services, not elsewhere classified
6000600000
2019625000
17. Manufacturing of other fuels, not elsewhere classified
Add product/service not listed
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Disposal services for non-hazardous waste
a. Landfilling services for non-hazardous waste
$
,000.00
6000350003
b. Incineration disposal services for non-hazardous waste
$
,000.00
6000350006
c. Other disposal services for non-hazardous waste
$
,000.00
6000350009
Subtotal
$
,000.00
6000350000
$
,000.00
6000525003
$
,000.00
6000525006
c. Other disposal services for hazardous waste
$
,000.00
6000525009
Subtotal
$
,000.00
6000525000
$
,000.00
6000575000
a. Treatment services for hazardous waste (biological-infectious waste)
$
,000.00
6000500003
b. Treatment services for hazardous waste (radioactive waste)
$
,000.00
6000500006
c. Treatment services for other hazardous waste (except waste water)
$
,000.00
6000500009
Subtotal
$
,000.00
6000500000
a. Residential collection services for non-hazardous waste
$
,000.00
6000200003
b. Residential collection services for non-hazardous recyclable material
$
,000.00
6000200006
2. Disposal services for hazardous waste
a. Disposal services for hazardous waste, by controlled confinement by landfilling
b. Disposal services for hazardous waste, by controlled confinement other than landfilling
3. Hazardous waste brokerage services
4. Treatment services for hazardous waste
5. Residential collection services for non-hazardous waste and recyclable material More
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
21
$
,000.00
6000200000
a. Nonresidential collection services for non-hazardous industrial waste
$
,000.00
6000225003
b. Nonresidential collection services for non-hazardous non-industrial waste
$
,000.00
6000225006
c. Nonresidential collection services for non-hazardous recyclable material
$
,000.00
6000225009
Subtotal
$
,000.00
6000225000
$
,000.00
6000250000
a. Transfer facility services for non-hazardous waste More
$
,000.00
6000325003
b. Recovery and preparation services for non-hazardous recyclable material More
$
,000.00
6000325006
Subtotal
$
,000.00
6000325000
a. Electricity generation (except waste energy generation)
$
,000.00
6000075003
b. Non-hazardous waste energy generation services
$
,000.00
6000075006
c. Hazardous waste energy generation services More
$
,000.00
6000075009
Subtotal
$
,000.00
6000075000
$
,000.00
6000425000
$
,000.00
6000450003
$
,000.00
6000450006
c. Cleaning and removal services for hazardous waste holding facilities
$
,000.00
6000450009
Subtotal
$
,000.00
6000450000
Subtotal
6. Nonresidential collection services for non-hazardous waste and recyclable material More
7. Collection services for non-hazardous construction and demolition waste
8. Consolidation, storage, and preparation services for non-hazardous waste and recyclable material
9. Electricity generation
10. Other non-hazardous waste management services, not elsewhere classified
11. Collection services for hazardous waste More
a. Residential collection services for hazardous waste
b. Nonresidential collection services for hazardous waste
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
22
$
,000.00
6000475000
$
,000.00
7011750003
b. Transportation of non-hazardous recyclable material by road
$
,000.00
7011750006
c. Transportation of hazardous waste by road
$
,000.00
7011750009
Subtotal
$
,000.00
7011750000
14. Transportation of waste by water
$
,000.00
7011775000
15. Non-hazardous waste brokerage services
$
,000.00
6000400000
16. Hazardous waste management services, not elsewhere classified
$
,000.00
6000600000
17. Manufacturing of other fuels, not elsewhere classified
$
,000.00
2019625000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
12. Consolidation, storage, and preparation services for hazardous waste and recyclable material More
13. Transportation of waste by road
a. Transportation of non-hazardous waste by road
Add product/service not listed
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
23
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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24
Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
2022
$
,000.00
25
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
26
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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27
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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28
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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29
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
30
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
31
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AS-5622X_mu.pdf Generated 2022-02-23 17:29:31
1000
characters remaining
34
Attachment D-15
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 61
Attachment Sector
D-15
61
Instrument
Path
Instrument Path Title
6100C
61140
61150
61170
Educational Services (Classification)
Business Schools and Computer and Management Training
Technical and Trade Schools
Educational Support Services
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_ED-6100C_su.pdf Generated 2022-02-23 17:03:50
1
Legal Boundary and Municipality
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
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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2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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4
Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Management, clerical, and computer training services, excluding degree-granting colleges and universities
Business leadership, entrepreneurial training, and skills development, including provision of seminars or instruction to improve professional
and management skills
(Exclude degree-granting colleges and universities.)
611430 003
Vocational school for certification to work in health fields
(Exclude degree-granting colleges and universities.)
611519 008
Medical technician and nursing continuing education and recertification services
611430 002
Teacher and staff professional development training and continuing education services
611430 004
Clerical, secretarial, or court reporting school
(Include business schools or colleges not offering academic degrees.)
611410 002
Computer and information technology (IT) training services, including computer programming, gaining proficiency with software packages
and systems, IT security, and local area network (LAN) management
(Exclude computer repair training and software development.)
611420 001
Technical and trade schools
Cosmetology or beauty school, including skin and nail care
611511 002
Barber or hairdresser college or school
611511 001
Beauty shop, spa, or hair salon
(Exclude beauty schools.)
812112 005
Massage therapy school
611519 007
Modeling or acting school
611519 006
Apprenticeship training programs, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
611513 002
Vocational school, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
(Exclude apprenticeships.)
611519 004
Truck, bus, or heavy equipment driving school
(Exclude automobile and motorcycle driving schools.)
611519 00A
Commercial art, photography, or graphic arts school
611519 005
Culinary or bartending school
611519 009
Real estate, stock trading, or insurance school
(Exclude degree-granting institutions.)
611519 003
Training of instructors for yoga, personal trainers, and other fitness certifications
611519 002
Flight/Pilot training school
(Include flight simulation training. Exclude air crew training.)
611512 001
Vocational rehabilitation facility, including sheltered workshops, Job Corps, and no-cost technical and trade education and training programs
(Exclude schools.)
624310 003
All other miscellaneous schools and instruction e.g., first aid, CPR, life guard, military combat, and survival skills training
(Exclude security guard training.)
611699 001
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Other schools and instruction
Dance schools, children's and/or professionals', except fitness classes
611610 101
Sports and recreation instruction, including swimming, gymnastics, horseback riding, martial arts, etc.
(Include day and/or overnight instructional sports camps. Exclude clubs, teams, or leagues.)
611620 001
Sports and recreation clubs, teams, or leagues that may also include instruction
(Exclude day and/or overnight sports camps.)
713990 80C
Day camp, excluding overnight and instructional camps
713990 80A
Yoga or pilates studio
713940 909
Art, drama, music, or other fine arts school
(Exclude training for commercial or graphic artists.)
611610 201
Automobile and motorcycle driving school, including driver education
(Exclude truck driving schools.)
611692 001
Basic academic skills learning center and adult literacy groups
(Exclude social services and English as a second language (ESL).)
611691 002
Community remedial education or learning center, social services for the elderly or disabled
(Exclude schools.)
624120 00C
Tutoring and exam preparation services, including college board preparation
611691 003
Youth scholars and leadership programs
(Exclude social services.)
611430 005
Child early intervention center or services - providing services to children with disabilities, special needs, or delays
624120 00B
Youth mentoring or guidance program, social services
624110 00A
Language school
(Include sign language. Exclude elementary or secondary schools.)
611630 001
Elementary or secondary school
611110 001
Junior college or community college - granting associate degrees or certificates
611210 001
College, university, or professional school - granting academic degrees
611310 001
Child care services, including those with preschool and/or Head Start programs
(Include services for children with or without disabilities.)
624410 001
Educational support services
Libraries
519120 003
Educational guidance services - evaluating and advising students and families on recommended course of study, choice of schools or
colleges, financial aid, international exchange and education, study abroad, etc.
611710 101
Educational test development and evaluation services, including testing services
611710 202
Educational research and curriculum development services
611710 102
Administrative and general management consulting services
541611 001
Scientific and technical consulting services provided to businesses and other organizations
541690 907
Multi-service organization providing a range of social assistance services to families and individuals, excluding services primarily to children,
the elderly, the disabled, the intellectually and developmentally disabled, or the mentally ill
624190 003
Other social advocacy organizations addressing issues such as antipoverty, peace and international understanding, drug abuse awareness,
firearms safety, public safety, social change, and taxpayer advocacy
813319 004
Grantmaking foundations
813211 004
Book publishers
511130 404
2022_ED-6100C_su.pdf Generated 2022-02-23 17:03:50
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Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
9
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Management, clerical, and computer training services, excluding degree-granting colleges and universities
Business leadership, entrepreneurial training, and skills development, including provision of seminars or instruction to improve professional
and management skills
(Exclude degree-granting colleges and universities.)
611430 003
Provision of continuing education seminars or conferences, including continuing education for recertification of health professionals and
medical technicians, nurses, legal, and financial workers
(Exclude vocational training programs and schools with specialized training for job-specific certification.)
611430 006
Computer and information technology (IT) training services, including computer programming, gaining proficiency with software packages
and systems, IT security, and local area network (LAN) management
(Exclude computer repair training and software development.)
611420 001
Clerical, secretarial, or court reporting school
(Include business schools or colleges not offering academic degrees.)
611410 002
Technical and trade schools
Apprenticeship training programs, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
611513 002
Vocational school, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
(Exclude apprenticeships.)
611519 004
Vocational rehabilitation facility, including sheltered workshops, Job Corps, and no-cost technical and trade education and training programs
(Exclude schools.)
624310 003
Other schools and instruction
Language school
(Include sign language. Exclude elementary or secondary schools.)
611630 001
Elementary or secondary school
611110 001
Junior college or community college - granting associate degrees or certificates
611210 001
College, university, or professional school - granting academic degrees
611310 001
Educational support services
Teacher and staff professional development training and continuing education services
611430 004
Basic academic skills learning center and adult literacy groups
(Exclude social services and English as a second language (ESL).)
611691 002
Tutoring and exam preparation services, including college board preparation
611691 003
Educational test development and evaluation services, including testing services
611710 202
Educational research and curriculum development services
611710 102
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
2022
$
,000.00
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
2022
$
,000.00
$
,000.00
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
2022
$
,000.00
$
,000.00
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second Language (ESL)
programs, and special educational programs for children.) More
2. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
Product Code
7003925000
7003950000
7003950003
7003950015
b. Business, management, and public administration
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
7003950021
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
7003950036
h. Certification training for operating machinery and equipment
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and courses
(Include instruction in culinary arts.)
7003950061
3. Higher career, technical, academic, and advanced research qualification programs More
7003975000
7004075000
4. Educational support and consulting services
7004000000
5. Exam preparation courses
6. Rental of space for meetings, conventions, and similar short-term business uses
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
7006425000
23
7. Retail sales of audio and video recordings of educational courses/lectures, including purchased downloads
8. Published applications software, including publishing educational software
5001000000
7009000000
Add product/service not listed
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
1. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second
Language (ESL) programs, and special educational programs for children.) More
Product Code
$
,000.00
7003925000
a. Education
(Include continuing education and recertification for instructors.)
$
,000.00
7003950003
b. Business, management, and public administration
$
,000.00
7003950015
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
$
,000.00
7003950021
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
$
,000.00
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
$
,000.00
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
$
,000.00
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
$
,000.00
7003950036
h. Certification training for operating machinery and equipment
$
,000.00
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
$
,000.00
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and
courses
(Include instruction in culinary arts.)
$
,000.00
7003950061
Subtotal
$
,000.00
7003950000
3. Higher career, technical, academic, and advanced research qualification programs More
$
,000.00
7003975000
4. Educational support and consulting services
$
,000.00
7004075000
5. Exam preparation courses
$
,000.00
7004000000
2. Trade, career, technical and professional development training programs
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
25
6. Rental of space for meetings, conventions, and similar short-term business uses
$
,000.00
7006425000
7. Retail sales of audio and video recordings of educational courses/lectures, including purchased downloads
$
,000.00
5001000000
8. Published applications software, including publishing educational software
$
,000.00
7009000000
$
,000.00
9900000000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
26
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second Language (ESL)
programs, and special educational programs for children.) More
2. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
Product Code
7003925000
7003950000
7003950003
7003950015
b. Business, management, and public administration
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
7003950021
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
7003950036
h. Certification training for operating machinery and equipment
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and courses
(Include instruction in culinary arts.)
7003950061
3. Higher career, technical, academic, and advanced research qualification programs More
7003975000
7004075000
4. Educational support and consulting services
7004000000
5. Exam preparation courses
6. Rental of space for meetings, conventions, and similar short-term business uses
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
7006425000
27
7. Retail sales of audio and video recordings of educational courses/lectures, including purchased downloads
8. Published applications software, including publishing educational software
9. Program service revenue including government fees and contracts More
5001000000
7009000000
8000200000
8000025000
10. Government contributions, gifts, and grants
11. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include
commissioned fundraising.)
8000050000
12. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
8000150000
13. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
1. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second
Language (ESL) programs, and special educational programs for children.) More
Product Code
$
,000.00
7003925000
a. Education
(Include continuing education and recertification for instructors.)
$
,000.00
7003950003
b. Business, management, and public administration
$
,000.00
7003950015
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
$
,000.00
7003950021
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
$
,000.00
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
$
,000.00
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
$
,000.00
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
$
,000.00
7003950036
h. Certification training for operating machinery and equipment
$
,000.00
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
$
,000.00
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and
courses
(Include instruction in culinary arts.)
$
,000.00
7003950061
Subtotal
$
,000.00
7003950000
3. Higher career, technical, academic, and advanced research qualification programs More
$
,000.00
7003975000
4. Educational support and consulting services
$
,000.00
7004075000
5. Exam preparation courses
$
,000.00
7004000000
2. Trade, career, technical and professional development training programs
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
29
6. Rental of space for meetings, conventions, and similar short-term business uses
$
,000.00
7006425000
7. Retail sales of audio and video recordings of educational courses/lectures, including purchased downloads
$
,000.00
5001000000
8. Published applications software, including publishing educational software
$
,000.00
7009000000
9. Program service revenue including government fees and contracts More
$
,000.00
8000200000
10. Government contributions, gifts, and grants
$
,000.00
8000025000
11. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc.
Include commissioned fundraising.)
$
,000.00
8000050000
12. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
$
,000.00
8000150000
13. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
$
,000.00
8000175000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
14. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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35
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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40
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
1000
characters remaining
43
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_ED-61140_su.pdf Generated 2022-02-23 17:04:53
,000.00
44
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Technical and trade schools
Vocational school, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
(Exclude apprenticeships.)
611519 004
Vocational rehabilitation facility, including sheltered workshops, Job Corps, and no-cost technical and trade education and training programs
(Exclude schools.)
624310 003
Apprenticeship training programs, including HVAC, electrical, mechanical, plumbing, welding, and carpentry
611513 002
Commercial art, photography, or graphic arts school
611519 005
Cosmetology or beauty school, including skin and nail care
611511 002
Barber or hairdresser college or school
611511 001
Modeling or acting school
611519 006
Massage therapy school
611519 007
Vocational school for certification to work in health fields
(Exclude degree-granting colleges and universities.)
611519 008
Provision of continuing education seminars or conferences, including continuing education for recertification of health professionals and
medical technicians, nurses, legal, and financial workers
(Exclude vocational training programs and schools with specialized training for job-specific certification.)
611430 006
Flight/Pilot training school
(Include flight simulation training. Exclude air crew training.)
611512 001
Truck, bus, or heavy equipment driving school
(Exclude automobile and motorcycle driving schools.)
611519 00A
Automobile and motorcycle driving school, including driver education
(Exclude truck driving schools.)
611692 001
Real estate, stock trading, or insurance school
(Exclude degree-granting institutions.)
611519 003
Culinary or bartending school
611519 009
Schools for training police, firefighters, security guards, and occupational safety workers
611519 00B
All other miscellaneous schools and instruction e.g., first aid, CPR, life guard, military combat, and survival skills training
(Exclude security guard training.)
611699 001
Management and computer training services, excluding colleges and universities
Computer and information technology (IT) training services, including computer programming, gaining proficiency with software packages
and systems, IT security, and local area network (LAN) management
(Exclude computer repair training and software development.)
611420 001
Business leadership, entrepreneurial training, and skills development, including provision of seminars or instruction to improve professional
and management skills
(Exclude degree-granting colleges and universities.)
611430 003
Other schools and instruction
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
15
Elementary or secondary school
611110 001
Junior college or community college - granting associate degrees or certificates
611210 001
College, university, or professional school - granting academic degrees
611310 001
Other primary business or activity
Beauty shop, spa, or hair salon
(Exclude beauty schools.)
812112 005
Other primary business or activity
779000 001
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
2022
$
,000.00
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
2022
$
,000.00
$
,000.00
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
2022
$
,000.00
$
,000.00
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
Product Code
7003950000
7003950003
7003950015
b. Business, management, and public administration
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
7003950021
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
7003950036
h. Certification training for operating machinery and equipment
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and courses
(Include instruction in culinary arts.)
7003950061
2. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second Language (ESL)
programs, and special educational programs for children.) More
3. Higher career, technical, academic, and advanced research qualification programs More
7003925000
7003975000
4. Hair care services
(Exclude training programs in beauty and personal care.)
7005025000
5. Nail care services
(Exclude training programs in beauty and personal care.)
7005050000
6. Skin care services
(Exclude training programs in beauty and personal care.)
7005075000
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
23
7009300000
7. Rental of air, rail, and water transportation equipment
Add product/service not listed
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
$
,000.00
7003950003
b. Business, management, and public administration
$
,000.00
7003950015
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
$
,000.00
7003950021
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
$
,000.00
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
$
,000.00
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
$
,000.00
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
$
,000.00
7003950036
$
,000.00
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
$
,000.00
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and
courses
(Include instruction in culinary arts.)
$
,000.00
7003950061
$
,000.00
7003950000
2. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second
Language (ESL) programs, and special educational programs for children.) More
$
,000.00
7003925000
3. Higher career, technical, academic, and advanced research qualification programs More
$
,000.00
7003975000
4. Hair care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005025000
5. Nail care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005050000
h. Certification training for operating machinery and equipment
Subtotal
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
25
6. Skin care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005075000
7. Rental of air, rail, and water transportation equipment
$
,000.00
7009300000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
26
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
Product Code
7003950000
7003950003
7003950015
b. Business, management, and public administration
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
7003950021
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
7003950036
h. Certification training for operating machinery and equipment
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and courses
(Include instruction in culinary arts.)
7003950061
2. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second Language (ESL)
programs, and special educational programs for children.) More
3. Higher career, technical, academic, and advanced research qualification programs More
7003925000
7003975000
4. Hair care services
(Exclude training programs in beauty and personal care.)
7005025000
5. Nail care services
(Exclude training programs in beauty and personal care.)
7005050000
6. Skin care services
(Exclude training programs in beauty and personal care.)
7005075000
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
27
7009300000
7. Rental of air, rail, and water transportation equipment
8. Program service revenue including government fees and contracts More
8000200000
8000025000
9. Government contributions, gifts, and grants
10. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include
commissioned fundraising.)
8000050000
11. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
8000150000
12. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
Add product/service not listed
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
28
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Trade, career, technical and professional development training programs
a. Education
(Include continuing education and recertification for instructors.)
$
,000.00
7003950003
b. Business, management, and public administration
$
,000.00
7003950015
c. Computer and information sciences, mathematics, architecture, engineering, and related technologies
$
,000.00
7003950021
d. Heating, ventilation, and air conditioning (HVAC); electrical; mechanical; plumbing; and carpentry
$
,000.00
7003950057
e. Parks, recreation, fitness, and public health
(Include instruction in first aid, CPR, lifeguarding, and survival skills.)
$
,000.00
7003950031
f. Professional development and management training programs and courses
(Include continuing education and recertification services for health professionals and technicians.)
$
,000.00
7003950033
g. Beauty and personal care
(Include instruction in massage therapy.)
$
,000.00
7003950036
h. Certification training for operating machinery and equipment
$
,000.00
7003950039
i. All other personal, protective, and transportation services
(Include pilot/flight training and commercial driver's license (CDL) training.)
$
,000.00
7003950042
j. All other occupational, technical and trade; professional development; and management training programs and
courses
(Include instruction in culinary arts.)
$
,000.00
7003950061
Subtotal
$
,000.00
7003950000
2. Basic education and skills programs
(Include tuition receipts for literacy and numeracy programs, GED, foreign language and English as a Second
Language (ESL) programs, and special educational programs for children.) More
$
,000.00
7003925000
3. Higher career, technical, academic, and advanced research qualification programs More
$
,000.00
7003975000
4. Hair care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005025000
5. Nail care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005050000
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
29
6. Skin care services
(Exclude training programs in beauty and personal care.)
$
,000.00
7005075000
7. Rental of air, rail, and water transportation equipment
$
,000.00
7009300000
8. Program service revenue including government fees and contracts More
$
,000.00
8000200000
9. Government contributions, gifts, and grants
$
,000.00
8000025000
10. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc.
Include commissioned fundraising.)
$
,000.00
8000050000
11. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
$
,000.00
8000150000
12. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
$
,000.00
8000175000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
13. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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33
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
35
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
37
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
38
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
39
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
40
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
41
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
1000
characters remaining
43
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_ED-61150_su.pdf Generated 2022-02-23 17:05:16
,000.00
44
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Educational support services
Educational guidance services - evaluating and advising students and families on recommended course of study, choice of schools or
colleges, financial aid, international exchange and education, study abroad, etc.
611710 101
Educational research and curriculum development services
611710 102
Educational test development and evaluation services, including testing services
611710 202
Tutoring and exam preparation services, including college board preparation
611691 003
Teacher and staff professional development training and continuing education services
611430 004
Youth mentoring or guidance program, social services
624110 00A
Youth scholars and leadership programs
(Exclude social services.)
611430 005
Child care services, including those with preschool and/or Head Start programs
(Include services for children with or without disabilities.)
624410 001
Child early intervention center or services - providing services to children with disabilities, special needs, or delays
624120 00B
Management and computer training services, excluding colleges and universities
Business leadership, entrepreneurial training, and skills development, including provision of seminars or instruction to improve professional
and management skills
(Exclude degree-granting colleges and universities.)
611430 003
Computer and information technology (IT) training services, including computer programming, gaining proficiency with software packages
and systems, IT security, and local area network (LAN) management
(Exclude computer repair training and software development.)
611420 001
Other schools and instruction
Elementary or secondary school
611110 001
Junior college or community college - granting associate degrees or certificates
611210 001
College, university, or professional school - granting academic degrees
611310 001
Language school
(Include sign language. Exclude elementary or secondary schools.)
611630 001
Other primary business or activity
Administrative and general management consulting services
541611 001
Scientific, technical, and safety or security consulting services
541690 908
Educational consulting services
(Exclude management, scientific, technical consulting)
611710 103
Other social advocacy organizations addressing issues such as antipoverty, peace and international understanding, drug abuse awareness,
firearms safety, public safety, social change, and taxpayer advocacy
813319 004
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
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779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
2022
$
,000.00
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
2022
$
,000.00
$
,000.00
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service Form 941,
Employer's Quarterly Federal Tax Return, and filed under the Employer Identification Number (EIN)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
2022
$
,000.00
$
,000.00
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7004075000
1. Educational support and consulting services
7004075003
a. Educational testing services
7004075006
b. Educational consulting services More
c. Other educational support services
(Include student exchange program services. Report continuing education and recertification for instructors on line 3.) More
7004075009
7004050000
2. Student services More
3. Trade, career, technical and professional development training programs
7003950000
Add product/service not listed
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23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Educational support and consulting services
a. Educational testing services
$
,000.00
7004075003
b. Educational consulting services More
$
,000.00
7004075006
$
,000.00
7004075009
$
,000.00
7004075000
2. Student services More
$
,000.00
7004050000
3. Trade, career, technical and professional development training programs
$
,000.00
7003950000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
c. Other educational support services
(Include student exchange program services. Report continuing education and recertification for instructors on line
3.) More
Subtotal
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7004075000
1. Educational support and consulting services
7004075003
a. Educational testing services
7004075006
b. Educational consulting services More
c. Other educational support services
(Include student exchange program services. Report continuing education and recertification for instructors on line 3.) More
7004075009
7004050000
2. Student services More
3. Trade, career, technical and professional development training programs
4. Program service revenue including government fees and contracts More
7003950000
8000200000
8000025000
5. Government contributions, gifts, and grants
6. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include commissioned
fundraising.)
8000050000
7. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
8000150000
8. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Educational support and consulting services
a. Educational testing services
$
,000.00
7004075003
b. Educational consulting services More
$
,000.00
7004075006
c. Other educational support services
(Include student exchange program services. Report continuing education and recertification for instructors on line
3.) More
$
,000.00
7004075009
$
,000.00
7004075000
2. Student services More
$
,000.00
7004050000
3. Trade, career, technical and professional development training programs
$
,000.00
7003950000
4. Program service revenue including government fees and contracts More
$
,000.00
8000200000
5. Government contributions, gifts, and grants
$
,000.00
8000025000
6. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include
commissioned fundraising.)
$
,000.00
8000050000
7. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
$
,000.00
8000150000
8. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
$
,000.00
8000175000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
Subtotal
9. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
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9900000002
26
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
40
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_ED-61170_su.pdf Generated 2022-02-23 17:05:56
,000.00
41
Attachment D-16
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 62
Attachment Sector
D-16
62
Instrument
Path
Instrument Path Title
6210C
6230C
62412
62441
Ambulatory Health Care Services (Classification)
Nursing and Residential Care Facilities (Classification)
Services for the Elderly, Disables, and Intellectually and
Developmentally Disabled
Child Day Care Services
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Physician services (Include physicians with the degree of M.D., D.O., O.D., D.C., D.P.M., D.M.D., D.D.S., or D.D.Sc.)
Office of physicians, excluding specialists in mental health or medical marijuana treatments
(Include practitioner(s) engaged in the practice of general or specialized medicine and/or surgery.)
621111 106
Office of physicians specializing in medical marijuana treatments (except mental health specialists)
621111 201
Pediatrician(s), obstetrics and gynecology physician(s) or other family health physician(s), excluding mental health specialists
621111 108
Psychiatrist(s) or other mental health physician(s)
621112 001
Ophthalmologist(s)
621111 102
Doctor(s) of Optometry
621320 001
Podiatrist(s)
621391 001
Dentist(s) or other specialty dental practitioner(s) having D.M.D., D.D.S., or D.D.Sc. degree, including orthodontists, endodontists, oral and
maxillofacial surgeons, etc.
621210 001
Dermatologist(s)
621111 109
Other health practitioners
Physical therapist(s)
621340 201
Mental health practitioner(s), except physicians and social service agencies
(Include psychologists, psychiatric social workers, clinical psychologists, neuropsychologists, and psychotherapists)
621330 002
Speech-language pathologist(s)
621340 103
Audiologist(s)
621340 102
Occupational therapist(s)
621340 203
Chiropractor(s)
621310 001
Massage therapist(s)
621399 006
Advanced practicing registered nurse(s) (APRN)
621399 005
Licensed practical and licensed vocational nurse(s)
621399 007
Certified registered nurse anesthetist(s)
621399 003
Dietician(s)
621399 004
Orthotist(s) and/or prosthetist(s)
621399 001
Outpatient care facilities
Multi-service clinic - services provided by physicians (with a degree of M.D. or D.O.) and at least one additional category of health
practitioners such as dentists, therapists, optometrists, chiropractors, podiatrists or other health practitioners
621498 007
Mental health clinic
621420 003
Ambulatory surgical center
621493 001
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6
Urgent care center or stand-alone emergency room
621493 002
Community health center or clinic
621498 001
Alcohol and/or substance abuse treatment clinic
621420 001
Sleep disorder center or clinic
621498 002
Provider of medical services at correctional facilities
621498 003
Health Maintenance Organization (HMO) medical clinic - operated by the provider of a prepaid medical plan
621491 001
Family planning center, including abortion and birth control clinics, fertility clinics, and pregnancy counseling centers
621410 001
Kidney dialysis center
621492 001
Medical and diagnostic laboratories
Medical laboratory - providing professional analytic or diagnostic services to the medical profession, or to the patient on prescription of a
physician
621511 001
Diagnostic imaging center - providing a variety of imaging services such as CT-scan (computer tomography), X-ray, ultrasound, and MRI
(magnetic resonance imaging)
621512 001
Mobile X-ray, mammography, MRI (magnetic resonance imaging), CT-scan (computer tomography), and/or ultrasound services
621512 002
Home health and hospice services
Home health care provider - providing physical, speech, and/or occupational therapy services
621610 004
Home health care provider with medical care, including visiting nurse associations, nursing agencies providing nursing and nursing assistant
services to patients in their home, or management of home health care services
621610 001
Nursing agency primarily providing nursing and nursing assistant services to patients in their homes
621610 003
Non-medical home care provider, including homemaker services such as cooking and cleaning or companion services with no medical
services provided
624120 004
Home hospice care
621610 002
Inpatient hospice facility
623110 001
Home infusion therapy
621610 005
Other activities and facilities associated with health care
Medical case management - assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's
health care needs to provide quality and cost-effective outcomes
621999 101
Health screening services, including drug testing
621999 906
Hearing testing services (except by offices of audiologists)
621999 902
Dental laboratory
339116 002
Mobile physical examination services, including exams for the purpose of obtaining insurance and/or employment
621999 901
Medical utilization review - advises health care providers how to provide cost-effective treatment that meets third-party reimbursement
requirements
(Exclude companies formulating specific treatment plans for individual patients.)
524298 003
Ambulance or emergency rescue services, air or ground
621910 003
Blood or blood product bank or donor station
621991 005
Eye, organ, tissue, or sperm bank, including cryobanks
621991 001
Other primary business or activity
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Nursing agency primarily providing nurses and other employees on a temporary basis to hospitals, doctors' offices, and other health care
providers
561320 001
Other primary business or activity
779000 001
Select Sector
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
9
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
3
Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
4
Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
5
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Nursing, assisted living, and residential care facilities and health services
Licensed nursing care facility providing inpatient nursing and rehabilitation services, including skilled nursing facilities
623110 003
Home for the elderly, including independent living or assisted living facilities WITHOUT on-site nursing care facility
623312 002
Continuing care retirement community - home for the elderly, including independent living or assisted living facilities WITH on-site nursing
care facility
623311 001
Intellectual and developmental disability facility, including group homes and intermediate care facilities for individuals with intellectual
disabilities (ICF/IID)
623210 002
Adult foster care for the intellectually or developmentally disabled
623210 001
Residential mental health facility, including psychiatric convalescent homes
623220 005
Residential alcohol or substance abuse rehabilitation facility, excluding nursing care facilities
623220 001
Inpatient hospice facility
623110 001
Home hospice care
621610 002
Home health care provider with medical care, including visiting nurse associations, nursing agencies providing nursing and nursing assistant
services to patients in their home, or management of home health care services
621610 001
Non-medical home care provider, including homemaker services such as cooking and cleaning or companion services with no medical
services provided
624120 004
Adult activity or day care center
624120 001
Children's home, group foster home, or orphanage
623990 001
Halfway homes and housing for reintegration of persons recently experiencing incarceration or treatment of substance abuse
623990 004
Group homes without nursing or medical care for persons with a disability
623990 003
Bootcamps or disciplinary camps (except correctional facilities) for delinquent youth
623990 005
Temporary or emergency shelter for the homeless, victims of abuse, families in medical crisis, and runaway youth
624221 001
Other community housing services to low-income individuals and families, including volunteer or non-profit housing construction or repair,
rent or utility assistance, and housing counseling
624229 007
Other health facilities and services
Physical therapist(s)
621340 201
Occupational therapist(s)
621340 203
Speech therapist(s) and/or audiologist(s)
621340 101
Multi-service organization providing a range of social assistance services to the elderly, disabled, intellectually and developmentally disabled,
or mentally ill
624120 003
General medical and surgical hospital, including osteopathic hospitals and combination hospital/nursing care facilities
622110 201
Other primary business or activity
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
6
779000 001
Other primary business or activity
Select Sector
Describe
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
7
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_HC-6230C_su.pdf Generated 2022-02-23 17:04:11
1000
characters remaining
8
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Services for the elderly, disabled, and intellectually and developmentally disabled
Agency for the aging, including adult day care and activity centers
624120 00A
Multi-service organization providing a range of social assistance services to the elderly, disabled, intellectually and developmentally disabled,
or mentally ill
624120 003
Non-medical home care provider, including homemaker services such as cooking and cleaning or companion services with no medical
services provided
624120 004
Non-profit meal delivery services and/or congregate meals
624210 002
Independent living skills training
624120 005
Social work case management services
624120 007
Job placement, training, or counseling program, including sheltered workshops
624310 002
Child early intervention center or services - providing services to children with disabilities, special needs, or delays
624120 00B
Support group for the disabled
624120 006
Childcare or preschool for the developmentally or physically disabled
624410 006
Counseling or therapy services provided by mental health practitioners, excluding services provided by physicians
(Include counseling by psychologists, psychiatric social workers, clinical psychologists, psychotherapists, etc.)
621330 003
Other non-medical counseling services to the elderly or disabled
624120 008
Home health care provider with medical care, including visiting nurse associations, nursing agencies providing nursing and nursing assistant
services to patients in their home, or management of home health care services
621610 001
Medical case management - assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's
health care needs to provide quality and cost-effective outcomes
621999 101
Residential care for the elderly, disabled, and intellectually and developmentally disabled
Intellectual and developmental disability facility, including group homes and intermediate care facilities for individuals with intellectual
disabilities (ICF/IID)
623210 002
Adult foster care for the intellectually or developmentally disabled
623210 001
Home for the elderly, including independent living or assisted living facilities WITHOUT on-site nursing care facility
623312 002
Residential facility for the mentally ill, excluding intellectual and developmental disability facilities
623220 002
Services for children and youth, excluding counseling and health services
Child care services, including those with preschool and/or Head Start programs
(Include services for children with or without disabilities.)
624410 001
Multi-service organization providing a range of social assistance services to children and youth
624110 006
Services for individuals and families, excluding counseling and health services
Community action agency
624190 001
Family services agency
624190 002
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
15
Multi-service organization, primarily providing a range of social assistance services to families and/or individuals, regardless of age
624190 00A
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
19
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
2022
$
,000.00
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
2022
$
,000.00
$
,000.00
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
2022
$
,000.00
$
,000.00
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Social assistance services for elderly and disabled adults
Product Code
7005014000
7005014003
a. Prepared on-site meals (i.e., at senior centers)
7005014006
b. Vocational rehabilitation services
7005014009
c. Adult day care services
d. Social interaction services, on-site
(Include senior centers.)
7005014012
7005014015
e. Counseling and information services More
f. Other social assistance services
(Include social assistance case management services.) More
2. Non-medical home aide services
(Include prepared meals and delivered meals.)
7005014018
7004575000
a. Home aide services for elderly and disabled adults - Homemaker services More
b. Home aide services for elderly and disabled adults - Personal care services More
c. Home aide services, excluding elderly and disabled adults More
7004575003
7004575006
7004575009
7005002000
3. Adoption services
7005004000
4. Foster care and guardianship arrangement services
5. Counseling and information services for children, youth, and families More
7005006000
7005006003
a. Self-help group services More
7005006006
b. Information and referral services More
7005006009
c. Hotline/Crisis intervention services More
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
23
d. Other counseling and information services
(Include mentoring services.)
7005006012
6. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
7005012000
7. Vocational rehabilitation services for the general population, including the homeless, abused, and victims of domestic violence
(Include revenue from providing job training, sheltered workshops, and work experience.)
7005017000
8. Counseling and information services for the general population, including the homeless, abused, and victims of domestic
violence More
7005018000
9. Food, clothing, and related assistance services for the general population, including the homeless, abused, and victims of domestic
violence
(Include social assistance related to donated household goods and food such as soup kitchens, food pantries, and food banks.)
7005019000
10. Shelter and related assistance services for the general population, including the homeless, abused, and victims of domestic
violence
7005020000
11. Other social assistance services for the general population, including the homeless, abused, and victims of domestic violence
(Include social assistance case management and private probation services.)
7005022000
7005010000
12. Children and youth recreational programs More
13. Child care services
(Include disabled children.) More
7005008000
14. Basic education and skills programs
(Include pre-primary grade instructional programs.) More
7003925000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
7003925003
b. Basic education and personal improvement programs and courses, excluding pre-primary instructional programs
7003925006
7005023000
15. Civic and social organization membership services
16. Trade, career, technical and professional development training programs
(Include training services, such as seminars and workshops, to promote social assistance.)
17. Local passenger transportation by road (except fixed-route)
7003950000
7002825000
Add product/service not listed
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Social assistance services for elderly and disabled adults
a. Prepared on-site meals (i.e., at senior centers)
$
,000.00
7005014003
b. Vocational rehabilitation services
$
,000.00
7005014006
c. Adult day care services
$
,000.00
7005014009
d. Social interaction services, on-site
(Include senior centers.)
$
,000.00
7005014012
e. Counseling and information services More
$
,000.00
7005014015
f. Other social assistance services
(Include social assistance case management services.) More
$
,000.00
7005014018
Subtotal
$
,000.00
7005014000
$
,000.00
7004575003
b. Home aide services for elderly and disabled adults - Personal care services More
$
,000.00
7004575006
c. Home aide services, excluding elderly and disabled adults More
$
,000.00
7004575009
Subtotal
$
,000.00
7004575000
3. Adoption services
$
,000.00
7005002000
4. Foster care and guardianship arrangement services
$
,000.00
7005004000
a. Self-help group services More
$
,000.00
7005006003
b. Information and referral services More
$
,000.00
7005006006
2. Non-medical home aide services
(Include prepared meals and delivered meals.)
a. Home aide services for elderly and disabled adults - Homemaker services More
5. Counseling and information services for children, youth, and families More
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
25
c. Hotline/Crisis intervention services More
$
,000.00
7005006009
d. Other counseling and information services
(Include mentoring services.)
$
,000.00
7005006012
Subtotal
$
,000.00
7005006000
6. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
$
,000.00
7005012000
7. Vocational rehabilitation services for the general population, including the homeless, abused, and victims of domestic
violence
(Include revenue from providing job training, sheltered workshops, and work experience.)
$
,000.00
7005017000
8. Counseling and information services for the general population, including the homeless, abused, and victims of
domestic violence More
$
,000.00
7005018000
9. Food, clothing, and related assistance services for the general population, including the homeless, abused, and
victims of domestic violence
(Include social assistance related to donated household goods and food such as soup kitchens, food pantries, and
food banks.)
$
,000.00
7005019000
10. Shelter and related assistance services for the general population, including the homeless, abused, and victims of
domestic violence
$
,000.00
7005020000
11. Other social assistance services for the general population, including the homeless, abused, and victims of domestic
violence
(Include social assistance case management and private probation services.)
$
,000.00
7005022000
12. Children and youth recreational programs More
$
,000.00
7005010000
13. Child care services
(Include disabled children.) More
$
,000.00
7005008000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
$
,000.00
7003925003
b. Basic education and personal improvement programs and courses, excluding pre-primary instructional programs
$
,000.00
7003925006
Subtotal
$
,000.00
7003925000
15. Civic and social organization membership services
$
,000.00
7005023000
16. Trade, career, technical and professional development training programs
(Include training services, such as seminars and workshops, to promote social assistance.)
$
,000.00
7003950000
17. Local passenger transportation by road (except fixed-route)
$
,000.00
7002825000
14. Basic education and skills programs
(Include pre-primary grade instructional programs.) More
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
26
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
27
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Social assistance services for elderly and disabled adults
Product Code
7005014000
7005014003
a. Prepared on-site meals (i.e., at senior centers)
7005014006
b. Vocational rehabilitation services
7005014009
c. Adult day care services
d. Social interaction services, on-site
(Include senior centers.)
7005014012
7005014015
e. Counseling and information services More
f. Other social assistance services
(Include social assistance case management services.) More
2. Non-medical home aide services
(Include prepared meals and delivered meals.)
7005014018
7004575000
a. Home aide services for elderly and disabled adults - Homemaker services More
b. Home aide services for elderly and disabled adults - Personal care services More
c. Home aide services, excluding elderly and disabled adults More
7004575003
7004575006
7004575009
7005002000
3. Adoption services
7005004000
4. Foster care and guardianship arrangement services
5. Counseling and information services for children, youth, and families More
7005006000
7005006003
a. Self-help group services More
7005006006
b. Information and referral services More
7005006009
c. Hotline/Crisis intervention services More
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
28
d. Other counseling and information services
(Include mentoring services.)
7005006012
6. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
7005012000
7. Vocational rehabilitation services for the general population, including the homeless, abused, and victims of domestic violence
(Include revenue from providing job training, sheltered workshops, and work experience.)
7005017000
8. Counseling and information services for the general population, including the homeless, abused, and victims of domestic
violence More
7005018000
9. Food, clothing, and related assistance services for the general population, including the homeless, abused, and victims of domestic
violence
(Include social assistance related to donated household goods and food such as soup kitchens, food pantries, and food banks.)
7005019000
10. Shelter and related assistance services for the general population, including the homeless, abused, and victims of domestic
violence
7005020000
11. Other social assistance services for the general population, including the homeless, abused, and victims of domestic violence
(Include social assistance case management and private probation services.)
7005022000
7005010000
12. Children and youth recreational programs More
13. Child care services
(Include disabled children.) More
7005008000
14. Basic education and skills programs
(Include pre-primary grade instructional programs.) More
7003925000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
7003925003
b. Basic education and personal improvement programs and courses, excluding pre-primary instructional programs
7003925006
7005023000
15. Civic and social organization membership services
16. Trade, career, technical and professional development training programs
(Include training services, such as seminars and workshops, to promote social assistance.)
17. Local passenger transportation by road (except fixed-route)
7003950000
7002825000
8000025000
18. Government contributions, gifts, and grants
19. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include
commissioned fundraising.)
8000050000
20. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
8000150000
21. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
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29
Add product/service not listed
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30
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Social assistance services for elderly and disabled adults
a. Prepared on-site meals (i.e., at senior centers)
$
,000.00
7005014003
b. Vocational rehabilitation services
$
,000.00
7005014006
c. Adult day care services
$
,000.00
7005014009
d. Social interaction services, on-site
(Include senior centers.)
$
,000.00
7005014012
e. Counseling and information services More
$
,000.00
7005014015
f. Other social assistance services
(Include social assistance case management services.) More
$
,000.00
7005014018
Subtotal
$
,000.00
7005014000
$
,000.00
7004575003
$
,000.00
7004575006
c. Home aide services, excluding elderly and disabled adults More
$
,000.00
7004575009
Subtotal
$
,000.00
7004575000
3. Adoption services
$
,000.00
7005002000
4. Foster care and guardianship arrangement services
$
,000.00
7005004000
a. Self-help group services More
$
,000.00
7005006003
b. Information and referral services More
$
,000.00
7005006006
2. Non-medical home aide services
(Include prepared meals and delivered meals.)
a. Home aide services for elderly and disabled adults - Homemaker services More
b. Home aide services for elderly and disabled adults - Personal care services More
5. Counseling and information services for children, youth, and families More
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31
c. Hotline/Crisis intervention services More
$
,000.00
7005006009
d. Other counseling and information services
(Include mentoring services.)
$
,000.00
7005006012
Subtotal
$
,000.00
7005006000
$
,000.00
7005012000
7. Vocational rehabilitation services for the general population, including the homeless, abused, and victims of domestic
violence
(Include revenue from providing job training, sheltered workshops, and work experience.)
$
,000.00
7005017000
8. Counseling and information services for the general population, including the homeless, abused, and victims of
domestic violence More
$
,000.00
7005018000
9. Food, clothing, and related assistance services for the general population, including the homeless, abused, and
victims of domestic violence
(Include social assistance related to donated household goods and food such as soup kitchens, food pantries, and
food banks.)
$
,000.00
7005019000
10. Shelter and related assistance services for the general population, including the homeless, abused, and victims of
domestic violence
$
,000.00
7005020000
11. Other social assistance services for the general population, including the homeless, abused, and victims of domestic
violence
(Include social assistance case management and private probation services.)
$
,000.00
7005022000
$
,000.00
7005010000
$
,000.00
7005008000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
$
,000.00
7003925003
b. Basic education and personal improvement programs and courses, excluding pre-primary instructional programs
$
,000.00
7003925006
Subtotal
$
,000.00
7003925000
15. Civic and social organization membership services
$
,000.00
7005023000
16. Trade, career, technical and professional development training programs
(Include training services, such as seminars and workshops, to promote social assistance.)
$
,000.00
7003950000
17. Local passenger transportation by road (except fixed-route)
$
,000.00
7002825000
6. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
12. Children and youth recreational programs More
13. Child care services
(Include disabled children.) More
14. Basic education and skills programs
(Include pre-primary grade instructional programs.) More
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32
18. Government contributions, gifts, and grants
$
,000.00
8000025000
19. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc.
Include commissioned fundraising.)
$
,000.00
8000050000
20. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
$
,000.00
8000150000
21. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
$
,000.00
8000175000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
22. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
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33
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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34
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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35
Item 28: Special Items - Grants and Contributions
ITEM 28: SPECIAL ITEMS - GRANTS AND CONTRIBUTIONS
During 2022, did this establishment do any of the following?
Award grants
Make gifts or contributions
Make payments to, or on behalf of, specific individuals
Pay assessments (dues) to the parent or other chapters of the same organization
Transfer funds raised by this establishment to charities or other organizations for charitable purposes
Yes
No
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36
Item 28: Special Items - Grants and Contributions - Continued
ITEM 28: SPECIAL ITEMS - GRANTS AND CONTRIBUTIONS
2022
What were the amount of grants, transferred contributions, and similar payments?
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$
,000.00
37
Item 28: Special Items - Social Assistance
ITEM 28: SPECIAL ITEMS - SOCIAL ASSISTANCE
What was the percentage of receipts for social assistance services reported in Item 22, lines 1 through 14b, from the following payers?
2022
%
1. Government payers
2. Private payers
%
3. TOTAL (Sum of lines 1 and 2 should equal 100%.)
%
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38
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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39
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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40
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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41
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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42
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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43
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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44
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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45
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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46
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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47
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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48
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
49
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_HC-62412_su.pdf Generated 2022-02-17 07:54:40
,000.00
50
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Childcare and selected educational services
Child care services, including those with preschool and/or Head Start programs
(Include services for children with or without disabilities.)
624410 001
Head Start centers and programs
(Include services for children with or without disabilities.)
624410 002
Preschool
(Include services for children with or without disabilities.)
624410 003
Before and/or after school care program, excluding tutoring services and sports and recreational clubs
624410 004
Elementary or secondary school
611110 001
Tutoring and exam preparation services, including college board preparation
611691 003
Babysitting services
624410 005
Case management and other social assistance services for children and youth
Child early intervention center or services for youth with developmental disabilities or delays
(Exclude child care.)
624120 00E
Child care food program
624210 001
Multi-service organization providing a range of social assistance services to children and youth
624110 006
Multi-service organization providing a range of social assistance services to families and individuals, excluding services primarily to children,
the elderly, the disabled, the intellectually and developmentally disabled, or the mentally ill
624190 003
Community action agency
624190 001
Family services agency
624190 002
Adult activity or day care center
624120 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
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18
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
2022
$
,000.00
19
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
2022
$
,000.00
$
,000.00
20
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
2022
$
,000.00
$
,000.00
21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Child care services
(Include application, registration, and late fees.)
Product Code
7005008000
7005008003
a. In-home child care services More
7005008006
b. Child care center services More
7003925000
2. Basic education and skills programs More
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
7003925003
b. Basic education and personal improvement instructional programs
(Exclude pre-primary and sports or recreational instructional programs.)
7003925006
3. Children and youth recreational programs
(Exclude instructional programs.) More
7005010000
4. Counseling and information services for children, youth, and families
(Include mentoring services.)
7005006000
5. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
7005012000
6. Leisure, recreational, and athletic instructional programs
(Include day and/or overnight instructional camps. Exclude overnight recreational camps.)
7002500000
7004025000
7. Academic tutoring and customized learning programs
Add product/service not listed
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22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Child care services
(Include application, registration, and late fees.)
a. In-home child care services More
$
,000.00
7005008003
b. Child care center services More
$
,000.00
7005008006
Subtotal
$
,000.00
7005008000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
$
,000.00
7003925003
b. Basic education and personal improvement instructional programs
(Exclude pre-primary and sports or recreational instructional programs.)
$
,000.00
7003925006
$
,000.00
7003925000
3. Children and youth recreational programs
(Exclude instructional programs.) More
$
,000.00
7005010000
4. Counseling and information services for children, youth, and families
(Include mentoring services.)
$
,000.00
7005006000
5. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
$
,000.00
7005012000
6. Leisure, recreational, and athletic instructional programs
(Include day and/or overnight instructional camps. Exclude overnight recreational camps.)
$
,000.00
7002500000
7. Academic tutoring and customized learning programs
$
,000.00
7004025000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
2. Basic education and skills programs More
Subtotal
Add product/service not listed
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Child care services
(Include application, registration, and late fees.)
Product Code
7005008000
7005008003
a. In-home child care services More
7005008006
b. Child care center services More
7003925000
2. Basic education and skills programs More
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
7003925003
b. Basic education and personal improvement instructional programs
(Exclude pre-primary and sports or recreational instructional programs.)
7003925006
3. Children and youth recreational programs
(Exclude instructional programs.) More
7005010000
4. Counseling and information services for children, youth, and families
(Include mentoring services.)
7005006000
5. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
7005012000
6. Leisure, recreational, and athletic instructional programs
(Include day and/or overnight instructional camps. Exclude overnight recreational camps.)
7002500000
7004025000
7. Academic tutoring and customized learning programs
8000025000
8. Government contributions, gifts, and grants
9. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include commissioned
fundraising.)
8000050000
10. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
8000150000
11. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
Add product/service not listed
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Child care services
(Include application, registration, and late fees.)
a. In-home child care services More
$
,000.00
7005008003
b. Child care center services More
$
,000.00
7005008006
Subtotal
$
,000.00
7005008000
a. Pre-primary grade instructional programs
(Include preschool programs combined with child care.)
$
,000.00
7003925003
b. Basic education and personal improvement instructional programs
(Exclude pre-primary and sports or recreational instructional programs.)
$
,000.00
7003925006
Subtotal
$
,000.00
7003925000
3. Children and youth recreational programs
(Exclude instructional programs.) More
$
,000.00
7005010000
4. Counseling and information services for children, youth, and families
(Include mentoring services.)
$
,000.00
7005006000
5. Other social assistance services for children, youth, and families
(Include social assistance case management and vocational rehabilitation services.)
$
,000.00
7005012000
6. Leisure, recreational, and athletic instructional programs
(Include day and/or overnight instructional camps. Exclude overnight recreational camps.)
$
,000.00
7002500000
7. Academic tutoring and customized learning programs
$
,000.00
7004025000
8. Government contributions, gifts, and grants
$
,000.00
8000025000
9. Private contributions, gifts, and grants
(Include contributions, gifts, and grants from individuals, foundations, business and industry, labor unions, etc. Include
commissioned fundraising.)
$
,000.00
8000050000
10. Trading securities and commodity contracts on own account
(Include investment income, interest, and dividends.) More
$
,000.00
8000150000
2. Basic education and skills programs More
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
25
11. Gains (losses) from non-financial assets sold
(Report losses by including a minus sign prior to the dollar amount.) More
8000175000
$
,000.00
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
12. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
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26
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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27
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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28
Item 28: Special Items - Grants and Contributions
ITEM 28: SPECIAL ITEMS - GRANTS AND CONTRIBUTIONS
During 2022, did this establishment do any of the following?
Award grants
Make gifts or contributions
Make payments to, or on behalf of, specific individuals
Pay assessments (dues) to the parent or other chapters of the same organization
Transfer funds raised by this establishment to charities or other organizations for charitable purposes
Yes
No
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29
Item 28: Special Items - Grants and Contributions - Continued
ITEM 28: SPECIAL ITEMS - GRANTS AND CONTRIBUTIONS
2022
What were the amount of grants, transferred contributions, and similar payments?
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$
,000.00
30
Item 28: Special Items - Social Assistance
ITEM 28: SPECIAL ITEMS - SOCIAL ASSISTANCE
What was the percentage of receipts for social assistance services reported in Item 22, lines 1 through 5, from the following payers?
2022
%
1. Government payers
%
2. Private payers
%
3. TOTAL (Sum of lines 1 and 2 should equal 100%.)
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31
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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32
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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33
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
34
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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35
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
37
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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38
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
39
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
40
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
41
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
1000
characters remaining
42
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_HC-62441_su.pdf Generated 2022-02-17 07:58:02
,000.00
43
Attachment D-17
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 71
Attachment Sector
D-17
71
Instrument
Path
Instrument Path Title
71120
71130
71140
71210
Spectator Sports
Promoters of Performing Arts, Sports, and Similar Events
Agents and Managers for Artists, Athletes, Entertainers, and Other
Public Figures
Museums, Historical Sites, and Similar Institutions
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Professional or semiprofessional sports club
Baseball clubs, professional
711211 321
Baseball clubs, minor-league, semi-professional, and collegiate
711211 421
Football clubs, professional
711211 311
Football clubs, semi-professional and collegiate
711211 411
Basketball clubs, professional
711211 331
Basketball clubs, semi-professional and collegiate
711211 431
Hockey clubs, professional
711211 341
Hockey clubs, semi-professional and collegiate
711211 441
Other sports clubs, professional (e.g., soccer, boxing, etc.)
711211 391
Other sports clubs, semi-professional and collegiate (e.g., soccer, boxing, etc.)
711211 491
Recreational sports team, club, or league with indoor or outdoor facilities
713990 807
Promoters with facilities, live sporting events
711310 301
Promoters without facilities, live sporting events
711320 301
Individual sports professional, including surfers, tennis players, wrestlers, snowboarders, and golfers (Exclude jockeys or race car drivers.)
711219 102
Professional athletes and sports trainers, except jockeys or race car drivers
711219 101
Golf or tennis professional providing instruction only (not participating)
611620 002
Agents or managers for artists, performers, individual sports professionals, authors, speakers, and other public figures
711410 002
Racetrack operation and other racing activities
Auto racetrack
711212 201
Racetrack casino (offering table wagering games), except casino hotels
713210 201
Racetrack casino hotel (offering table wagering games)
721120 201
Horse racetrack operation with other gambling (except table game wagering)
711212 311
Horse racetrack without other gambling activities onsite
711212 321
Dog racetrack operation with other gambling (except table game wagering)
711212 111
Dog racetrack without other gambling activities onsite
711212 121
Race car owner, driver, or team
711219 211
Racing stable, dog or horse - entered in racing events
711219 222
Jockey or harness driver or owner
711219 221
Trainer - animals for racing
711219 223
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
15
711219 224
Horse, dog, and other animal racing
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
2022
$
,000.00
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
2022
$
,000.00
$
,000.00
20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001775000
1. Admissions to live sports events More
2. Live performing arts performances produced under contract More
7010075000
7010275000
3. Live sporting events produced under contract More
7013050000
4. Public relations event management services More
5. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings More
6. Licensing of rights to others to distribute audiovisual works protected by copyright
7. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
8. Licensing of other rights to use audiovisual works protected by copyright, not elsewhere classified
9. Licensing of rights to use intellectual property protected by trademark More
7009581000
7009575000
7009576000
7009577000
7009625000
7010225000
10. Sporting event broadcast and other media rights More
7010225003
a. Sporting event broadcast rights
7010225006
b. Other sporting event media rights
7002310000
11. Sports coaching services More
7012275000
12. Advertising space in printed publications More
7012300000
13. Television air time for advertising
7012325000
14. Radio air time for advertising
7012350000
15. Internet advertising
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
21
7012375000
16. Leased display advertising media space More
7012410000
17. Other advertising space, time, and similar services
7012410006
a. Venue naming rights More
7012410009
b. Sponsorship rights More
7012410012
c. Endorsement services More
7012410015
d. Exclusivity rights More
e. Advertising space, time, and similar services, not elsewhere classified
7012410018
7017200000
18. Race animal training services
7002400000
19. Pari-mutuel sports gambling More
a. Pari-mutuel sports gambling, on the event premises More
b. Pari-mutuel sports gambling, away from the event premises
7002400003
7002400006
7002375000
20. Gambling machine products More
7002350000
21. Table wagering games
7002750000
22. Parking services
23. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
24. Alcoholic beverages, prepared and served or dispensed for immediate consumption
25. Hosting of coin-operated self-service gambling machines More
26. Rental of space for sporting, entertainment, and other events
7000025000
7000050000
7006550000
7006500000
5000350000
27. Retail sales of men's clothing
5000375000
28. Retail sales of women's clothing
29. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including school uniforms
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
5000400000
22
30. Retail sales of household goods, not elsewhere classified
5000860000
Add product/service not listed
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to live sports events More
$
,000.00
7001775000
2. Live performing arts performances produced under contract More
$
,000.00
7010075000
3. Live sporting events produced under contract More
$
,000.00
7010275000
4. Public relations event management services More
$
,000.00
7013050000
5. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings More
$
,000.00
7009581000
6. Licensing of rights to others to distribute audiovisual works protected by copyright
$
,000.00
7009575000
7. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
$
,000.00
7009576000
8. Licensing of other rights to use audiovisual works protected by copyright, not elsewhere classified
$
,000.00
7009577000
9. Licensing of rights to use intellectual property protected by trademark More
$
,000.00
7009625000
a. Sporting event broadcast rights
$
,000.00
7010225003
b. Other sporting event media rights
$
,000.00
7010225006
$
,000.00
7010225000
11. Sports coaching services More
$
,000.00
7002310000
12. Advertising space in printed publications More
$
,000.00
7012275000
13. Television air time for advertising
$
,000.00
7012300000
14. Radio air time for advertising
$
,000.00
7012325000
15. Internet advertising
$
,000.00
7012350000
10. Sporting event broadcast and other media rights More
Subtotal
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
24
$
,000.00
7012375000
a. Venue naming rights More
$
,000.00
7012410006
b. Sponsorship rights More
$
,000.00
7012410009
$
,000.00
7012410012
d. Exclusivity rights More
$
,000.00
7012410015
e. Advertising space, time, and similar services, not elsewhere classified
$
,000.00
7012410018
Subtotal
$
,000.00
7012410000
$
,000.00
7017200000
a. Pari-mutuel sports gambling, on the event premises More
$
,000.00
7002400003
b. Pari-mutuel sports gambling, away from the event premises
$
,000.00
7002400006
Subtotal
$
,000.00
7002400000
20. Gambling machine products More
$
,000.00
7002375000
21. Table wagering games
$
,000.00
7002350000
22. Parking services
$
,000.00
7002750000
23. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
24. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
25. Hosting of coin-operated self-service gambling machines More
$
,000.00
7006550000
26. Rental of space for sporting, entertainment, and other events
$
,000.00
7006500000
27. Retail sales of men's clothing
$
,000.00
5000350000
16. Leased display advertising media space More
17. Other advertising space, time, and similar services
c. Endorsement services More
18. Race animal training services
19. Pari-mutuel sports gambling More
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
25
28. Retail sales of women's clothing
$
,000.00
5000375000
29. Retail sales of children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including
school uniforms
$
,000.00
5000400000
30. Retail sales of household goods, not elsewhere classified
$
,000.00
5000860000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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26
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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27
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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28
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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29
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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30
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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31
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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32
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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33
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
1000
characters remaining
38
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AE-71120_su.pdf Generated 2022-02-18 07:44:06
,000.00
39
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Facility operators, including operators promoting arts, sports, and similar events
Promoters with facilities, live performing arts productions (except popular music)
711310 101
Promoters with facilities, live popular music productions
711310 201
Promoters with facilities, live sporting events
711310 301
Promoters with facilities, other live events (i.e. - agricultural fair, beauty pageant)
711310 401
Owner of theater, arena, stadium, or similar facility but not promoting or presenting shows or events - only renting facility to others
531120 905
Promoters of arts, sports, and similar events, without facilities
Promoters without facilities, live popular music productions
711320 201
Promoters without facilities, live sporting events
711320 301
Promoters without facilities, live performing arts productions (except popular music)
711320 101
Promoters without facilities, other live events (i.e. - agricultural fair, beauty pageant)
711320 401
Agents and managers for artists, athletes, entertainers, and other public figures
Agents or managers for artists, performers, individual sports professionals, authors, speakers, and other public figures
711410 002
Talent agency
711410 004
Authors, speakers, and other non-performing artists' agent
711410 001
Modeling agency
711410 005
Literary agency
711410 006
Speakers bureau
711410 003
Independent artists, writers, and performers
Actor, actress, comedian, or other independent entertainer
711510 001
Author, writer, or composer
711510 004
Independent film director or other motion picture artist or technician
711510 002
Other music groups and artists (e.g., bands, musicians, choirs, independent musicians), except symphony orchestras and chamber music
organizations
711130 901
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
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Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
2022
$
,000.00
19
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
2022
$
,000.00
$
,000.00
20
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
2022
$
,000.00
$
,000.00
21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001600000
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
b. Admissions to live musical theater and opera performances
c. Admissions to live symphony and classical music performances
7001600003
7001600006
7001600009
7001600012
d. Admissions to live popular music performances
e. Admissions to live dance performances, musical and non-musical
7001600015
7001600018
f. Admissions to live public appearances and speeches
g. Admissions to live performing arts performances, not elsewhere classified
7001600021
7001775000
2. Admissions to live sports events More
3. Live performing arts performances produced under contract More
7010075000
7010275000
4. Live sporting events produced under contract More
7013050000
5. Public relations event management services
7010100000
6. Audiovisual performances produced under contract
7010225000
7. Sporting event broadcast and other media rights More
7010225003
a. Sporting event broadcast rights
7010225006
b. Other sporting event media rights
7012275000
8. Advertising space in printed publications
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
22
7012300000
9. Television air time for advertising
7012325000
10. Radio air time for advertising
7012350000
11. Internet advertising
7012375000
12. Leased display advertising media space
13. Advertising space in publications on electronic and other media, except online
7012400000
7012410000
14. Other advertising space, time, and similar services
7012410006
a. Venue naming rights More
7012410009
b. Sponsorship rights More
7012410012
c. Endorsement services More
7012410015
d. Exclusivity rights More
e. Advertising space, time, and similar services, not elsewhere classified More
15. Membership services of performing arts societies and cultural institutions More
16. Other membership (including religious congregation) services
17. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
18. Alcoholic beverages, prepared and served or dispensed for immediate consumption
19. Rental of space for sporting, entertainment, and other events
7012410018
7001650000
7005024000
7000025000
7000050000
7006500000
7006375000
20. Rental and leasing of commercial space More
Add product/service not listed
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
$
,000.00
7001600003
b. Admissions to live musical theater and opera performances
$
,000.00
7001600006
c. Admissions to live symphony and classical music performances
$
,000.00
7001600009
d. Admissions to live popular music performances
$
,000.00
7001600012
e. Admissions to live dance performances, musical and non-musical
$
,000.00
7001600015
f. Admissions to live public appearances and speeches
$
,000.00
7001600018
g. Admissions to live performing arts performances, not elsewhere classified
$
,000.00
7001600021
$
,000.00
7001600000
2. Admissions to live sports events More
$
,000.00
7001775000
3. Live performing arts performances produced under contract More
$
,000.00
7010075000
4. Live sporting events produced under contract More
$
,000.00
7010275000
5. Public relations event management services
$
,000.00
7013050000
6. Audiovisual performances produced under contract
$
,000.00
7010100000
a. Sporting event broadcast rights
$
,000.00
7010225003
b. Other sporting event media rights
$
,000.00
7010225006
Subtotal
$
,000.00
7010225000
Subtotal
7. Sporting event broadcast and other media rights More
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
24
8. Advertising space in printed publications
$
,000.00
7012275000
9. Television air time for advertising
$
,000.00
7012300000
$
,000.00
7012325000
11. Internet advertising
$
,000.00
7012350000
12. Leased display advertising media space
$
,000.00
7012375000
13. Advertising space in publications on electronic and other media, except online
$
,000.00
7012400000
a. Venue naming rights More
$
,000.00
7012410006
b. Sponsorship rights More
$
,000.00
7012410009
c. Endorsement services More
$
,000.00
7012410012
d. Exclusivity rights More
$
,000.00
7012410015
e. Advertising space, time, and similar services, not elsewhere classified More
$
,000.00
7012410018
Subtotal
$
,000.00
7012410000
15. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
16. Other membership (including religious congregation) services
$
,000.00
7005024000
17. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
18. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
19. Rental of space for sporting, entertainment, and other events
$
,000.00
7006500000
20. Rental and leasing of commercial space More
$
,000.00
7006375000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
10. Radio air time for advertising
14. Other advertising space, time, and similar services
Add product/service not listed
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
25
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001600000
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
b. Admissions to live musical theater and opera performances
c. Admissions to live symphony and classical music performances
7001600003
7001600006
7001600009
7001600012
d. Admissions to live popular music performances
e. Admissions to live dance performances, musical and non-musical
7001600015
7001600018
f. Admissions to live public appearances and speeches
g. Admissions to live performing arts performances, not elsewhere classified
7001600021
7001775000
2. Admissions to live sports events More
3. Live performing arts performances produced under contract More
7010075000
7010275000
4. Live sporting events produced under contract More
7013050000
5. Public relations event management services
7010100000
6. Audiovisual performances produced under contract
7010225000
7. Sporting event broadcast and other media rights More
7010225003
a. Sporting event broadcast rights
7010225006
b. Other sporting event media rights
7012275000
8. Advertising space in printed publications
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
26
7012300000
9. Television air time for advertising
7012325000
10. Radio air time for advertising
7012350000
11. Internet advertising
7012375000
12. Leased display advertising media space
13. Advertising space in publications on electronic and other media, except online
7012400000
7012410000
14. Other advertising space, time, and similar services
a. Venue naming rights
Report receipts from granting the right to name a performing arts or spectator sports venue. This right is typically sold to companies
and serves to increase exposure of a company's brand name.
7012410006
b. Sponsorship rights
Report receipts from granting the right to associate specific goods or services, or a corporation or other entity, with an activity,
product, or project that is carried out by another entity. Sponsorships usually include the provision of advertising display space and
may include exclusivity rights.
7012410009
c. Endorsement services
Report receipts from providing product endorsements by individual professional athletes, performing artists, sports teams, or
performing arts groups or companies.
7012410012
d. Exclusivity rights
Report receipts from granting the right to require that all sellers of a specified good or service sell only specific brands of that good or
service (i.e., pouring rights).
7012410015
e. Advertising space, time, and similar services, not elsewhere classified
Report receipts from providing services that attract attention to a product, business, cause, etc., not elsewhere specified. Include the
creation of advertising messages.
7012410018
15. Membership services of performing arts societies and cultural institutions More
16. Other membership (including religious congregation) services
17. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
18. Alcoholic beverages, prepared and served or dispensed for immediate consumption
19. Rental of space for sporting, entertainment, and other events
7001650000
7005024000
7000025000
7000050000
7006500000
7006375000
20. Rental and leasing of commercial space More
8000025000
21. Government contributions, gifts, and grants
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
27
a. Contributions, gifts, and grants from the National Endowment for the Arts
b. All other federal, state, county, and municipal contributions, gifts, and grants
8000025003
8000025006
8000050000
22. Private contributions, gifts, and grants
8000050003
a. Private contributions, gifts, and grants from individuals
b. Private contributions, gifts, and grants from foundations
c. Private contributions, gifts, and grants from business and industry
d. Other contributions, gifts, and grants, including from labor unions, etc.
23. Program service revenue including government fees and contracts
8000050006
8000050009
8000050012
8000200000
8000175000
24. Gains (losses) from non-financial assets sold More
25. Trading securities and commodity contracts on own account
8000150000
Add product/service not listed
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
28
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
$
,000.00
7001600003
b. Admissions to live musical theater and opera performances
$
,000.00
7001600006
c. Admissions to live symphony and classical music performances
$
,000.00
7001600009
d. Admissions to live popular music performances
$
,000.00
7001600012
e. Admissions to live dance performances, musical and non-musical
$
,000.00
7001600015
f. Admissions to live public appearances and speeches
$
,000.00
7001600018
g. Admissions to live performing arts performances, not elsewhere classified
$
,000.00
7001600021
$
,000.00
7001600000
2. Admissions to live sports events More
$
,000.00
7001775000
3. Live performing arts performances produced under contract More
$
,000.00
7010075000
4. Live sporting events produced under contract More
$
,000.00
7010275000
5. Public relations event management services
$
,000.00
7013050000
$
,000.00
7010100000
a. Sporting event broadcast rights
$
,000.00
7010225003
b. Other sporting event media rights
$
,000.00
7010225006
Subtotal
$
,000.00
7010225000
Subtotal
6. Audiovisual performances produced under contract
7. Sporting event broadcast and other media rights More
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
29
8. Advertising space in printed publications
$
,000.00
7012275000
9. Television air time for advertising
$
,000.00
7012300000
$
,000.00
7012325000
11. Internet advertising
$
,000.00
7012350000
12. Leased display advertising media space
$
,000.00
7012375000
13. Advertising space in publications on electronic and other media, except online
$
,000.00
7012400000
a. Venue naming rights
Report receipts from granting the right to name a performing arts or spectator sports venue. This right is typically sold
to companies and serves to increase exposure of a company's brand name.
$
,000.00
7012410006
b. Sponsorship rights
Report receipts from granting the right to associate specific goods or services, or a corporation or other entity, with an
activity, product, or project that is carried out by another entity. Sponsorships usually include the provision of
advertising display space and may include exclusivity rights.
$
,000.00
7012410009
c. Endorsement services
Report receipts from providing product endorsements by individual professional athletes, performing artists, sports
teams, or performing arts groups or companies.
$
,000.00
7012410012
d. Exclusivity rights
Report receipts from granting the right to require that all sellers of a specified good or service sell only specific brands
of that good or service (i.e., pouring rights).
$
,000.00
7012410015
$
,000.00
7012410018
$
,000.00
7012410000
15. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
16. Other membership (including religious congregation) services
$
,000.00
7005024000
17. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
18. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
19. Rental of space for sporting, entertainment, and other events
$
,000.00
7006500000
20. Rental and leasing of commercial space More
$
,000.00
7006375000
10. Radio air time for advertising
14. Other advertising space, time, and similar services
e. Advertising space, time, and similar services, not elsewhere classified
Report receipts from providing services that attract attention to a product, business, cause, etc., not elsewhere
specified. Include the creation of advertising messages.
Subtotal
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
30
21. Government contributions, gifts, and grants
a. Contributions, gifts, and grants from the National Endowment for the Arts
$
,000.00
8000025003
b. All other federal, state, county, and municipal contributions, gifts, and grants
$
,000.00
8000025006
Subtotal
$
,000.00
8000025000
a. Private contributions, gifts, and grants from individuals
$
,000.00
8000050003
b. Private contributions, gifts, and grants from foundations
$
,000.00
8000050006
c. Private contributions, gifts, and grants from business and industry
$
,000.00
8000050009
d. Other contributions, gifts, and grants, including from labor unions, etc.
$
,000.00
8000050012
$
,000.00
8000050000
23. Program service revenue including government fees and contracts
$
,000.00
8000200000
24. Gains (losses) from non-financial assets sold More
$
,000.00
8000175000
25. Trading securities and commodity contracts on own account
$
,000.00
8000150000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
22. Private contributions, gifts, and grants
Subtotal
26. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
31
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
32
Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
33
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
34
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
35
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
36
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
37
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
38
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
39
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
40
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
41
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
42
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
1000
characters remaining
43
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AE-71130_su.pdf Generated 2022-02-18 07:42:59
,000.00
44
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_AE-71140_su.pdf Generated 2022-02-18 07:45:09
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AE-71140_su.pdf Generated 2022-02-18 07:45:09
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_AE-71140_su.pdf Generated 2022-02-18 07:45:09
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Facility operators, including operators promoting arts, sports, and similar events
Promoters with facilities, live performing arts productions (except popular music)
711310 101
Promoters with facilities, live sporting events
711310 301
Promoters with facilities, other live events (i.e. - agricultural fair, beauty pageant)
711310 401
Owner of theater, arena, stadium, or similar facility but not promoting or presenting shows or events - only renting facility to others
531120 905
Promoters of arts, sports, and similar events, without facilities
Promoters without facilities, live popular music productions
711320 201
Promoters without facilities, live performing arts productions (except popular music)
711320 101
Promoters without facilities, live sporting events
711320 301
Promoters without facilities, other live events (i.e. - agricultural fair, beauty pageant)
711320 401
Film festival exhibitor
512131 002
Agents and managers for artists, athletes, entertainers, and other public figures
Agents or managers for artists, performers, individual sports professionals, authors, speakers, and other public figures
711410 002
Talent agency
711410 004
Authors, speakers, and other non-performing artists' agent
711410 001
Modeling agency
711410 005
Literary agency
711410 006
Speakers bureau
711410 003
Independent artists, writers, and performers
Actor, actress, comedian, or other independent entertainer
711510 001
Author, writer, or composer
711510 004
Independent film director or other motion picture artist or technician
711510 002
Other music groups and artists (e.g., bands, musicians, choirs, independent musicians), except symphony orchestras and chamber music
organizations
711130 901
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001600000
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
b. Admissions to live musical theater and opera performances
c. Admissions to live symphony and classical music performances
7001600003
7001600006
7001600009
7001600012
d. Admissions to live popular music performances
e. Admissions to live dance performances, musical and non-musical
7001600015
7001600018
f. Admissions to live public appearances and speeches
g. Admissions to live performing arts performances, not elsewhere classified
2. Live performing arts performances produced under contract More
3. Public relations event management services, including sports and performing arts event organization and management
services More
7001600021
7010075000
7013050000
7014950000
4. Career management services More
7014975000
5. Representation services More
7014975003
a. Performance contract representation services
b. Sponsorship and endorsement contract representation services
7014975006
7014975009
c. Other contract representation services
6. Outright sale of rights to intellectual property works protected by copyright More
7009550000
7010100000
7. Audiovisual performances produced under contract
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8. Other artistic and literary intellectual property protected by copyright produced under contract, except live performances and
audiovisual works More
7010125000
9. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical compositions and
recordings More
7009581000
10. Licensing of rights to use musical compositions protected by copyright
11. Licensing of rights to others to distribute audiovisual works protected by copyright
12. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
13. Licensing of other rights to use audiovisual works protected by copyright, not elsewhere classified
14. Licensing of rights to use intellectual property protected by trademark More
7009578000
7009575000
7009576000
7009577000
7009625000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to live performing arts performances More
a. Admissions to live theatrical performances, non-musical
$
,000.00
7001600003
b. Admissions to live musical theater and opera performances
$
,000.00
7001600006
c. Admissions to live symphony and classical music performances
$
,000.00
7001600009
d. Admissions to live popular music performances
$
,000.00
7001600012
e. Admissions to live dance performances, musical and non-musical
$
,000.00
7001600015
$
,000.00
7001600018
g. Admissions to live performing arts performances, not elsewhere classified
$
,000.00
7001600021
Subtotal
$
,000.00
7001600000
2. Live performing arts performances produced under contract More
$
,000.00
7010075000
3. Public relations event management services, including sports and performing arts event organization and
management services More
$
,000.00
7013050000
4. Career management services More
$
,000.00
7014950000
a. Performance contract representation services
$
,000.00
7014975003
b. Sponsorship and endorsement contract representation services
$
,000.00
7014975006
c. Other contract representation services
$
,000.00
7014975009
Subtotal
$
,000.00
7014975000
$
,000.00
7009550000
f. Admissions to live public appearances and speeches
5. Representation services More
6. Outright sale of rights to intellectual property works protected by copyright More
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22
$
,000.00
7010100000
8. Other artistic and literary intellectual property protected by copyright produced under contract, except live
performances and audiovisual works More
$
,000.00
7010125000
9. Licensing of rights to use intellectual property protected by copyright, excluding audiovisual works and musical
compositions and recordings More
$
,000.00
7009581000
10. Licensing of rights to use musical compositions protected by copyright
$
,000.00
7009578000
11. Licensing of rights to others to distribute audiovisual works protected by copyright
$
,000.00
7009575000
12. Licensing of rights to exhibit, broadcast, or rent audiovisual works protected by copyright
$
,000.00
7009576000
13. Licensing of other rights to use audiovisual works protected by copyright, not elsewhere classified
$
,000.00
7009577000
14. Licensing of rights to use intellectual property protected by trademark More
$
,000.00
7009625000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
7. Audiovisual performances produced under contract
Add product/service not listed
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
35
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
36
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Museums and art galleries
Museums
712110 003
Historic or heritage site
712120 001
Art gallery or exhibitor with receipts primarily from admissions, contributions, and/or grants
712110 001
Art gallery with receipts primarily from sales or commissions on sales of artwork
453920 002
Art council
813410 402
Botanical or zoological garden
Botanical gardens and other live plant exhibits (e.g., arboretum, botanical conservatories, plant exhibition, etc.)
712130 201
Zoos, aquariums, and other live animal exhibits (e.g., wild animal or safari parks, petting zoos, etc.)
712130 101
Tree, plant, and flower exhibitions
712130 203
Other attractions or exhibits
Planetarium, observatory, or science center
712110 002
Nature parks and other similar institutions, including wildlife sanctuaries, and conservation areas
712190 001
Conservation area, nature park, or preserve
712190 002
Caverns, natural wonders, nature trails, and similar tourist attractions
712190 003
Foundation - not operating museums, zoos, etc.
813211 003
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
18
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
2022
$
,000.00
19
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
2022
$
,000.00
$
,000.00
20
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
2022
$
,000.00
$
,000.00
21
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001625000
1. Admissions to cultural institutions More
a. Admissions to museums
7001625003
Include receipts from access or attendance to science centers.
7001625006
b. Admissions to historic sites
7001625009
c. Admissions to botanical gardens
7001625012
d. Admissions to zoological and similar institutions
7001625015
e. Admissions to nature parks and other natural areas
2. Membership services of performing arts societies and cultural institutions More
7001650000
7001675000
3. Traveling exhibits More
4. Leisure, recreational, and athletic instructional programs (Include day and/or overnight camp. Include dance, music, and arts
instruction. Exclude overnight recreational camps.) More
7002500000
7003225000
5. Tour guide services
6. School visits, children's parties and similar children's programs of cultural institutions
7001725000
7001575000
7. Admissions to film exhibitions
7001600000
8. Admissions to live performing arts performances
9. Conservation services for artistic, historical, and cultural works More
7017100000
7002325000
10. Amusement park and arcade services
7002750000
11. Parking services
7003850000
12. Recreational vehicle and tent sites for travelers
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
22
13. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
14. Alcoholic beverages, prepared and served or dispensed for immediate consumption
7000025000
7000050000
7006375000
15. Rental and leasing of commercial space More
Add product/service not listed
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to cultural institutions More
a. Admissions to museums
$
,000.00
7001625003
b. Admissions to historic sites
$
,000.00
7001625006
c. Admissions to botanical gardens
$
,000.00
7001625009
d. Admissions to zoological and similar institutions
$
,000.00
7001625012
e. Admissions to nature parks and other natural areas
$
,000.00
7001625015
Subtotal
$
,000.00
7001625000
2. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
3. Traveling exhibits More
$
,000.00
7001675000
4. Leisure, recreational, and athletic instructional programs (Include day and/or overnight camp. Include dance, music,
and arts instruction. Exclude overnight recreational camps.) More
$
,000.00
7002500000
5. Tour guide services
$
,000.00
7003225000
6. School visits, children's parties and similar children's programs of cultural institutions
$
,000.00
7001725000
7. Admissions to film exhibitions
$
,000.00
7001575000
8. Admissions to live performing arts performances
$
,000.00
7001600000
9. Conservation services for artistic, historical, and cultural works More
$
,000.00
7017100000
10. Amusement park and arcade services
$
,000.00
7002325000
11. Parking services
$
,000.00
7002750000
Include receipts from access or attendance to science centers.
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
24
12. Recreational vehicle and tent sites for travelers
$
,000.00
7003850000
13. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
14. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
15. Rental and leasing of commercial space More
$
,000.00
7006375000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
25
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7001625000
1. Admissions to cultural institutions More
a. Admissions to museums
7001625003
Include receipts from access or attendance to science centers.
7001625006
b. Admissions to historic sites
7001625009
c. Admissions to botanical gardens
7001625012
d. Admissions to zoological and similar institutions
7001625015
e. Admissions to nature parks and other natural areas
2. Membership services of performing arts societies and cultural institutions More
7001650000
7001675000
3. Traveling exhibits More
4. Leisure, recreational, and athletic instructional programs More
7002500000
7003225000
5. Tour guide services
6. School visits, children's parties and similar children's programs of cultural institutions
7001725000
7001575000
7. Admissions to film exhibitions
7001600000
8. Admissions to live performing arts performances
9. Conservation services for artistic, historical, and cultural works More
7017100000
7002325000
10. Amusement park and arcade services
7002750000
11. Parking services
7003850000
12. Recreational vehicle and tent sites for travelers
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26
13. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
14. Alcoholic beverages, prepared and served or dispensed for immediate consumption
7000025000
7000050000
7006375000
15. Rental and leasing of commercial space More
8000025000
16. Government contributions, gifts, and grants
a. Contributions, gifts, and grants from the National Endowment for the Arts
b. All other federal, state, county, and municipal contributions, gifts, and grants
8000025003
8000025006
8000050000
17. Private contributions, gifts, and grants
8000050003
a. Private contributions, gifts, and grants from individuals
b. Private contributions, gifts, and grants from foundations
c. Private contributions, gifts, and grants from business and industry
d. Other contributions, gifts, and grants, including from labor unions, etc.
18. Program service revenue including government fees and contracts
8000050006
8000050009
8000050012
8000200000
8000175000
19. Gains (losses) from non-financial assets sold
20. Trading securities and commodity contracts on own account
8000150000
Add product/service not listed
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27
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Admissions to cultural institutions More
a. Admissions to museums
$
,000.00
7001625003
b. Admissions to historic sites
$
,000.00
7001625006
c. Admissions to botanical gardens
$
,000.00
7001625009
d. Admissions to zoological and similar institutions
$
,000.00
7001625012
e. Admissions to nature parks and other natural areas
$
,000.00
7001625015
Subtotal
$
,000.00
7001625000
2. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
3. Traveling exhibits More
$
,000.00
7001675000
4. Leisure, recreational, and athletic instructional programs More
$
,000.00
7002500000
5. Tour guide services
$
,000.00
7003225000
6. School visits, children's parties and similar children's programs of cultural institutions
$
,000.00
7001725000
7. Admissions to film exhibitions
$
,000.00
7001575000
8. Admissions to live performing arts performances
$
,000.00
7001600000
9. Conservation services for artistic, historical, and cultural works More
$
,000.00
7017100000
10. Amusement park and arcade services
$
,000.00
7002325000
11. Parking services
$
,000.00
7002750000
Include receipts from access or attendance to science centers.
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
28
12. Recreational vehicle and tent sites for travelers
$
,000.00
7003850000
13. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
14. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
15. Rental and leasing of commercial space More
$
,000.00
7006375000
a. Contributions, gifts, and grants from the National Endowment for the Arts
$
,000.00
8000025003
b. All other federal, state, county, and municipal contributions, gifts, and grants
$
,000.00
8000025006
$
,000.00
8000025000
a. Private contributions, gifts, and grants from individuals
$
,000.00
8000050003
b. Private contributions, gifts, and grants from foundations
$
,000.00
8000050006
c. Private contributions, gifts, and grants from business and industry
$
,000.00
8000050009
d. Other contributions, gifts, and grants, including from labor unions, etc.
$
,000.00
8000050012
$
,000.00
8000050000
18. Program service revenue including government fees and contracts
$
,000.00
8000200000
19. Gains (losses) from non-financial assets sold
$
,000.00
8000175000
$
,000.00
8000150000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
16. Government contributions, gifts, and grants
Subtotal
17. Private contributions, gifts, and grants
Subtotal
20. Trading securities and commodity contracts on own account
21. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
9900000002
29
Add product/service not listed
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30
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
34
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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35
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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38
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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39
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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40
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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41
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
1000
characters remaining
42
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AE-71210_su.pdf Generated 2022-02-18 07:53:15
,000.00
43
Attachment D-18
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 72
Attachment Sector
D-18
72
Instrument
Path
Instrument Path Title
7200C
72110
72130
72230
Accommodation, Food Services, and Drinking Places (Classification)
Traveler Accommodation
Rooming and Boarding Houses
Special Food Services
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.
MAILING ADDRESS
ATTN
Name 1
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
2
Item 3: Operational Status
ITEM 3: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
3
Item 3: Operational Status - Ceased Operation Date
ITEM 3: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
4
Item 3: Operational Status - New Owner or Operator Information
ITEM 3 - OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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
99999-9999
EIN
99-9999999
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
5
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Full-service restaurant, patrons order through waiter/waitress service and pay after eating
722511 001
Limited-service restaurant (patrons pay before eating), including delivery-only and take-out-only locations
722513 005
Fast food restaurant
722513 002
Bar, tavern, pub, or other drinking place, selling alcoholic beverages for consumption on premises
722410 001
Coffee shop
722515 501
Ice cream/soft serve shop
722515 101
Frozen yogurt shop
722515 201
Doughnut shop, selling for carry-out or eat-in customers
722515 301
Cookie shop
722515 601
Bagel shop, selling for carry-out or eat-in customers
722515 401
Bakery cafe, primarily selling baked goods for eat-in customers
722515 701
Bakery, primarily selling goods baked on premises for carry-out customers (no customer seating)
311811 002
Bakery, primarily selling goods not baked on premises for carry-out customers
445291 001
Pizza take-and-bake store
445299 007
Meal assembly kitchen or store
445299 006
Delicatessen, primarily preparing sandwiches and meals for immediate consumption
722513 004
Delicatessen, primarily selling fresh and prepared meats
445210 001
Supermarket or grocery store, including delicatessen primarily selling meats and a range of grocery items
445110 006
Specialty snack or nonalcoholic beverage shop/stand not listed above (such as pretzel, cupcake, soda, smoothie, or juice shop/stand) selling
from a permanent location for immediate consumption on or near the premises
722515 702
Cafeteria, buffet, or grill buffet, not operating on a contract basis
722514 001
School, university, corporate, government, or other facility cafeteria/dining, operating on a contract basis
722310 001
Contract feeding/food service contractor, including school, university, corporate, government, or other facility cafeteria/dining
722310 007
Caterer for banquets, weddings, etc.
722320 001
Mobile food service, including ice cream, snacks, sandwiches, and meals distributed from trucks, carts, or other vehicles
722330 001
Convenience food store
445120 001
Liquor store
445310 001
Bar or restaurant operated by social or fraternal organization for members
813410 403
Dinner theater, operating food service but not producing shows
722511 002
Trailer park, recreational vehicle (RV) park, or campground, except residential
721211 001
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
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Sporting or recreation camp, including fishing camp, dude ranch, etc.
721214 001
Bed-and-breakfast inn
721191 001
Hotel (except with casino), motel, or motor hotel
721110 002
Rooming and boarding house including lodging house operated by membership organization
721310 001
Other primary business or activity
779000 001
Select Sector
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AF-7200C_su.pdf Generated 2022-02-18 07:41:22
1000
characters remaining
8
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Hotel (except with casino), motel, or motor hotel
721110 002
Hotel resort with golf course, spa, and/or conference center
721110 003
Bed-and-breakfast inn
721191 001
Casino hotel (gambling) with guestrooms for lodging
721120 101
Casino without guestrooms for lodging (operating table-wagering games such as blackjack, roulette, keno, and craps along with other
gambling activities such as slot machines and sports betting)
713210 101
Ski area or resort with guestrooms for lodging
721110 001
Ski facility, area, or resort without guestrooms for lodging (including operating equipment such as ski lifts and tows)
713920 001
Room and boarding houses, dormitories and workers' camps, including dormitories (off campus), and fraternity and sorority houses
721310 002
All other traveler accommodation, including cabins, guest houses, villas, cottage resorts, and hostels
721199 001
Home for the elderly, including independent living or assisted living facilities WITHOUT on-site nursing care facility
623312 002
Property owners' association, including home owners', condominium owners', and cooperative owners' associations (Not strictly providing
property management.)
813990 401
Sporting or recreation camp, including fishing camp, dude ranch, etc.
721214 001
Trailer park, recreational vehicle (RV) park, or campground, except residential
721211 001
Bar or restaurant operated by social or fraternal organization for members
813410 403
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
What were the operating receipts and sales of other merchandise in 2022? (Exclude sales taxes or other taxes
collected.)
For further clarification, click the "Additional Information" link above.
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
Check
if
None
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
Estimate the percentage of this establishment's total sales (reported in Item 5) by class of customer.
2022
%
1. Household consumers and individuals
2. Businesses
(billed to expense accounts)
%
3. Governmental bodies
(Federal, state, and local)
%
TOTAL (Sum of lines 1 through 3 should equal 100%.)
%
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7003825000
1. Room or unit accommodation for travelers
a. Room or unit accommodation for travelers, with maid service
b. Room or unit accommodation for travelers, without maid service
c. Shared-room accommodation for travelers, including hostel rooms for short-term accommodation
7003825003
7003825006
7003825009
7003850000
2. Recreational vehicle and tent sites for travelers More
3. Home, apartment, rooming house, and other residential space rental and leasing
7000275000
7002350000
4. Table wagering games
5. Gambling machine products, including slot machines and video lottery terminals
7002375000
7002400000
6. Pari-mutuel sports gambling
7. Sale of tickets of/for lotteries and other games of chance to gamblers, for a fee or commission
7002475000
7002425000
8. Sports and other bookmaking
9. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and salad bars, and
prepared sandwiches, dishes, and entrees.)
10. Retail sales of candy, prepackaged cookies, and snack foods
5000150000
5000200000
5000250000
11. Retail sales of soft drinks and nonalcoholic beverages
5000300000
12. Retail sales of alcoholic beverages
13. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids, and other
smoking supplies
14. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
5000325000
5000860000
21
15. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
16. Alcoholic beverages, prepared and served or dispensed for immediate consumption
17. Meals, snacks, other food items, and beverages prepared for catered events
18. Short-term access to communications services, including telephone and internet services
19. Short-term entertainment access services including pay-per-view services
7000025000
7000050000
7000060000
7014175000
7003875000
7017275000
20. Laundry and dry-cleaning agency services
21. Laundry machines operated by coin, card, or by an attendant
7000100000
7002750000
22. Parking services
23. Rental of home audiovisual equipment (including cable program distribution equipment), components, and accessories, except
computers and peripherals
7000925000
24. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles, and musical
instruments)
7001800000
7006375000
25. Rental and leasing of commercial space More
26. Rental and leasing of nonresidential space in buildings or other facilities for business or social use, exclude hosting of coinoperated self-service gambling machines and vending machine hosting More
7006575000
7001600000
27. Admissions to live performing arts performances
28. Admissions to dance halls and clubs (including cover charges)
7002000000
7001850000
29. Golf course and country club services
7001875000
30. Skiing facility services
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Room or unit accommodation for travelers
a. Room or unit accommodation for travelers, with maid service
$
,000.00
7003825003
b. Room or unit accommodation for travelers, without maid service
$
,000.00
7003825006
c. Shared-room accommodation for travelers, including hostel rooms for short-term accommodation
$
,000.00
7003825009
Subtotal
$
,000.00
7003825000
2. Recreational vehicle and tent sites for travelers More
$
,000.00
7003850000
3. Home, apartment, rooming house, and other residential space rental and leasing
$
,000.00
7000275000
$
,000.00
7002350000
5. Gambling machine products, including slot machines and video lottery terminals
$
,000.00
7002375000
6. Pari-mutuel sports gambling
$
,000.00
7002400000
7. Sale of tickets of/for lotteries and other games of chance to gamblers, for a fee or commission
$
,000.00
7002475000
8. Sports and other bookmaking
$
,000.00
7002425000
9. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and
salad bars, and prepared sandwiches, dishes, and entrees.)
$
,000.00
5000150000
10. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
11. Retail sales of soft drinks and nonalcoholic beverages
$
,000.00
5000250000
12. Retail sales of alcoholic beverages
$
,000.00
5000300000
13. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids,
and other smoking supplies
$
,000.00
5000325000
14. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
$
,000.00
5000860000
4. Table wagering games
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15. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
16. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
17. Meals, snacks, other food items, and beverages prepared for catered events
$
,000.00
7000060000
18. Short-term access to communications services, including telephone and internet services
$
,000.00
7014175000
19. Short-term entertainment access services including pay-per-view services
$
,000.00
7003875000
$
,000.00
7017275000
21. Laundry machines operated by coin, card, or by an attendant
$
,000.00
7000100000
22. Parking services
$
,000.00
7002750000
23. Rental of home audiovisual equipment (including cable program distribution equipment), components, and
accessories, except computers and peripherals
$
,000.00
7000925000
24. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles,
and musical instruments)
$
,000.00
7001800000
25. Rental and leasing of commercial space More
$
,000.00
7006375000
26. Rental and leasing of nonresidential space in buildings or other facilities for business or social use, exclude hosting
of coin-operated self-service gambling machines and vending machine hosting More
$
,000.00
7006575000
27. Admissions to live performing arts performances
$
,000.00
7001600000
28. Admissions to dance halls and clubs (including cover charges)
$
,000.00
7002000000
29. Golf course and country club services
$
,000.00
7001850000
30. Skiing facility services
$
,000.00
7001875000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
20. Laundry and dry-cleaning agency services
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Property Type
ITEM 28: SPECIAL ITEMS - PROPERTY TYPE
Which of the following best describes this establishment?
Limited-service facility - hotels and motels that provide lodging but very few additional services or amenities. These hotels and motels do not earn revenues from food and beverage
services (such as operating a restaurant on-site or providing catering services). A hotel/motel which earns no food and beverage revenues but offers a free continental breakfast should
still be considered a limited-service hotel.
Full-service facility - hotels and motels that offer food and beverage services, lounge facilities, and meeting spaces. These hotels and motels typically also offer bell service and room
service.
Luxury facility - hotels that offer all the services of a full-service hotel as well as additional services, which may include 24-hour room service, upscale restaurants managed in-house,
and concierge services.
Not a hotel/motel - a lodging facility that is not known as a hotel/motel, such as a bed-and-breakfast inn, guest house, hostel, or tourist home.
Limited-service facility
Full-service facility
Luxury facility
Not a Hotel/Motel
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
31
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
32
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
33
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
34
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
35
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
36
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
37
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
1000
characters remaining
38
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
Describe kind of business at this location
2022
What is the number of rooms in this hotel, motel, or other lodging facility?
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AF-72110_su.pdf Generated 2022-02-18 07:55:31
,000.00
39
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Room and boarding houses, dormitories and workers' camps, including dormitories (off campus), and fraternity and sorority houses
721310 002
Dormitories (off campus)
721310 003
Workers camp
721310 004
All other traveler accommodation, including cabins, guest houses, villas, cottage resorts, and hostels
721199 001
Hotel (except with casino), motel, or motor hotel
721110 002
Bed-and-breakfast inn
721191 001
Sporting or recreation camp, including fishing camp, dude ranch, etc.
721214 001
Trailer park, recreational vehicle (RV) park, or campground, except residential
721211 001
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
What were the operating receipts and sales of other merchandise in 2022? (Exclude sales taxes or other taxes
collected.)
For further clarification, click the "Additional Information" link above.
2022_AF-72130_su.pdf Generated 2022-02-18 07:56:34
Check
if
None
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AF-72130_su.pdf Generated 2022-02-18 07:56:34
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
Estimate the percentage of this establishment's total sales (reported in Item 5) by class of customer.
2022
%
1. Household consumers and individuals
2. Businesses
(billed to expense accounts)
%
3. Governmental bodies
(Federal, state, and local)
%
TOTAL (Sum of lines 1 through 3 should equal 100%.)
%
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Home, apartment, rooming house, and other residential space rental and leasing
Product Code
7000275000
7003825000
2. Room or unit accommodation for travelers
a. Room or unit accommodation for travelers, with maid service
b. Room or unit accommodation for travelers, without maid service
c. Shared-room accommodation for travelers, including hostel rooms for short-term accommodation More
3. Civic and social organization membership services More
4. Retail sales of perishable prepared foods packaged for future consumption
5. Retail sales of candy, prepackaged cookies, and snack foods
6. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
7003825003
7003825006
7003825009
7005023000
5000150000
5000200000
5000250000
5000300000
7. Retail sales of packaged alcoholic beverages
8. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids, and other
smoking supplies
9. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
10. Retail sales of household fuels, including oil, LP gas, wood, coal
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
12. Alcoholic beverages, prepared and served or dispensed for immediate consumption
13. Meals, snacks, other food items, and beverages prepared for catered events
14. Short-term access to communications services, including telephone and internet services
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5000325000
5000860000
5001750000
7000025000
7000050000
7000060000
7014175000
21
15. Rental of home audiovisual equipment (including cable program distribution equipment), components, and accessories, except
computers and peripherals
7000925000
16. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles, and musical
instruments)
7001800000
7000100000
17. Access to laundry machines
7002750000
18. Parking services
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
$
,000.00
7000275000
a. Room or unit accommodation for travelers, with maid service
$
,000.00
7003825003
b. Room or unit accommodation for travelers, without maid service
$
,000.00
7003825006
c. Shared-room accommodation for travelers, including hostel rooms for short-term accommodation More
$
,000.00
7003825009
Subtotal
$
,000.00
7003825000
$
,000.00
7005023000
$
,000.00
5000150000
5. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
6. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
$
,000.00
5000250000
7. Retail sales of packaged alcoholic beverages
$
,000.00
5000300000
8. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids,
and other smoking supplies
$
,000.00
5000325000
9. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
$
,000.00
5000860000
10. Retail sales of household fuels, including oil, LP gas, wood, coal
$
,000.00
5001750000
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
$
,000.00
7000050000
13. Meals, snacks, other food items, and beverages prepared for catered events
$
,000.00
7000060000
14. Short-term access to communications services, including telephone and internet services
$
,000.00
7014175000
1. Home, apartment, rooming house, and other residential space rental and leasing
2. Room or unit accommodation for travelers
3. Civic and social organization membership services More
4. Retail sales of perishable prepared foods packaged for future consumption
12. Alcoholic beverages, prepared and served or dispensed for immediate consumption
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15. Rental of home audiovisual equipment (including cable program distribution equipment), components, and
accessories, except computers and peripherals
$
,000.00
7000925000
16. Rental services for recreational, sports, and fitness equipment (including boats, motorcycles, other sports vehicles,
and musical instruments)
$
,000.00
7001800000
17. Access to laundry machines
$
,000.00
7000100000
18. Parking services
$
,000.00
7002750000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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34
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
37
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
Describe kind of business at this location
2022
What is the number of rooms in this hotel, motel, or other lodging facility?
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AF-72130_su.pdf Generated 2022-02-18 07:56:34
,000.00
38
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Contract feeding/food service contractor, including school, university, corporate, government, or other facility cafeteria/dining
722310 007
School, university, corporate, government, or other facility cafeteria/dining, operating on a contract basis
722310 001
Industrial/institutional/in-plant feeding
722310 002
Caterers, including banquet halls with catering staff
722320 003
Banquet facility (hall) with catering staff
722320 004
Mobile food service, including ice cream, snacks, sandwiches, and meals distributed from trucks, carts, or other vehicles
722330 001
Food and beverage concession service, operating on a contract basis
722310 004
Full-service restaurant, patrons order through waiter/waitress service and pay after eating
722511 001
Limited-service restaurant (patrons pay before eating), including delivery-only and take-out-only locations
722513 005
Cafeteria, buffet, or grill buffet, not operating on a contract basis
722514 001
Specialty snack or nonalcoholic beverage shop/stand not listed above (such as pretzel, cupcake, soda, smoothie, or juice shop/stand) selling
from a permanent location for immediate consumption on or near the premises
722515 702
Airline (in-flight) catering
722310 003
Other primary business or activity
779000 001
Select Sector
Describe
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
15
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
What were the operating receipts and sales of other merchandise in 2022? (Exclude sales taxes or other taxes
collected.)
For further clarification, click the "Additional Information" link above.
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
Check
if
None
2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
2022
$
,000.00
$
,000.00
19
Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
Estimate the percentage of this establishment's total sales (reported in Item 5) by class of customer.
2022
%
1. Household consumers and individuals
2. Businesses
(billed to expense accounts)
%
3. Governmental bodies
(Federal, state, and local)
%
TOTAL (Sum of lines 1 through 3 should equal 100%.)
%
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20
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Meals, snacks, other food items, and beverages for immediate consumption, prepared under long-term contract
Product Code
7000055000
a. Meals, snacks, other food items, and nonalcoholic beverages prepared for immediate consumption under long-term contract for
transportation businesses
7000055003
b. Meals, snacks, other food items, and nonalcoholic beverages prepared for immediate consumption under long-term contract for
other than transportation businesses More
7000055006
c. Alcoholic beverages prepared for immediate consumption under long-term contract
2. Meals, snacks, other food items, and beverages prepared for catered events More
a. Meals, snacks, other food items, and nonalcoholic beverages prepared for catered events held on the caterer's premises
b. Meals, snacks, other food items, and nonalcoholic beverages prepared and served at catered events held on the customer's
premises
c. Meals, snacks, other food items, and nonalcoholic beverages dropped off at the customer's event More
d. Meals, snacks, other food items, and nonalcoholic beverages prepared for customer pick-up, including party platters
7000055009
7000060000
7000060003
7000060006
7000060009
7000060012
7000060015
e. Alcoholic beverages prepared for catered events
3. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
a. Meals, snacks, and other food items, prepared and served More
7000025000
7000025003
7000025006
b. Nonalcoholic beverages, prepared and served
c. Meals, snacks, and other food items, prepared and dispensed without table service for consumption on the premises More
d. Nonalcoholic beverages, prepared and dispensed without table service for consumption on the premises
e. Meals, snacks, and other food items, prepared and dispensed via drive-through service
f. Nonalcoholic beverages, prepared and dispensed via drive-through service
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
7000025009
7000025012
7000025015
7000025018
21
g. Meals, snacks, and other food items, prepared and dispensed for immediate consumption off the premises, except via drivethrough service, including take-out, curbside pick-up, and delivery
7000025021
h. Nonalcoholic beverages, prepared and dispensed for immediate consumption off the premises, except via drive-through service,
including take-out, curbside pick-up, and delivery
7000025024
i. Meals, snacks, and other food items dispensed via mobile vending service
j. Nonalcoholic beverages dispensed via mobile vending service More
4. Alcoholic beverages, prepared and served or dispensed for immediate consumption
a. Wine and wine drinks, prepared and served or dispensed for immediate consumption
b. Beer, ale, and malt beverages, prepared and served or dispensed for immediate consumption (excluding brewed on site)
c. Beer, ale, and malt beverages, brewed on site, prepared and served or dispensed for immediate consumption
d. Drinks with distilled spirits, prepared and served or dispensed for immediate consumption
7000025027
7000025033
7000050000
7000050003
7000050005
7000050007
7000050009
5. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and salad bars, and
prepared sandwiches, dishes, and entrees.) More
5000150000
6. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy milk, and egg
and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies, pasta, and crackers.) More
5000225000
7. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
8. Retail sales of bottled, canned, or packaged alcoholic beverages
9. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
10. Rental of space for weddings, banquets, parties, and similar short-term social uses
11. Rental of space for meetings, conventions, and similar short-term business uses
12. Rental of nonresidential space for hosting rides, games, or vending machines More
13. Rental and leasing of social events equipment, including tents, tables, and chairs
5000250000
5000300000
5000860000
7006475000
7006425000
7006575000
7000760000
7010350000
14. Temporary staffing services More
15. Local transportation and delivery of purchased or serviced items, including food and beverages
7011125000
Add product/service not listed
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
22
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
23
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Meals, snacks, other food items, and beverages for immediate consumption, prepared under long-term contract
a. Meals, snacks, other food items, and nonalcoholic beverages prepared for immediate consumption under longterm contract for transportation businesses
$
,000.00
7000055003
b. Meals, snacks, other food items, and nonalcoholic beverages prepared for immediate consumption under longterm contract for other than transportation businesses More
$
,000.00
7000055006
c. Alcoholic beverages prepared for immediate consumption under long-term contract
$
,000.00
7000055009
$
,000.00
7000055000
a. Meals, snacks, other food items, and nonalcoholic beverages prepared for catered events held on the caterer's
premises
$
,000.00
7000060003
b. Meals, snacks, other food items, and nonalcoholic beverages prepared and served at catered events held on the
customer's premises
$
,000.00
7000060006
c. Meals, snacks, other food items, and nonalcoholic beverages dropped off at the customer's event More
$
,000.00
7000060009
d. Meals, snacks, other food items, and nonalcoholic beverages prepared for customer pick-up, including party
platters
$
,000.00
7000060012
e. Alcoholic beverages prepared for catered events
$
,000.00
7000060015
Subtotal
$
,000.00
7000060000
a. Meals, snacks, and other food items, prepared and served More
$
,000.00
7000025003
b. Nonalcoholic beverages, prepared and served
$
,000.00
7000025006
c. Meals, snacks, and other food items, prepared and dispensed without table service for consumption on the
premises More
$
,000.00
7000025009
d. Nonalcoholic beverages, prepared and dispensed without table service for consumption on the premises
$
,000.00
7000025012
Subtotal
2. Meals, snacks, other food items, and beverages prepared for catered events More
3. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
24
e. Meals, snacks, and other food items, prepared and dispensed via drive-through service
$
,000.00
7000025015
f. Nonalcoholic beverages, prepared and dispensed via drive-through service
$
,000.00
7000025018
g. Meals, snacks, and other food items, prepared and dispensed for immediate consumption off the premises, except
via drive-through service, including take-out, curbside pick-up, and delivery
$
,000.00
7000025021
h. Nonalcoholic beverages, prepared and dispensed for immediate consumption off the premises, except via drivethrough service, including take-out, curbside pick-up, and delivery
$
,000.00
7000025024
i. Meals, snacks, and other food items dispensed via mobile vending service
$
,000.00
7000025027
j. Nonalcoholic beverages dispensed via mobile vending service More
$
,000.00
7000025033
Subtotal
$
,000.00
7000025000
a. Wine and wine drinks, prepared and served or dispensed for immediate consumption
$
,000.00
7000050003
b. Beer, ale, and malt beverages, prepared and served or dispensed for immediate consumption (excluding brewed
on site)
$
,000.00
7000050005
c. Beer, ale, and malt beverages, brewed on site, prepared and served or dispensed for immediate consumption
$
,000.00
7000050007
d. Drinks with distilled spirits, prepared and served or dispensed for immediate consumption
$
,000.00
7000050009
Subtotal
$
,000.00
7000050000
5. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and
salad bars, and prepared sandwiches, dishes, and entrees.) More
$
,000.00
5000150000
6. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy
milk, and egg and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies, pasta, and
crackers.) More
$
,000.00
5000225000
7. Retail sales of bottled, canned, or packaged soft drinks and nonalcoholic beverages
$
,000.00
5000250000
8. Retail sales of bottled, canned, or packaged alcoholic beverages
$
,000.00
5000300000
9. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
$
,000.00
5000860000
10. Rental of space for weddings, banquets, parties, and similar short-term social uses
$
,000.00
7006475000
$
,000.00
7006425000
4. Alcoholic beverages, prepared and served or dispensed for immediate consumption
11. Rental of space for meetings, conventions, and similar short-term business uses
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
25
12. Rental of nonresidential space for hosting rides, games, or vending machines More
$
,000.00
7006575000
13. Rental and leasing of social events equipment, including tents, tables, and chairs
$
,000.00
7000760000
14. Temporary staffing services More
$
,000.00
7010350000
$
,000.00
7011125000
$
,000.00
9900000000
15. Local transportation and delivery of purchased or serviced items, including food and beverages
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
31
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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35
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
1000
characters remaining
39
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_AF-72230_su.pdf Generated 2022-02-18 07:40:45
,000.00
40
Attachment D-19
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Sector 81
Attachment Sector
D-19
81
Instrument
Path
Instrument Path Title
81210
81230
8127X
81349
Personal Care Services
Drycleaning and Laundry Services
Parking Lots and Garages (Enterprise Support)
Civic, Social, and Other Membership Organizations
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Barber, beautician, and nail care services
Beauty shop, spa, or hair salon
812112 005
Nail salon
812113 001
Unisex hair shop, including combined beauty/barber shop
812112 001
Day spa, including hair services
812112 003
Barber shop
812111 001
Day spa, excluding hair services
812199 007
Skin care (i.e., esthetician) services
812112 004
Facial salon
812112 002
Cosmetology or beauty school and barber college or school
611511 003
Other personal care and appearance services
Tanning salon
812199 002
Massage therapist(s) - NCTMB (Nationally Certified in Therapeutic Massage and Bodywork)
621399 00G
Massage salon
812199 001
Hair replacement services, excluding services performed by a physician
812199 006
Tattoo parlor
812199 005
Hair removal services, including electrolysis, laser removal, and waxing
812199 004
Sauna, steam bath, or Turkish bath
812199 003
Diet or weight reducing center, excluding physical fitness facilities
812191 001
Physical fitness, strength development, or weight training center
713940 902
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
(Beauty shops and barber shops should include rents from leased stations/booths.)
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
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2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7005025000
1. Hair care services More
7005025003
a. Permanent hair texture modification
7005025006
b. Hair coloring and tinting
7005025009
c. Hair cut and styling services
7005025012
d. Other hair care services
7005050000
2. Nail care services
7005050003
a. Manicure services
7005050006
b. Pedicure services
7005050009
c. Other nail care services
7005075000
3. Skin care services
7005075009
a. Facial services
7005075012
b. Masks and body wrap services
7005075003
c. Temporary makeup services
7005075006
d. Permanent makeup services
7005075015
e. Other skin care services
7005100000
4. Hair removal services
7005100003
a. Permanent hair removal services
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7005100006
b. Temporary hair removal services
7005125000
5. Non-therapeutic massage services
6. Therapeutic massage services
7004925000
Include sports massage therapy.
7. Tattoo, tanning and other body modification services More
7005150000
7005150003
a. Tanning services
7005150006
b. Tattoo services
7005150009
c. Tattoo removal services
7005150012
d. Piercing services
7005150015
e. Other body modification services
7006375000
8. Rental and leasing of commercial space
7006375003
a. Rental and leasing of retail space in shopping malls
b. Rental and leasing of food service space in shopping malls
c. Rental and leasing of retail space in free-standing locations
d. Rental and leasing of food service space in free-standing locations
e. Rental and leasing of booths and chairs in beauty and personal care establishments
7006375006
7006375009
7006375012
7006375015
7006375018
f. Rental and leasing of other commercial space
7005175000
9. Weight loss services More
7005175003
a. Non-medical weight loss programs
7005175006
b. Non-medical diet management services
10. Fitness evaluation and personal fitness training services
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7002100000
21
11. Trade, career, technical and professional development training programs
12. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements, including medicines used for
infusion services
7003950000
5001350000
5001450000
13. Retail sales of cosmetics and fragrances
5001425000
14. Retail sales of personal hygiene supplies
15. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers; frypans; personal
care appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
16. Other personal services, including access to public saunas and Turkish baths
5000725000
7002560000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Hair care services More
a. Permanent hair texture modification
$
,000.00
7005025003
b. Hair coloring and tinting
$
,000.00
7005025006
c. Hair cut and styling services
$
,000.00
7005025009
d. Other hair care services
$
,000.00
7005025012
Subtotal
$
,000.00
7005025000
a. Manicure services
$
,000.00
7005050003
b. Pedicure services
$
,000.00
7005050006
$
,000.00
7005050009
$
,000.00
7005050000
a. Facial services
$
,000.00
7005075009
b. Masks and body wrap services
$
,000.00
7005075012
c. Temporary makeup services
$
,000.00
7005075003
d. Permanent makeup services
$
,000.00
7005075006
e. Other skin care services
$
,000.00
7005075015
Subtotal
$
,000.00
7005075000
2. Nail care services
c. Other nail care services
Subtotal
3. Skin care services
4. Hair removal services
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$
,000.00
7005100003
$
,000.00
7005100006
$
,000.00
7005100000
5. Non-therapeutic massage services
$
,000.00
7005125000
6. Therapeutic massage services
$
,000.00
7004925000
a. Tanning services
$
,000.00
7005150003
b. Tattoo services
$
,000.00
7005150006
c. Tattoo removal services
$
,000.00
7005150009
$
,000.00
7005150012
e. Other body modification services
$
,000.00
7005150015
Subtotal
$
,000.00
7005150000
a. Rental and leasing of retail space in shopping malls
$
,000.00
7006375003
b. Rental and leasing of food service space in shopping malls
$
,000.00
7006375006
c. Rental and leasing of retail space in free-standing locations
$
,000.00
7006375009
d. Rental and leasing of food service space in free-standing locations
$
,000.00
7006375012
e. Rental and leasing of booths and chairs in beauty and personal care establishments
$
,000.00
7006375015
f. Rental and leasing of other commercial space
$
,000.00
7006375018
Subtotal
$
,000.00
7006375000
a. Permanent hair removal services
b. Temporary hair removal services
Subtotal
Include sports massage therapy.
7. Tattoo, tanning and other body modification services More
d. Piercing services
8. Rental and leasing of commercial space
9. Weight loss services More
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a. Non-medical weight loss programs
$
,000.00
7005175003
b. Non-medical diet management services
$
,000.00
7005175006
$
,000.00
7005175000
10. Fitness evaluation and personal fitness training services
$
,000.00
7002100000
11. Trade, career, technical and professional development training programs
$
,000.00
7003950000
12. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements, including
medicines used for infusion services
$
,000.00
5001350000
$
,000.00
5001450000
14. Retail sales of personal hygiene supplies
$
,000.00
5001425000
15. Retail sales of small household appliances, including mixers; blenders; can openers; toasters; coffee makers;
frypans; personal care appliances, such as hair dryers, curling irons, and shavers; tap water purifiers and filters; etc.
$
,000.00
5000725000
16. Other personal services, including access to public saunas and Turkish baths
$
,000.00
7002560000
$
,000.00
9900000000
Subtotal
13. Retail sales of cosmetics and fragrances
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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36
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_OS-81210_su.pdf Generated 2022-02-18 08:04:46
1000
characters remaining
38
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_OS-81210_su.pdf Generated 2022-02-18 08:04:46
,000.00
39
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
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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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
If more than one establishment:
Do not consider branch locations of laundries and drycleaners (including industrial, linen, and diaper supply) that are only providing pick-up and distribution of finished work as
separate establishments. Data for these locations should be included with the plant in which the work is actually done.
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Laundry and drycleaning services
Self-service laundry and/or drycleaning store
812310 201
Coin-operated laundry washing machine route, including service provided in apartments, dormitories, etc.
812310 101
Drycleaning services, excluding rug cleaning
812320 201
Carpet, rug, and upholstery cleaning services
561740 001
Commercial or family laundry services
812320 101
Linen supply services on a rental or contract basis
812331 001
Industrial laundry services on a rental or contract basis
812332 001
Drop off/pick up site or garment pressing, including laundry or cleaning done by others
812320 301
Retail agent for laundries and drycleaners (work done by others)
812320 302
Wash and fold services
812320 303
Leather and/or fur cleaning services
812320 401
Other clothing and fabric services
Garment alteration or repair service
811490 401
Footwear, luggage, handbag, briefcase and leather goods repair
811430 001
Other primary business or activity
Car washes and automotive detailing services
811192 001
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
16
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
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Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts?
For further clarification, click the "Additional Information" link above.
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2022
$
,000.00
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_OS-81230_su.pdf Generated 2022-02-18 08:05:50
2022
$
,000.00
$
,000.00
19
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7000100000
1. Access to laundry machines More
7000100003
a. Access to washing machines
7000100006
b. Access to drying machines
7000100009
c. Access to dry-cleaning machines
7000150000
2. Dry-cleaning services More
7000150003
a. General dry-cleaning services
7000150006
b. Specialty dry-cleaning services
7017250000
3. Commercial laundry services More
7000125000
4. Non-commercial laundry services
7017275000
5. Laundry and dry-cleaning agency services More
7017275003
a. Laundry agency services
7017275006
b. Dry-cleaning agency services
7017300000
6. Uniform rental and linen supply services
7017300003
a. Garments supply, including gowns, coats, aprons, etc.
7017300006
b. Flatwork and full dry linens supply
c. Industrial garments supply, excluding 'clean room' garments
7017300009
7017300012
d. Industrial 'clean room' garments supply
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20
7017300015
e. Industrial wiping cloths supply
f. Industrial mats supply, including launderable and unlaunderable
g. Industrial mops, cloths, and miscellaneous dust control items supply
7017300018
7017300021
7000175000
7. Steam pressing and ironing services
7000225000
8. Seasonal apparel and textile storage services
9. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines
10. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry More
a. Restoration and repair services for garments and textiles
7006575000
7000200000
7000200003
7000200006
b. Garment alteration services
7000200009
c. Footwear maintenance and repair services
7000200012
d. Watch and jewelry maintenance and repair services
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Access to laundry machines More
a. Access to washing machines
$
,000.00
7000100003
b. Access to drying machines
$
,000.00
7000100006
c. Access to dry-cleaning machines
$
,000.00
7000100009
Subtotal
$
,000.00
7000100000
a. General dry-cleaning services
$
,000.00
7000150003
b. Specialty dry-cleaning services
$
,000.00
7000150006
$
,000.00
7000150000
3. Commercial laundry services More
$
,000.00
7017250000
4. Non-commercial laundry services
$
,000.00
7000125000
a. Laundry agency services
$
,000.00
7017275003
b. Dry-cleaning agency services
$
,000.00
7017275006
Subtotal
$
,000.00
7017275000
a. Garments supply, including gowns, coats, aprons, etc.
$
,000.00
7017300003
b. Flatwork and full dry linens supply
$
,000.00
7017300006
c. Industrial garments supply, excluding 'clean room' garments
$
,000.00
7017300009
2. Dry-cleaning services More
Subtotal
5. Laundry and dry-cleaning agency services More
6. Uniform rental and linen supply services
2022_OS-81230_su.pdf Generated 2022-02-18 08:05:50
22
$
,000.00
7017300012
e. Industrial wiping cloths supply
$
,000.00
7017300015
f. Industrial mats supply, including launderable and unlaunderable
$
,000.00
7017300018
g. Industrial mops, cloths, and miscellaneous dust control items supply
$
,000.00
7017300021
Subtotal
$
,000.00
7017300000
$
,000.00
7000175000
8. Seasonal apparel and textile storage services
$
,000.00
7000225000
9. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service
gambling machines
$
,000.00
7006575000
a. Restoration and repair services for garments and textiles
$
,000.00
7000200003
b. Garment alteration services
$
,000.00
7000200006
$
,000.00
7000200009
d. Watch and jewelry maintenance and repair services
$
,000.00
7000200012
Subtotal
$
,000.00
7000200000
$
,000.00
9900000000
d. Industrial 'clean room' garments supply
7. Steam pressing and ironing services
10. Maintenance, repair, and alteration services for apparel, footwear, watches, and jewelry More
c. Footwear maintenance and repair services
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
36
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_OS-81230_su.pdf Generated 2022-02-18 08:05:50
,000.00
37
Location Information
DEFINITION OF ESTABLISHMENT
An establishment is generally a single physical location where business is conducted or where services or industrial operations are performed. This includes all locations of a company or
organization, including administrative offices, warehouses, etc., that were in operation at any time during 2022. Report activity for each establishment on a separate form.
DEFINITION OF AN ENTERPRISE
An enterprise or company is a business, service, or membership organization consisting of one or more establishments within the United States under common ownership or control. It
includes all establishments of subsidiary companies, where there is more than 50 percent ownership, as well as establishments of firms which the enterprise has the power to direct or
cause the direction of management and policies.
DEFINITION OF AN ENTERPRISE SUPPORT ESTABLISHMENT
An enterprise support establishment is an establishment that is primarily engaged in performing management, supervision, general administrative functions, and supporting services for
other establishments of the same enterprise, rather than for the general public or other business firms.
PHYSICAL ADDRESS
Please update the location's physical address if needed.
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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5
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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6
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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8
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Automobile parking
Parking lots and garages providing parking space for motor vehicles (usually on an hourly, daily or monthly basis) including valet parking
services
812930 001
Parking garage, underground
812930 002
Metered parking
812930 006
Valet parking services
812930 003
Other parking services - Describe
812930 005
Describe
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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9
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
%
10
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Sales, Receipts, or Revenue
Include:
Sales, receipts, or revenue from customers outside your enterprise originating from this location.
Exclude:
Sales, receipts, or revenue from other establishments within your own enterprise.
For further clarification, click "Additional Information" link above.
Check
if
None
What were the sales, receipts, or revenue (exclude billings) from customers outside your enterprise originating from
this location?
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
2022
$
,000.00
11
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
2022
$
,000.00
$
,000.00
12
Item 8: Support Services
ITEM 8: SUPPORT SERVICES
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of your enterprise (rather than for the general public or
other business firms) in 2022?
Yes
No
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Item 8: Support Services - Continued
ITEM 8: SUPPORT SERVICES - PRIMARY BUSINESS OR ACTIVITY OF THE OPERATING ESTABLISHMENTS SERVICED
What primary kind of business or activity is performed by the establishments of your enterprise that are managed or serviced by this establishment?
Example: If this establishment is a corporate, subsidiary, or regional managing office, data processing service center, or administrative/support office to a chain of clothing stores, please
describe "clothing stores" below.
Describe
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14
Item 16: Selected Expenses
ITEM 16: SELECTED EXPENSES
Report the payment of selected expenses allocated by category
Report payments for expenses directly incurred by this establishment in column 1.
Report payments made by this establishment for expenses incurred by other establishments of your enterprise in column 2 (where applicable).
Exclude:
Transfers made within the company
Capitalized expenses
Impairment
Interest
Bad debt
Income tax
Taxes collected from customers (e.g., sales and excise)
Cost of merchandise for resale
Personnel costs, except payroll
1. Employer's cost for employer paid insurance premiums,
pension plans, payroll taxes, and other employee
benefits More
Check
if
None
2022 Expenses of this
establishment ONLY
$
,000.00
$
,000.00
3. Expensed computer hardware and other equipment More
$
,000.00
4. Expensed purchases of other materials, parts, and
supplies More
$
,000.00
5. Expensed purchases of software More
$
,000.00
6. Purchased electricity More
$
,000.00
7. Purchased fuels (Exclude motor fuels.) More
$
,000.00
2. Temporary staff and leased employee expense More
Expensed equipment and materials
Expensed purchased services
2022 Payments made by
this establishment on
behalf of other
establishments of your
enterprise
Check
if
None
8. Data processing and other purchased computer
services More
$
,000.00
$
,000.00
9. Purchased communication services More
$
,000.00
$
,000.00
10. Purchased repairs and maintenance to machinery,
vehicles, and equipment More
$
,000.00
$
,000.00
11. Purchased repairs and maintenance to buildings,
structures, and offices More
$
,000.00
$
,000.00
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15
12. Water, sewer, refuse removal, and other utility
payments More
$
,000.00
$
,000.00
13. Purchased advertising and promotional services More
$
,000.00
$
,000.00
$
,000.00
$
,000.00
15. Lease and rental payments for machinery, equipment,
and other tangible items More
$
,000.00
$
,000.00
16. Lease and rental payments for land, buildings,
structures, store spaces, and offices More
$
,000.00
$
,000.00
17. Governmental taxes and license fees (Exclude sales,
excise, and income taxes.) More
$
,000.00
$
,000.00
18. Depreciation and amortization charges More
$
,000.00
19. All other selected expenses
(Describe - If more than 50% of TOTAL reported on line
20.) More
$
,000.00
$
,000.00
14. Purchased professional and technical services More
Other selected expenses
Describe
20. TOTAL SELECTED EXPENSES of this establishment
ONLY, excluding payroll (Add lines 1 through 19.)
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Item 20: Class of Customer
ITEM 20: CLASS OF CUSTOMER
Estimate the percentage of receipts (reported in Item 5) from services provided to clients outside your enterprise by class of customer.
2022
%
1. Business firms and farms
2. Not-for-profit organizations (Include religious organizations.)
%
3. Federal government
%
4. State and local governments
%
5. Household consumers and individuals
%
%
6. TOTAL (Sum of lines 1 through 5 should equal 100%.)
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17
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7002750000
1. Parking services
7002750003
a. Off-street parking services, hourly or daily
b. Off-street parking services, weekly or monthly, in buildings
7002750006
7002750009
c. Off-street parking services, weekly or monthly, on lots
7002750012
d. On-street parking services
7002750015
e. Valet parking services
2. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines
7006575000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Parking services
a. Off-street parking services, hourly or daily
$
,000.00
7002750003
b. Off-street parking services, weekly or monthly, in buildings
$
,000.00
7002750006
c. Off-street parking services, weekly or monthly, on lots
$
,000.00
7002750009
d. On-street parking services
$
,000.00
7002750012
$
,000.00
7002750015
$
,000.00
7002750000
2. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service
gambling machines
$
,000.00
7006575000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
e. Valet parking services
Subtotal
Add product/service not listed
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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Item 28: Special Items - Exported Services Revenue
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES REVENUE
What were the receipts or revenue for exported services in 2022?
(This is a breakout of receipts or revenue reported in Item 5 - $,000.00.)
Include:
Services provided to unaffiliated and affiliated foreign businesses (i.e., foreign parent firms, subsidiaries, branches, etc.) located
outside the U.S.
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
2022_OS-8127X_mu.pdf Generated 2022-02-18 07:58:55
2022
$
,000.00
21
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
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22
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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25
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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27
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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28
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
30
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
City, town, village, etc.
ZIP Code
State
99999-9999
Select State or Territory
PHYSICAL LOCATION
Please update the physical location if needed.
(P.O. Box and rural route addresses are not physical locations.)
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
For Census Bureau Use Only
CFN
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1
Legal Boundary and Municipality
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
In what type of municipality is this establishment physically located?
City, village, or borough
Town or township
Other
Do not know
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941, Employer’s Federal Quarterly Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
14
Item 4: Primary Business or Activity
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Civic, social, and recreational associations
Property owners' association, including home owners', condominium owners', and cooperative owners' associations (Not strictly providing
property management.)
813990 401
Civic, social, or fraternal association (Include alumni associations, community membership clubs, etc., exclude scouting and related youth
development organizations.)
813410 405
Veterans membership organization
813410 404
Scouting and related youth development membership organization developing life, leadership, or business skills
813410 301
Youth development membership organization developing life, leadership, or business skills. (Exclude scouting membership organizations.)
813410 302
Day camp, excluding overnight and instructional camps
713990 80A
Youth or adult sports instructional day camp
611620 003
Adult or family sporting or recreation overnight camp, including fishing and hunting camps and camps operated by membership
organizations
721214 005
Adult activity or day care center
624120 001
Recreational sports club, program, or team for youth and adults
713990 806
Fitness or recreational sports center, membership or non-membership
713940 903
Bar or restaurant operated by social or fraternal organization for members
813410 403
Bar, tavern, pub, or other drinking place, selling alcoholic beverages for consumption on premises
722410 001
Child care services, including those with preschool and/or Head Start programs
624410 001
Business and professional membership associations
Business association - organized to promote the business interests of its members (Include trade associations, farm bureaus, chambers of
commerce, boards of realtors, etc.)
813910 001
Professional membership organization - organized to advance the professional interests of their members and the profession as a whole
(Include bar associations, accountants' associations, physicians' associations, sports players' associations, etc.)
813920 001
Labor, political, and religious organizations
Labor unions or similar labor organizations
813930 001
Political organization
813940 001
Religious organization for worship, religious training or study, or administration of an organized religion
813110 001
Other membership organizations
Sports governing body (Include professional leagues, collegiate sports conferences, athletic regulatory associations, etc.)
813990 901
Automobile enthusiast club
813410 401
Automobile club, road and travel services
561599 201
Art council
813410 402
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
15
Economic or industrial planning or development organization (non-government)
561990 301
Grantmaking, giving, and advocacy
Philanthropic trust or foundation - making grants but not directly providing services
813211 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, 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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
Check
if
None
2022
$
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
How to Report Percents:
Percents should be rounded to whole percents.
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
%
17
Consolidating Data for Multiple Locations
CONSOLIDATING DATA FOR MULTIPLE LOCATIONS
Since multiple locations operate under EIN , report on a consolidated basis (sum the total of each location and combine) for:
Item 5: Sales, Shipments, Receipts, or Revenue
Item 7: Employment, Annual Payroll, and First Quarter Payroll
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
Item 28: Special Items - questions vary by survey (if applicable)
Note:
All other Items should be reported individually for the location listed above.
At the end of the Survey, after Remarks, Item 32: Location List will contain a means for you to report information for each establishment individually.
Name, Store/Plant, Address, Kind of Business
Number of Employees; Annual Payroll; First Quarter Payroll; Sales, Shipments, Receipts, or Revenue
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Was all or part of the income of this establishment or organization exempt from Federal income taxes under section 501, 521, 527, or 528 of the Internal Revenue Code?
For further clarification, click the "Additional Information" link above.
Yes
No
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
19
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
What were the total operating receipts of this taxable establishment?
For further clarification, click the "Additional Information" link above.
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
2022
$
,000.00
20
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Revenue and expenses of this tax-exempt establishment
For further clarification, click the "Additional Information" link above.
Check
if
None
1. What was the total revenue?
2. What were the total expenses?
(Include payroll, exclude bad debt.)
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
2022
$
,000.00
$
,000.00
21
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
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)
Exclude:
Temporary staffing obtained from a staffing service
Contractors, subcontractors, or independent contractors
Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN
Purchased or managed services, such as janitorial, guard, or landscape services
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services
For further clarification, click the "Additional Information" link above.
A. Employment
Check
if
None
2022
What was the number of employees for pay period including March 12?
B. Payroll before deductions
(Exclude employer's cost for fringe benefits.)
Check
if
None
1. What was the annual payroll?
2. What was the first quarter payroll (January-March 2022)?
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
2022
$
,000.00
$
,000.00
22
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Membership services of performing arts societies and cultural institutions More
2. Civic and social organization membership services More
3. Business and professional association membership services More
Product Code
7001650000
7005023000
7017150000
7005024000
4. Other membership services More
a. Condominium and homeowners' association membership services More
b. Other membership services, except condominium and homeowners' associations, labor unions, civic and social organizations,
performing arts societies and clubs, and business and professional associations
5. Trade, career, technical and professional development training programs More
6. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
7. Alcoholic beverages, prepared and served or dispensed for immediate consumption
8. Meals, snacks, other food items, and beverages prepared for catered events
9. Charitable gaming (Include net charitable gaming income.) More
10. Directories, professional and technical periodicals, and periodicals of general interest More
7005024003
7005024006
7003950000
7000025000
7000050000
7000060000
7002450000
7014505000
7012425000
11. Advertising space, time and similar services More
12. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines More
13. Home, apartment, rooming house, and other residential space rental and leasing
7006575000
7000275000
7003825000
14. Room or unit accommodation for travelers
15. Other social assistance services for the general population
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
7005022000
23
Add product/service not listed
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
24
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
2. Civic and social organization membership services More
$
,000.00
7005023000
3. Business and professional association membership services More
$
,000.00
7017150000
a. Condominium and homeowners' association membership services More
$
,000.00
7005024003
b. Other membership services, except condominium and homeowners' associations, labor unions, civic and social
organizations, performing arts societies and clubs, and business and professional associations
$
,000.00
7005024006
Subtotal
$
,000.00
7005024000
5. Trade, career, technical and professional development training programs More
$
,000.00
7003950000
6. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
7. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
8. Meals, snacks, other food items, and beverages prepared for catered events
$
,000.00
7000060000
9. Charitable gaming (Include net charitable gaming income.) More
$
,000.00
7002450000
10. Directories, professional and technical periodicals, and periodicals of general interest More
$
,000.00
7014505000
11. Advertising space, time and similar services More
$
,000.00
7012425000
12. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated selfservice gambling machines More
$
,000.00
7006575000
13. Home, apartment, rooming house, and other residential space rental and leasing
$
,000.00
7000275000
14. Room or unit accommodation for travelers
$
,000.00
7003825000
15. Other social assistance services for the general population
$
,000.00
7005022000
4. Other membership services More
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
25
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
26
Item 22: Detail of Sales, Shipments, Receipts, or Revenue
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
1. Membership services of performing arts societies and cultural institutions More
2. Civic and social organization membership services More
3. Business and professional association membership services More
Product Code
7001650000
7005023000
7017150000
7005024000
4. Other membership services
a. Condominium and homeowners' association membership services More
b. Other membership services, except condominium and homeowners' associations, labor unions, civic and social organizations,
performing arts societies and clubs, and business and professional associations
5. Trade, career, technical and professional development training programs More
6. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
7. Alcoholic beverages, prepared and served or dispensed for immediate consumption
8. Meals, snacks, other food items, and beverages prepared for catered events
9. Charitable gaming (Include net charitable gaming income.) More
10. Directories, professional and technical periodicals, and periodicals of general interest More
7005024003
7005024006
7003950000
7000025000
7000050000
7000060000
7002450000
7014505000
7012425000
11. Advertising space, time and similar services More
12. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated self-service gambling
machines More
13. Home, apartment, rooming house, and other residential space rental and leasing
7006575000
7000275000
7003825000
14. Room or unit accommodation for travelers
15. Other social assistance services for the general population
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
7005022000
27
8000025000
16. Government contributions, gifts, and grants
a. Contributions, gifts, and grants from the National Endowment for the Arts
b. All other federal, state, county, and municipal contributions, gifts, and grants
8000025003
8000025006
8000050000
17. Private contributions, gifts, and grants
8000050003
a. Private contributions, gifts, and grants from individuals
b. Private contributions, gifts, and grants from foundations
c. Private contributions, gifts, and grants from business and industry
d. Other contributions, gifts, and grants, including from labor unions, etc.
18. Program service revenue including government fees and contracts More
8000050006
8000050009
8000050012
8000200000
8000175000
19. Gains (losses) from non-financial assets sold More
20. Trading securities and commodity contracts on own account More
21. Appropriations from general government revenues and intergovernmental transfers
8000150000
8000225000
Add product/service not listed
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
28
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued
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 for each product or service?
Description
Value
Product Code
1. Membership services of performing arts societies and cultural institutions More
$
,000.00
7001650000
2. Civic and social organization membership services More
$
,000.00
7005023000
3. Business and professional association membership services More
$
,000.00
7017150000
a. Condominium and homeowners' association membership services More
$
,000.00
7005024003
b. Other membership services, except condominium and homeowners' associations, labor unions, civic and social
organizations, performing arts societies and clubs, and business and professional associations
$
,000.00
7005024006
Subtotal
$
,000.00
7005024000
5. Trade, career, technical and professional development training programs More
$
,000.00
7003950000
6. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
7. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
8. Meals, snacks, other food items, and beverages prepared for catered events
$
,000.00
7000060000
9. Charitable gaming (Include net charitable gaming income.) More
$
,000.00
7002450000
10. Directories, professional and technical periodicals, and periodicals of general interest More
$
,000.00
7014505000
11. Advertising space, time and similar services More
$
,000.00
7012425000
12. Rental and leasing of nonresidential space in buildings or other facilities, except hosting of coin-operated selfservice gambling machines More
$
,000.00
7006575000
13. Home, apartment, rooming house, and other residential space rental and leasing
$
,000.00
7000275000
14. Room or unit accommodation for travelers
$
,000.00
7003825000
15. Other social assistance services for the general population
$
,000.00
7005022000
4. Other membership services
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
29
16. Government contributions, gifts, and grants
a. Contributions, gifts, and grants from the National Endowment for the Arts
$
,000.00
8000025003
b. All other federal, state, county, and municipal contributions, gifts, and grants
$
,000.00
8000025006
$
,000.00
8000025000
a. Private contributions, gifts, and grants from individuals
$
,000.00
8000050003
b. Private contributions, gifts, and grants from foundations
$
,000.00
8000050006
c. Private contributions, gifts, and grants from business and industry
$
,000.00
8000050009
$
,000.00
8000050012
$
,000.00
8000050000
18. Program service revenue including government fees and contracts More
$
,000.00
8000200000
19. Gains (losses) from non-financial assets sold More
$
,000.00
8000175000
20. Trading securities and commodity contracts on own account More
$
,000.00
8000150000
$
,000.00
8000225000
$
,000.00
8000250003
$
,000.00
8000250006
$
,000.00
Subtotal
17. Private contributions, gifts, and grants
d. Other contributions, gifts, and grants, including from labor unions, etc.
Subtotal
21. Appropriations from general government revenues and intergovernmental transfers
22. All other nonoperating or tax-exempt revenue
a. All other nonoperating or tax-exempt revenue - write-in #1
Describe
b. All other nonoperating or tax-exempt revenue - write-in #2
Describe
TOTAL - Sum of lines should equal total Revenue reported in Item 5
9900000002
Add product/service not listed
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30
Item 26: Business Cooperative
ITEM 26: BUSINESS 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, membercontrolled non-profits, consumer co-ops, marketing co-ops, worker co-ops, etc.
Is this establishment a cooperative?
Yes
No
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Item 28: Special Items - Social Assistance
ITEM 28: SPECIAL ITEMS - SOCIAL ASSISTANCE
If applicable, estimate the percent of receipts for social assistance services reported in Item 22, line 15, from the following payers:
2022
%
1. Government payers
2. Private payers
%
3. TOTAL (Sum of lines 1 and 2 should equal 100%.)
%
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Item 28: Special Items - Exported Services
ITEM 28: SPECIAL ITEMS - EXPORTED SERVICES
Did this establishment sell services (not goods) to foreign businesses in 2022 (i.e., exported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services provided to any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Exported goods
Services provided to domestic subsidiaries of foreign businesses
Yes
No
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33
Item 28: Special Items - Imported Services
ITEM 28: SPECIAL ITEMS - IMPORTED SERVICES
Did this establishment purchase services (not goods) from foreign businesses in 2022 (i.e., imported services)?
Foreign businesses are those located outside the United States (i.e., outside the 50 States, District of Columbia, U.S. Commonwealth Territories, or U.S. possessions).
Include:
Services purchased from any foreign businesses, whether affiliated or unaffiliated (i.e., foreign parent firms, subsidiaries, branches, etc.)
Exclude:
Imported goods
Services purchased from domestic subsidiaries of foreign businesses
Yes
No
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34
Item 29: Business Technologies
ITEM 29: BUSINESS TECHNOLOGIES
1. In 2022, did this establishment use touchscreens/kiosks for customer interface in its own operations?
Touchscreens/kiosks for customer interface are computers with touchscreens that allow customers to receive information or perform tasks related to the business, such as registering
for a service or purchasing items.
Include:
Self-checkout, self-check-in, touchscreen ordering, etc.
Yes
No
Do not know
2. In 2022, did this establishment use additive manufacturing (e.g., 3D printing) in its own operations?
Additive manufacturing is the process of making three-dimensional, solid objects from a digital file.
Yes
No
Do not know
3. In 2022, did this establishment use radio-frequency identification (RFID) in its own operations?
Radio-frequency identification (RFID) is the use of passive or active radio-frequency identification chips to track inventory, products, or other objects.
Exclude:
Bar codes read with a scanner
Yes
No
Do not know
4. In 2022, did this establishment use industrial robots in its own operations?
Industrial robots are automatically controlled, reprogrammable, and multipurpose machines used in industrial automated operations. They may be mobile, incorporated into stand-alone
stations, or integrated into a production line.
Include:
Industrial robotic equipment that typically performs palletizing, pick and place, machine tending, machine handling, dispensing, welding, and packing/repacking
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), driverless forklifts, automated storage and retrieval systems, CNC machining equipment, and service
robots
Yes
No
Do not know
5. In 2022, did this establishment use service robots in its own operations?
Service robots perform tasks for humans for personal or professional use, not in an industrial or warehouse setting.
Include:
Medical, cleaning, delivery, construction/demolition, and field (such as mining, firefighting, and forestry) service robots
Exclude:
Automated guided vehicles (AGV), autonomous mobile robots (AMR), CNC machining equipment, and industrial robots
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
35
Yes
No
Do not know
6. In 2022, did this establishment use automated guided vehicles (AGV) or autonomous mobile robots (AMR) in its own operations?
Automated guided vehicles (AGV) are computer-controlled vehicles that use sensor-based systems and software to navigate fixed routes (including driverless forklifts).
Autonomous mobile robots (AMR) are computer-controlled vehicles that use sensor-based systems and software to navigate without the need for fixed routes.
Yes
No
Do not know
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36
Item 29: Business Technologies - Touchscreens/Kiosks for Customer Interface
ITEM 29: BUSINESS TECHNOLOGIES - TOUCHSCREENS/KIOSKS FOR CUSTOMER INTERFACE
How did this establishment acquire the touchscreens/kiosks for customer interface used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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37
Item 29: Business Technologies - Additive Manufacturing
ITEM 29: BUSINESS TECHNOLOGIES - ADDITIVE MANUFACTURING
How did this establishment acquire the additive manufacturing (e.g., 3D printing) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
38
Item 29: Business Technologies - Radio-Frequency Identification (RFID)
ITEM 29: BUSINESS TECHNOLOGIES - RADIO-FREQUENCY IDENTIFICATION (RFID)
How did this establishment acquire the radio-frequency identification (RFID) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
39
Item 29: Business Technologies - Industrial Robots
ITEM 29: BUSINESS TECHNOLOGIES - INDUSTRIAL ROBOTS
How did this establishment acquire the industrial robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
40
Item 29: Business Technologies - Service Robots
ITEM 29: BUSINESS TECHNOLOGIES - SERVICE ROBOTS
How did this establishment acquire the service robots used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
41
Item 29: Business Technologies - Automated Guided Vehicles (AGV) or Autonomous Mobile Robots (AMR)
ITEM 29: BUSINESS TECHNOLOGIES - AUTOMATED GUIDED VEHICLES (AGV) OR AUTONOMOUS MOBILE ROBOTS (AMR)
How did this establishment acquire the automated guided vehicles (AGV) or autonomous mobile robots (AMR) used in its own operations?
Select ALL that apply.
Purchased
Leased/rented
Developed in-house
Other
Describe
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
1000
characters remaining
43
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
City, town, village, etc.
ZIP Code
State
Select State or Territory
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_OS-81349_su.pdf Generated 2022-02-18 08:11:47
,000.00
44
Attachment D-20
Department of Commerce
United States Census Bureau
OMB Information Collection Request
2022 Economic Census
OMB Control Number 0607-XXXX
Draft Previews of Standard, Consolidated, and Classification Questionnaires
Island Areas
Attachment Sector
Instrument
Path
Instrument Path Title
D-20
92104
N/A
92304
93104
94204
94404
95104
95204
97204
American Samoa - Mining, Utilities, Transportation, and
Warehousing
American Samoa - Construction
American Samoa - Manufacturing
American Samoa - Wholesale Trade
American Samoa - Retail Trade
American Samoa - Services
American Samoa - Finance, Insurance, Real Estate, Rental and
Leasing
American Samoa - Accommodation and Food Services
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
1
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Mining
Sand, gravel, clay, and ceramic and refractory minerals mining and quarrying
212320 001
Support activities for mining
213110 001
Utilities
Electric power generation
221110 001
Natural gas distribution
221210 003
Water supply and water treatment, except irrigation
221310 003
Sewerage system, including sewage treatment plant
221320 001
Pipeline transportation
Pipeline transport of refined petroleum including liquefied gas
486910 002
Air transportation
Scheduled air transportation including passenger and freight carrier
481110 001
Sightseeing airplane or helicopter
487990 001
Nonscheduled air transportation including charter passenger and freight services, air taxi, and specialized flying services, such as aerial
advertising and photography, and aerial surveying
481210 001
Airport operation and terminal services including air traffic control, airfreight and baggage handling, hanger operations, runway maintenance,
etc.
488110 001
Other airport and aircraft transportation services including aircraft maintenance and repair (except factory conversion, factory overhaul,
factory rebuilding)
488190 003
Water transportation
Deep sea and coastal transportation of cargo and passengers to and from foreign ports
483110 001
Scenic and sightseeing water transportation including dinner cruises, excursions, and charter fishing
487210 001
Inland waterways including water taxis and towing services for barges
483210 001
Port and harbor operations including operation of a port or waterfront terminal
488310 001
Marine cargo handling including stevedoring
488320 002
Navigational services to shipping including fleeting and harbor service, piloting of vessels, and marine salvaging
488330 001
Other services incidental to water transportation including boat barge cleaning, marine cargo inspector and surveyors, ship dismantling,
floating dry-docks, etc.
488390 005
Truck transportation
General freight trucking
484110 001
Used household and office goods moving
484210 001
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15
Specialized local freight trucking (except used goods), including hazardous materials, agricultural products, and auto and boat transport
484220 001
Truck or weighing stations operations and other services for road transportation
488490 004
Motor vehicle towing
488410 002
Warehousing and Storage
General warehousing and storage
493110 001
Refrigerated products warehousing
493120 001
Farm products warehousing and storage except cold storage
493130 004
Specialized goods (except refrigerated) including bulk petroleum, chemicals, and other products requiring special storage
493190 001
Courier and Messenger Service
Courier services including intercity and air courier services
492110 001
Local messenger and delivery services including bicycles
492210 003
Transit and ground passenger transportation
Urban transit systems, including bus transportation
485110 001
Interurban and rural bus transportation
485210 002
Taxi or ridesharing service by automobile or van
485310 001
Limousine or luxury sedan with drivers, excluding scheduled airport shuttle services
485320 002
School or employee bus service
485410 001
Charter bus service except scenic and sightseeing
485510 001
Sightseeing bus
487110 001
Other transit and ground passenger transportation
485990 001
Other transportation-related activities
Freight forwarding service such as marine shipping agents or customs brokers
488510 001
Other services incidental to transportation including packing, crating, and preparing goods for shipping
488990 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
%
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
2022
$
,000.00
A. What was the operating revenue for this establishment in 2022?
B. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
C. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
D. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
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2022
%
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
Check
if
None
2022
$
,000.00
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
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19
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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20
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
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End of 2021
$
,000.00
21
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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22
Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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23
Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
$
,000.00
C. TOTAL (Add lines A and B)
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24
Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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25
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
$
,000.00
C. Interest paid
$
,000.00
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
$
,000.00
A. Cost of products bought for resale without further processing
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26
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line D, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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27
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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28
Item 28: Special Items
ITEM 28: SPECIAL ITEMS
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of the same company (rather than for the general public or
other business firms) in 2022?
Yes
No
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29
Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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30
Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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31
Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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32
Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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33
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
1000
characters remaining
34
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-92104_su.pdf Generated 2022-02-23 17:12:30
,000.00
35
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
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1
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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Construction of buildings
New single-family, multifamily housing construction, or residential remodeling contractors
236110 001
Industrial building construction (e.g., processing and assembly plants, factories, refineries, waste disposal facilities), excluding warehouses
and sewage disposal plants
236210 001
Commercial and institutional building construction (e.g., office and school buildings, hospitals, health and data facilities, stores, and
warehouses)
236220 001
Heavy and civil engineering construction
Water and sewer line and related structures construction (e.g., mains, sewage disposal plants, pumping stations, and water well drilling)
237110 001
Power and communication line and related structures construction (e.g., alternative energy structures, power plants, transformer stations,
high voltage transmission cable connections, and cellular phone towers)
237130 001
Land subdivision and development (installation of utility, infrastructure) into lots for sale to builders
237210 001
Highway, street, and bridge construction, including curbs, airport runway construction, and line painting of streets and parking lots
237310 001
Other heavy and civil engineering construction (e.g., tunnels, railways, outside recreation areas, dams, flood and drainage control projects,
dredging, trenching, and marine facilities)
237990 001
Specialty trade contractors
Poured concrete foundation and structure contractor (e.g., shotcrete, mud-jacking, gunning, gunite, pumping, and placement footing)
238110 001
Structural steel and precast concrete contractor, including structural iron work
238120 001
Framing contractor, including wood and steel (excluding structural steel or precast concrete)
238130 001
Masonry contractor (e.g., brick, stone, slate, glass block, cement, cinder blocking, stucco setting and other stone work)
238140 001
Glass and glazing contractor (e.g., glass coating and tinting (excluding automotive), window pane, glass sheet, glass curtain wall, and mirror
installation)
238150 001
Roofing contractor, including treating roofs (i.e., spraying, painting or coating) and skylight installation
238160 001
Siding contractor (e.g., gutters, downspouts, fascia, soffit, eavestrough, flashing, and ice apron)
238170 001
Other foundation, structure, and building exterior contractor (e.g., awning, metal balcony and stairway, and falsework construction), including
decorative steel and wrought iron work; poured concrete form installation and dismantling; and welding at site
238190 001
Electrical and other wiring installation contractor (e.g., electronic and environmental controls, telecommunications and fiber optic equipment
(excluding transmission line), solar panel installation, traffic signals, and fire and security systems)
238210 001
Plumbing, heating, and air-conditioning (HVAC) contractor, including installation, maintenance, and repair of refrigeration systems, sprinkler
systems, water systems, gas and oil line individual hookups, and steam and pipe fittings
238220 001
Other building equipment contractor (e.g., millwrights, machine rigging), including installation, maintenance, and repair of ATM equipment,
elevators, escalators, service station gasoline pumps, commercial and industrial doors)
238290 001
Drywall and insulation contractor, including acoustical, plastering, and fireproofing contractors
238310 001
Painting and wall covering contractor, including on-site electrostatic painting, whitewashing, and rustproofing of buildings, ships, bridges,
tanks, and towers (excluding automotive)
238320 001
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15
Flooring contractor (e.g., laying carpet, linoleum, hardwood, laminate, and vinyl flooring), excluding fireproof, stone, concrete, and ceramic
tile flooring
238330 001
Tile and terrazzo contractor (e.g., marble, granite, slate, ceramic, stone, and mosaic work for floors, walls, and ceilings), excluding exterior
marble, granite, and slate work
238340 001
Finish carpentry contractor (e.g., door, window, cabinetry, countertop, stairway, deck, molding, trim, and paneling work, residential-type,
installation), excluding framing
238350 001
Other building finishing contractor (e.g., waterproofing, spectator seating, modular furniture system attachments, closet organizer systems,
concrete coating, window shades and blinds, and trade show exhibit installation and dismantling)
238390 001
Site preparation contractor, without land subdivision (e.g., land clearing, drilling, demolition, trenching, and earthmoving), and rental of
construction equipment with operators (excluding cranes))
238910 001
All other specialty trade contractor (e.g., driveway paving; constructions of residential and commercial parking lots, sidewalks, patios, and
outdoor swimming pools; installation of fences (excluding electric) and playground equipment; and crane rental with operator)
238990 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
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%
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. Receipts, Billings, or Sales for Construction Work
Include:
Receipts (or billings) derived from contract construction work done for others.
Sales of houses and other buildings you built and sold.
Construction management and design-build contracts.
Site preparation, such as land clearing, laying roads, installing utilities, and subdividing land into lots.
New construction and remodeling, as well as maintenance and repair work.
The work of prime and trade contractors.
The work of some trades not traditionally thought of as construction, such as land subdivision, excavation, building demolition, painting, carpet-laying, and water well drilling.
Exclude:
Cost of land other than site preparation.
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building structure).
Check
if
None
2022
$
What were the receipts, billings, or sales for construction work?
,000.00
B. Receipts for Other Business Activities
Include:
Architectural services, except the design portion of integrated design-build contracts.
Engineering services.
Manufacturing.
Mining and quarrying.
Rental or lease of properties.
Real estate commissions and property management fees.
Rental of construction machinery or equipment to others, without an operator.
Retail trade.
Transportation.
Wholesale trade.
Other business activities.
Check
if
None
2022
$
What were the receipts for all other business activities done by this establishment?
Check
if
None
2022
$
C. TOTAL (Add lines A and B)
,000.00
,000.00
D. Were any of the sales, shipments, receipts, or revenue reported in line C a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
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Extranet
Other online systems
Yes
No
Check
if
None
2022
E. What is the percent of total sales, shipments, receipts, or revenue reported in line C that are a result of e-commerce
transactions?
%
Check
if
None
F. What is the percent of total sales, shipments, receipts, or revenue reported in line C that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
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2022
%
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Number of employees at this establishment
Include:
Full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941-SS,
Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1.
If the legal form of organization for this business is a corporation, the reporting of other employees and other payroll at this domestic reporting unit is required. If payroll and
employment for this EIN are zero, please indicate if the EIN is a joint venture in Item 31.
All persons on paid sick leave, paid holidays, and paid vacation during the year at this domestic reporting unit.
Spread on stock options that are taxable to employees at this domestic reporting unit as wages.
Exclude:
Full- or part-time leased employees whose payroll was filed under a professional employer organization's EIN. (Report values in Item 16, line F.)
Temporary staffing obtained from a staffing service. (Report values in Item 16, line F.)
Contractors, subcontractors, or independent contractors.
Purchased or managed services, such as janitorial, guard, or landscape services. (Report values in Item 16, line F.)
Professional or technical services purchased from another firm, such as software consulting, computer programming, engineering, or accounting services. (Report values in Item
16, line F.)
Members of the Armed Forces and pensioners carried on your active rolls.
Proprietors and partners, if an unincorporated concern.
Number of construction workers at this establishment include:
Apprentices
Working foremen
Equipment operators and mechanics
Journeymen
Job-site record keepers
Craftsmen
Laborers
Truck drivers and helpers
Others engaged directly in construction
Number of other employees at this establishment include:
Supervisors above working foremen
Office staff
Executives
Architects
Others engaged in nonconstruction activities
Personnel staff
Engineers
Accounting staff
Purchasing agents
A. Report the number of employees at this establishment for pay periods including the 12th of:
March 2022
June 2022
September 2022
December 2022
1. What was the number of construction workers
(direct labor including first-line supervisors)?
2. What was the number of other employees?
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20
TOTAL (Add lines A1 and A2.)
B. Hours Worked
Check
if
None
2022 Hours
What was the annual number of hours worked by the construction workers at this establishment (direct labor
including first-line supervisors) reported in line A?
,000
C. Payroll
Include:
Payroll for officers at this establishment
Exclude:
Income or costs not recorded as payroll for IRS by establishment.
Employer-paid annual cost for fringe benefits reported in lines 7D1 and 7D2
Check
if
None
2022
1. What was the annual payroll at this establishment before deductions for construction workers (direct labor
including first-line supervisors)?
$
,000.00
2. What was the annual payroll before deductions for other employees?
$
,000.00
TOTAL (Add lines C1 and C2.)
$
,000.00
3. Of the $0,000.00 reported above, what was the first quarter payroll at this establishment before deductions
(January-March 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
TOTAL (Add lines D1 and D2)
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Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
21
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories of materials and supplies, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories of materials and
supplies owned by this establishment?
Check
if
None
End of 2022
$
,000.00
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End of 2021
$
,000.00
23
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
C. TOTAL (Add lines A and B)
$
,000.00
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Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the rental payments for the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
A. Construction equipment and tools, machinery, office equipment, furniture, and vehicles
B. Buildings, job-site trailers, and other structures
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2022
$
,000.00
$
,000.00
27
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
A. Materials, parts, containers, and supplies
Include:
All job-site, office, and construction materials and supplies
Cost of materials purchased by this establishment for subcontractors
Check
if
None
2022
$
,000.00
B. Construction work subcontracted out to others
$
,000.00
C. Fuels consumed for heat, power, or the generation of electricity
$
,000.00
D. Electricity
$
,000.00
E. Cost of products bought for resale without further processing
$
,000.00
F. All other operating expenses
(Include payroll, benefits, office supplies, communication services, computer services, and routine maintenance and
repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as reported
in Item 13.)
$
,000.00
G. Interest paid
$
,000.00
Exclude:
Cost of manufacturing and production machinery, furniture, etc. (any item installed that is not part of a building
structure)
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line F, what was the estimated percentage of this establishment's total sales (reported in Item 5, line C) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
%
4. Wholesalers/distributors for resale
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 28: Special Items Additional Information
ITEM 28: SPECIAL ITEMS
A. Ownership of Construction Projects
What was the percent of receipts for construction work reported in Item 5, line A, on projects owned by the following?
2022
%
1. Private businesses and individuals
2. Federal, commonwealth, territorial, and municipal governments
%
3. TOTAL (Sum of lines A1 and A2 should equal 100%)
%
B. Construction Work Done as a Subcontractor
What was the percent of receipts for construction work reported in Item 5, line A, which represents work you did for contractors or
builders?
(Enter "0" if you did not subcontract work from contractors or builders.)
2022
%
C. Type of Construction
What was the percent of receipts for construction work reported in Item 5, line A, for the following types of construction?
1. New building construction
(Include the original construction work done, all finishing work, land development work on the site, demolition of existing
structures, etc.)
2022
%
2. Building additions, alterations, or reconstruction
(Include construction work which adds to the value of an existing building or which adapts a building to a new or different use,
including major replacements of building systems such as new roofs, etc.)
%
3. Building maintenance and repair work
(Include incidental construction work which keeps a property in ordinary working conditions. Exclude trash removal, lawn
maintenance, landscaping, cleaning, and janitorial services.)
%
4. Other types of new construction
(Include the original construction work done, all finishing work, land development work on the site, demolition of existing streets,
highways, structures, etc.)
%
5. Other types of additions, alterations, or reconstruction
(Include construction work which adds to the value of existing streets, highways, structures, etc., and major replacements of
nonbuilding systems such as resurfacing of streets and highways, improvements to structures, etc.)
%
6. Other types of maintenance and repair work
(Include incidental construction work which keeps streets, highways, structures, etc., in ordinary working conditions. Exclude
trash removal, lawn maintenance, landscaping, and cleaning services.)
%
7. TOTAL (Sum of lines C1 through C6 should equal 100%)
%
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Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
36
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
37
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
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Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Food manufacturing
Animal food manufacturing
311110 001
Sugar manufacturing and refining
311310 001
Nonchocolate confectionery manufacturing, including retailing nonchocolate confectioneries made on premises, not for immediate
consumption
311340 001
Chocolate confectionery manufacturing
311350 001
Frozen food manufacturing, including juices, vegetables, and specialty foods (excluding bakery, dairy, meat, and seafood-based products)
311410 001
Fruit and vegetable canning, pickling, and drying
311420 001
Dairy product (except frozen) manufacturing
311510 001
Ice cream and frozen dessert manufacturing (excluding bakery products)
311520 001
Slaughtering and processing animals
311610 001
Seafood product (fresh or frozen) preparation and packaging, including seafood soups
311710 001
Bread and bakery product manufacturing, fresh and frozen
311810 001
Cookie, cracker, and pasta manufacturing
311820 001
Tortilla manufacturing
311830 001
Snack food manufacturing, including potato chips, pretzels (except soft), and other similar snacks
311910 001
Coffee and tea manufacturing, including concentrates (instant and freeze-dried), herbal tea, coffee substitutes, and coffee extracts and
flavorings (excluding bottled beverages)
311920 001
Flavoring syrup and concentrate manufacturing, for soda fountain use or for the manufacture of soft drinks (excluding coffee, tea, chocolate,
or milk-based)
311930 001
Seasoning and dressing manufacturing, including mayonnaise, sauces (except tomato-based sauces), table salt, and spices
311940 001
All other food manufacturing
311990 001
Beverage manufacturing
Soft drink and ice manufacturing, including purified and bottled water
312110 001
Brewery
312120 001
Winery
312130 001
Distillery
312140 001
Fabrics and textile products
Carpet and rug mill, excluding cutting and binding only
314110 001
Curtain and linen mill (made from purchased materials), including sheets, towels, pillows, and shower curtains; and textile products made on
a custom basis for sale to individual retail customers (excluding lace curtains made on lace machines)
314120 001
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Textile bag and canvas mill (made from purchased materials), including boat, swimming pool, and truck covers; awnings; sails; tarpaulins;
and tents (excluding blinds and shades, handbags, and luggage)
314910 001
All other textile product mills, including ropes, cordage, twine, tire cord, etc.
314990 001
Apparel manufacturing
Cut and sew apparel contractor (on materials owned by others), including tailors and seamstresses (excluding embroidering apparel)
315210 001
Men's and boys' cut and sew apparel made from purchased fabric, including manufacturers, jobbers, and custom tailors (excluding
contractors and apparel made in knitting mills)
315220 001
Women's, girls', and infants' cut and sew apparel made from purchased fabric, including manufacturers, jobbers, and custom tailors
(excluding contractors and apparel made in knitting mills)
315240 001
Other cut and sew apparel (uniforms, costumers, etc.) made from purchased fabric, including manufacturers, jobbers, and custom tailors
(excluding contractors and apparel made in knitting mills)
315280 001
Apparel accessories and other apparel made from purchased fabrics, including belts, caps, gloves (excluding medical, sporting, and safety),
hats, and neckties (excluding products made in knitting mills)
315990 001
Leather and allied products manufacturing, except apparel
Footwear manufacturing, including athletic and cleated shoes, rubber footwear, and ballet slippers
316210 001
Other leather and allied product manufacturing
316990 001
Wood products manufacturing
Sawmills and wood preservation
321110 001
Veneer, plywood, and engineered wood product manufacturing
321210 001
Millwork, including wood products for construction (e.g., windows, doors, frames, floors, etc.)
321910 002
Wood container and pallet manufacturing
321920 001
All other wood product manufacturing (except burial caskets)
321990 001
Paper manufacturing
Paper mill
322120 001
Paperboard container manufacturing
322210 001
Paper bag and coated and treated paper manufacturing
322220 001
Stationery product manufacturing, including computer paper, die-cut paper products for office use made from purchased paper or
paperboard, envelopes, and tablets
322230 001
Other converted paper product manufacturing, including disposable diapers, egg cartons, paper plates, etc.
322290 001
Printing and related support activities
Printing of newspapers, magazines, continuous forms, rapid printing, and printing on clothing
323110 001
Support activities for printing (prepress, postpress, and binding)
323120 001
Petroleum and coal products manufacturing
Petroleum refinery
324110 001
Asphalt paving, roofing, and saturated materials manufacturing
324120 001
Other petroleum and coal products manufacturing
324190 001
Chemical manufacturing
Petrochemical manufacturing (excluding products made from refining crude petroleum)
2022_IA-93104_su.pdf Generated 2022-02-23 17:25:36
325110 001
16
Pharmaceutical and medicine manufacturing
325410 001
Paint and coating manufacturing
325510 001
Adhesive manufacturing
325520 001
Soap and cleaning compound manufacturing
325610 001
Toilet preparation manufacturing (including perfumes, shaving preparations, hair preparations, face creams, lotions, sunscreens, and other
cosmetic preparations)
325620 001
Plastic and rubber products manufacturing
326160 001
Plastics bottle manufacturing
Nonmetallic mineral products manufacturing
Cement manufacturing
327310 001
Ready-mix concrete manufacturing
327320 001
Concrete pipe, brick, and block manufacturing
327330 001
Other concrete product manufacturing, including precast slabs and tile, wall panels, prefabricated building components, bridge beams, burial
boxes and vaults, etc.
327390 001
Sand, gravel, clay, and ceramic and refractory minerals mining and quarrying
212320 001
Primary metal manufacturing
Iron and steel mills and ferroalloy manufacturing
331110 001
Alumina and aluminum production and processing
331310 001
Fabricated metal products manufacturing
Forging and stamping
332110 001
Cutlery and handtools manufacturing
332210 001
Plate work and fabricated structural product manufacturing
332310 001
Ornamental and architectural metal product manufacturing, including metal windows and doors
332320 001
Power boiler and heat exchanger manufacturing
332410 001
Metal tank (heavy gauge) manufacturing, including cutting, forming, and joining heavy gauge metal
332420 001
Hardware manufacturing, including hinges, handles, keys, doorlocks, etc.
332510 001
Spring and wire product manufacturing
332610 001
Machine shop, machining metal and plastic parts and parts of other composite materials on a job or order basis, using machine tools
332710 001
Turned product and screw, nut, and bolt manufacturing
332720 001
Metal coating, engraving (except jewelry and silverware), electroplating, plating, polishing, anodizing, and coloring
332810 001
All other fabricated metal product manufacturing
332990 001
Machinery manufacturing
Commercial and service industry machinery manufacturing
333310 001
Ventilation, heating, air-conditioning, and commercial refrigeration equipment manufacturing
333410 001
Metalworking machinery manufacturing, including accessories such as special dies, tools, jigs, fixtures, and industrial molds
333510 001
Computer and electronic products manufacturing
2022_IA-93104_su.pdf Generated 2022-02-23 17:25:36
17
Computer and peripheral equipment manufacturing
334110 001
Audio and video equipment manufacturing, including home entertainment, motor vehicle, public address, and musical instrument
applications
334310 001
Semiconductor and other electronic component manufacturing
334410 001
Navigational, measuring, electromedical, and control instruments manufacturing
334510 002
Manufacturing and reproducing magnetic and optical media, including prerecorded CD, tape, and record reproducing
334610 001
Electrical equipment, appliance, and components
335310 001
Electrical equipment manufacturing
Transportation equipment
Motor vehicle body and trailer manufacturing
336210 001
Motor vehicle gasoline engine and engine parts manufacturing, including rebuilding engines and engine parts
336310 001
Other motor vehicle parts manufacturing, including engine filters, air-conditioning systems, air bag assemblies, wheels, frames, bumpers,
radiators, fuel tanks, exhaust system parts, etc.
336390 001
Ship and boat building, and repairing
336610 001
Furniture and related products
Wood kitchen cabinet and countertop manufacturing
337110 001
Household and institutional furniture manufacturing
337120 001
Office furniture (including fixtures) manufacturing
337210 001
Mattress manufacturing
337910 001
Miscellaneous manufacturing
Medical equipment and supplies manufacturing
339110 001
Jewelry and silverware manufacturing, including lapidary work, and manufacturing unassembled jewelry parts and stock shop products
(excluding manufacturing synthetic stones and plating jewelry)
339910 001
Sporting and athletic goods manufacturing, excluding apparel, footwear, and small arms and ammunition
339920 001
Doll, toy, and game manufacturing, including electronic games, and doll parts and clothes (excluding metal bicycles and tricycles, coinoperated game machines, electronic video game cartridges, and reproducing video game software)
339930 001
Office supplies (excluding paper) manufacturing, including crayons, chalk, modeling clay, and stencils (excluding writing, drawing, and india
inks; rubber erasers; loose-leaf binders and devices; and inkjet and toner cartridges)
339940 001
Manufacturer of signs and related displays, excluding printing paper and paperboard signs, notices, and displays
339950 002
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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18
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-93104_su.pdf Generated 2022-02-23 17:25:36
%
19
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
A. What was the total value of shipments for products manufactured at this establishment?
(Include interplant transfers)
2022
$
,000.00
$
,000.00
$
,000.00
$
,000.00
D. What were the total receipts for resales?
(Sales of products bought and sold without further manufacture, processing, or assembly. Report cost in Item 16, line F.)
$
,000.00
E. TOTAL (Add lines A through D)
$
,000.00
B. What were the total receipts for contract work performed for others on their materials?
C. What were the miscellaneous receipts for the following?
1. Sales of scrap and refuse
2. Other miscellaneous receipts
F. Were any of the sales, shipments, receipts, or revenue reported in line E a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
G. What was the percent of total sales, shipments, receipts, or revenue reported in line E that were a result of e-commerce
transactions?
%
Check
if
None
H. What is the percent of total sales, shipments, receipts, or revenue reported in line E that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
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2022
%
20
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. Exclude
subcontractors and their employees. For further clarification, see Additional Information.
EMPLOYMENT
A. What was the number of paid production workers for pay periods including the following?
(Exclude proprietors and partners)
Check
if
None
2022 Number
Check
if
None
2022 Hours
1. March 12 (Q1)
2. June 12 (Q2)
3. September 12 (Q3)
4. December 12 (Q4)
5. Add lines A1 through A4
6. Average annual production workers (Divide line A5 by 4 - omit fractions)
7. What was the number of all other paid employees for pay period including March 12?
8. TOTAL (Add lines A6 and A7)
Hours Worked
,000
B. What was the annual number of hours worked by the production workers at this establishment?
TOTAL PAYROLL BEFORE DEDUCTIONS
C. What was the annual payroll at this establishment for the following?
(Report payroll only for employees reported in lines A5 and A7. Exclude employer's cost for fringe benefits.)
Check
if
None
2022
$
1. Production workers
2022_IA-93104_su.pdf Generated 2022-02-23 17:25:36
,000.00
21
2. All other employees
$
,000.00
3. TOTAL (Add lines C1 and C2)
$
,000.00
4. What was the first quarter payroll for all employees (January-March, 2022)?
$
,000.00
D. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
Check
if
None
2022
$
,000.00
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
$
,000.00
TOTAL (Add lines D1 and D2)
$
,000.00
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22
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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23
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
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End of 2021
$
,000.00
24
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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25
Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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26
Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
C. TOTAL (Add lines A and B)
$
,000.00
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27
Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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28
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. Fuels consumed for heat, power, or the generation of electricity
$
,000.00
C. Electricity
$
,000.00
D. Contract work and nonproduction labor done for you by others
$
,000.00
E. Contract labor for production
$
,000.00
F. Cost of products bought for resale without further processing
(Report sales in Item 5, line D)
$
,000.00
G. All other operating expenses
(Include payroll, benefits, office supplies, communication services, computer services, and routine maintenance and
repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as reported
in Item 13.)
$
,000.00
H. Interest paid
$
,000.00
A. Materials, parts, containers, and supplies
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29
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line H, what was the estimated percentage of this establishment's total sales (reported in Item 5, line E) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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30
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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31
Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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32
Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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33
Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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34
Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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35
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
36
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-93104_su.pdf Generated 2022-02-23 17:25:37
,000.00
37
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
1
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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4A: Primary Business or Activity Additional Information
ITEM 4A: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Motor vehicles and motor vehicle parts and supplies
Wholesaler of automobiles and other motor vehicles, new and used
423110 001
New motor vehicle parts excluding tires and tubes
423120 001
Tires and tubes
423130 001
Used parts dealers
423140 003
New motor vehicle dealer
441110 002
Motor vehicle sales, used only
441120 002
Automotive parts and accessories store, new and/or used
441310 001
Furniture and home furnishings
Household, lawn, office, and business furniture including church pews and school desks
423210 001
Household china, glassware, crockery, linens, domestics, curtains, draperies, floor coverings including carpet pads, and other home
furnishings
423220 001
Lumber and other construction materials
Lumber, plywood, millwork, and wood panels, including wood roofing and siding
423310 001
Brick, block, clay/cement sewer pipe, sand, gravel, stone, asphalt, cement, concrete mixtures, and related products
423320 001
Roofing, siding, and insulation materials
423330 001
Other construction materials including flat glass, ironwork and fencing accessories
423390 001
Professional and commercial equipment and supplies
Photographic equipment and supplies
423410 001
Office equipment, excluding furniture
423420 001
Software publishers, including developing and publishing or publishing only, packaged software, including cloud-based
511210 001
Custom computer programming services
541511 004
Systems integrators engaged in the development or modification of software and the "bundling" of software with computers and peripheral
equipment to create an integrated system designed for a specific application
541512 103
Computer and peripheral equipment and software (packaged)
423430 001
Restaurant and hotel equipment and supplies, store machines and equipment and other commercial equipment, and supplies
423440 001
Medical, surgical, dental, and hospital equipment and supplies
423450 001
Optical and ophthalmic goods, including eyewear, sunglasses, reading glasses, and frames
423460 001
Other professional equipment and supplies, including school supplies and equipment, religious supplies, scientific instruments, and
surveying equipment and supplies
423490 001
Metal and mineral, except petroleum
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
15
Ferrous/nonferrous metal service center or sales office distributing products including pipes, metal bars, plates, sheets, and nails
423510 001
Coal, other minerals, and ores
423520 001
Electrical and electronic goods
Electrical apparatus and equipment, wiring supplies, and construction materials, including industrial controls
423610 001
Electrical household appliances excluding water heaters
423620 003
Communication equipment and supplies including blank audio and video tapes and other electronic parts and equipment
423690 001
Hardware, and plumbing and heating equipment and supplies
Hardware
423710 001
Plumbing and heating equipment and supplies, i.e. hydronics
423720 004
Warm air heating and air-conditioning equipment and supplies
423730 003
Refrigeration equipment and supplies
423740 001
Machinery, equipment, and supplies
Construction and mining machinery and equipment
423810 004
Farm, lawn, and garden machinery and equipment
423820 001
Other industrial machinery and equipment including food processing machinery and equipment, hydraulic and pneumatic (fluid power)
pumps, motors, and parts
423830 001
Industrial supplies including mechanical power transmission supplies, welding supplies, containers, valves and fittings, except fluid power
423840 603
Service establishment equipment and supplies including beauty, barber, custodial (janitorial), laundry, and dry-cleaning equipment and
supplies
423850 001
Transportation equipment and supplies (except motor vehicle and marine pleasure craft) including aircraft, aeronautical, and marine
machinery equipment and supplies
423860 001
Miscellaneous durable goods
Sporting and recreational goods and supplies
423910 001
Toys and hobby goods and supplies
423920 003
Recyclable material including iron and steel scrap, recyclable paper and paperboard, and other recyclable products
423930 001
Jewelry, watches, diamonds, gemstones, silverware, and other precious metals (except ore)
423940 001
Miscellaneous durable goods including forest products (except lumber), extinguishers, fire safety equipment, musical instruments and
supplies, prerecorded compact discs, audio tapes, phonograph records, luggage, and works of art
423990 001
Paper and paper products
Printing and writing paper
424110 001
Stationery, office supplies, and greeting cards
424120 004
Industrial and personal service paper including paper and plastic eating utensils and dishes, paper napkins and bags, and sanitary paper
products
424130 006
Drugs and druggists' sundries
424210 001
Drugs and druggists' sundries
Apparel, piece goods, and notions
Piece goods, notions, and other dry goods
424310 001
Men's and boys' clothing and furnishings
424320 001
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
16
Women's, children's, and infants' clothing and accessories
424330 001
Footwear
424340 001
Grocery and related products
Warehouse club
452311 101
General-line groceries
424410 001
Packaged frozen food
424420 008
Dairy products excluding dried and canned
424430 001
Poultry and poultry products
424440 001
Confectioneries
424450 003
Fish and seafood
424460 001
Meat and meat products, excluding frozen packaged, canned, and boxed beef
424470 004
Fresh fruits and vegetables
424480 001
Other grocery specialties including coffee, tea, spices, bread, baked goods, soft drinks, bottled water, beverage concentrates, canned foods,
food and beverage basic materials
424490 001
Farm product raw materials
Grain and field beans
424510 001
Livestock
424520 001
Other farm product raw materials including hides, skins, leaf tobacco, wool, and cotton
424590 001
Chemical and allied products
Plastics materials and basic shapes and forms
424610 001
Other chemicals and allied products including industrial gases and excluding liquefied petroleum
424690 001
Petroleum and petroleum products
Bulk stations and terminals including liquefied petroleum, sold for resale
424710 001
Petroleum distributor with no storage capacity
424720 005
Fuel dealer including heating oil and liquefied petroleum gas (except gasoline stations)
454310 001
Gasoline station with convenience store
447110 001
Gasoline station with no convenience store
447190 106
Petroleum futures commodity traders
523130 004
Beer, wine, and distilled alcoholic beverage
Beer and ale
424810 001
Wine and/or distilled alcoholic beverages
424820 001
Miscellaneous nondurable goods
Farm supplies
424910 001
Books, periodicals, newspapers, and other printed materials
424920 001
Flowers, plants, trees, nursery stock, soil, landscaping and florists' supplies (excluding plant bulbs and seeds)
424930 002
Tobacco and tobacco products, including electronic cigarettes
424940 001
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17
Retail paint and wallpaper store or dealer
444120 002
Paints, varnishes, wallpaper, and supplies
424950 004
Miscellaneous nondurable goods including art materials and supplies, textile bags and bagging, yarns, leather products, and wigs
424990 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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18
Item 4B: Type of Operation Additional Information
ITEM 4B: TYPE OF OPERATION
Which ONE of the following best describes this establishment's primary type of operation in 2022?
Merchant wholesaler, buying and selling on own account
12
Importer
13
Exporter
11
Merchant wholesale distributor or jobber
14
Own-brand importer and marketer
20
Manufacturers' sales branch or office
Agent, broker, or commission merchant
46
Manufacturers' representative or agent
41
Auction company
42
Broker, representing buyers and sellers
43
Commission merchant
44
Import agent
45
Export agent
49
Electronic market - business-to-business marketplace that facilitates the sale of goods via the Internet or other electronic
means, and operates on a commission or fee basis
Other type of operation
77
Other type of operation - Describe
Describe
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19
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
%
20
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
A. What were the total sales and operating receipts?
(Include the gross selling value of business conducted for others. Include shipping and handling charges.)
2022
$
,000.00
B. Did this establishment earn commissions for the sale of merchandise?
Yes
No
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
21
Item 5: Sales, Shipments, Receipts, or Revenue - Commissions Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - COMMISSIONS
2022
C. What was the gross selling value of business conducted on a commission basis?
(Include on line A)
$
,000.00
2022
D. What were the total commissions received on transactions reported on line C?
$
,000.00
2022
E. What was this establishment's average commission rate earned for the transactions reported on line C?
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
%
22
Item 5: Sales, Shipments, Receipts, or Revenue - Continued Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE - CONTINUED
F. What percent of products sold by this establishment was manufactured or mined in the United States, Puerto Rico, or other U.S. territories by your company or its subsidiaries?
0%
1-25%
26-49%
50-75%
76-100%
G. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
H. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
I. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
2022
%
23
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
Check
if
None
2022
$
,000.00
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
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24
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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25
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
End of 2021
$
,000.00
26
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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27
Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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28
Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
$
,000.00
C. TOTAL (Add lines A and B)
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29
Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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30
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
$
,000.00
C. Interest paid
$
,000.00
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
$
,000.00
A. Cost of products bought for resale without further processing
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31
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. Excluding the exports reported in Item 5, line I, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
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32
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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33
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following categories best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
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34
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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35
Item 28: Special Items Additional Information
ITEM 28: SPECIAL ITEMS
Employment by Primary Function
A. What was the number of employees reported in Item 7, line A, by the employee's primary function?
Number
1. Selling
2. Sales support - including office, clerical, warehousing, customer service, maintenance employees, and drivers
3. General support of other establishments in your company - including central administrative, accounting, research, and other
support employees
4. Packaging
5. Production - including employees who manufacture products from raw materials or semi-finished products (Report assembly
employees on line 6 below.)
6. Assembly - assembling prefabricated components designed for a single application or reassembly of completed products
7. Other
Describe
8. TOTAL (Add lines 1 through 7)
Storage Space
B. What was the warehouse, stockroom, or other inventory storage space at the end of 2022?
(Include only usable under-roof storage space. Exclude space occupied by interior walls, permanent aisles, elevator
shafts, stairways, offices, shipping platforms, etc.)
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
Check
if
None
Square feet as of
December 31,
2022
36
Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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37
Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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38
Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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39
Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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40
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
1000
characters remaining
41
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-94204_su.pdf Generated 2022-02-25 07:52:24
,000.00
42
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
1
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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Motor vehicle and parts dealers
New motor vehicle dealer
441110 002
Motor vehicle dealer, used
441120 001
Recreational vehicle (RV) dealer, including travel trailers, camping trailers, motor homes, truck campers, etc.
441210 002
Motorcycle, boat, and all other motor vehicle dealers including aircraft, all-terrain vehicles (ATV's), utility trailers, etc.
441220 001
Automotive parts and accessories store, new and/or used
441310 001
Tire dealer, new and/or used
441320 003
Furniture and homefurnishings stores
Furniture store, except custom or used
442110 001
Ceramic tile and/or wood flooring store or dealer
444190 001
Other floor coverings store or dealer including rugs, carpets, vinyl floor coverings, floor tiles, except ceramic, or wood only
442210 005
Home furnishings store including china, glassware, lamps, linens, etc.
442299 008
Building material and garden equipment and supplies dealers
Home improvement center
444110 001
Paint and wallpaper store
444120 004
Hardware store
444130 001
Retail lumber yard
444190 002
Electrical supplies store or dealer including ceiling fan/light fixture store
444190 003
Plumbing equipment and supplies store or dealer
444190 004
Door and window store or dealer including rolling doors, hurricane aluminum shutters, iron grilles, garage doors, etc.
444190 005
Outdoor power equipment store or dealer including lawnmowers, chainsaws, trimmers, etc.
444210 003
Nursery, garden center, or farm supplies store or dealer including feed, seed, grain, and fertilizer
444220 001
Food and beverage stores
Food supermarket
445110 003
Convenience food store
445120 001
Liquor store
445310 001
Meat market
445210 002
Fish (seafood) market
445220 001
Fruit stand, vegetable market (permanent location)
445230 001
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15
Other specialty food stores, including baked goods, confectionery, and nut stores
445290 001
Food services
Full-service restaurant, patrons order through waiter/waitress service and pay after eating
722511 001
Limited-service restaurant (patrons pay before eating), including delivery-only and take-out-only locations
722513 005
Cafeterias, grill buffets, and buffets
722514 002
Snack and nonalcoholic beverage shops serving specialty snacks such as ice cream, doughnuts, bagels, coffee, popcorn, and cookies for
consumption on or near the premises
722515 001
Food service contractors, including airline food service contractors, food concession contractors, and cafeteria food service contractors
722310 005
Caterer for banquets, weddings, conferences, seminars, etc.
722320 002
Bar, tavern, pub, or other drinking place, selling alcoholic beverages for consumption on premises
722410 001
Health and personal care stores
Pharmacy or drug store (except Internet only or mail-order)
446110 001
Cosmetics, beauty supplies, and perfume store
446120 001
Health food, vitamins, and food supplements store
446191 002
Hearing aids, convalescent aids, and medical equipment store
446199 006
Optical goods store including sunglasses (except offices of optometrists)
446130 005
Other health and personal care store
446190 001
Gasoline stations
Gasoline station with convenience store
447110 001
Gasoline station with no convenience store
447190 001
Clothing and clothing accessories stores
Women's clothing store including maternity shop
448120 002
Men's clothing store
448110 001
Children's and infants' clothing store
448130 001
Family clothing store
448140 001
Accessory store including costume jewelry, ties, wigs, hairpieces, etc.
448150 005
Specialized clothing store including women's lingerie, bridal wear, custom printed T-shirts, uniforms, except athletic, etc.
448190 001
Formal wear and costume rental
532281 001
Shoe store
448210 001
Jewelry store
448310 001
Luggage and leather goods store
448320 001
Sporting goods, hobby, book, and music stores
General (full-line) sporting goods store
451110 102
Hobby, toy, and game store
451120 101
Sewing, fabric, and piece goods store including upholstery fabrics
451130 006
Musical instrument and supply store
451140 001
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
16
Book / newsstand / comic book store
451210 001
Electronics stores
443140 001
Department stores, including discount or mass merchandising
452210 001
General merchandise stores, including warehouse clubs and supercenters
452310 001
Miscellaneous store retailers
Florist
453110 001
Office supply, stationery, and school supplies store
453210 005
Gift, novelty, party supply or souvenir store including crafts and greeting cards
453220 005
Used merchandise store including antique, flea market, thrift, etc. (except pawn shop)
453310 001
Pet and pet supplies store
453910 006
Art dealer/gallery
453920 001
Manufactured (mobile) home retailer, new and used
453930 001
Other miscellaneous retailer including tobacco, trophy, religious goods (except books), etc.
453990 001
Nonstore retailers
Electronic shopping, mail-order, and TV shopping
454110 001
Vending machine operator
454210 003
Fuel dealer including heating oil and liquefied petroleum gas (except gasoline stations)
454310 001
Other direct selling establishment including house-to-house, party plan, home delivery newspaper routes, coffee break services, etc.
454390 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
17
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
%
18
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What were the merchandise sales and operating receipts in 2022?
(Exclude sales and other taxes collected. Include shipping and handling charges.)
Check
if
None
2022
$
,000.00
B. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
C. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
D. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
2022
%
19
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
TOTAL (Add lines C1 and C2)
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
20
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
21
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
End of 2021
$
,000.00
22
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
23
Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
24
Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
C. TOTAL (Add lines A and B)
$
,000.00
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
25
Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
26
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
$
,000.00
C. Interest paid
$
,000.00
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
$
,000.00
A. Cost of products bought for resale without further processing
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
27
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. As a general business practice, did this establishment sell to household consumers and individual users in 2022?
Yes
No
B. Were 75% or more of this establishment's sales to retailers/wholesalers/distributors for resale in 2022?
Yes
No
C. Did this establishment require proof of business or professional license from new customers in 2022?
Yes
No
D. Excluding the exports reported in Item 5, line D, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
%
9. Construction contractors
%
10. Federal government
11. Commonwealth or territorial government
%
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
28
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
29
Item 21: Method of Selling
ITEM 21: METHOD OF SELLING
Which ONE of the following categories best describes this establishment's primary method of selling in 2022?
Electronic commerce (selling goods or facilitating the sale of goods via the Internet or other electronic means)
Warehouse or office (including telephone/fax orders or outside sales representatives)
Store or display showroom (selling from a fixed or permanent location with physical displays of priced merchandise and/or from a counter)
Mail order
Home shopping via television
Direct selling (selling in a face-to-face manner away from a fixed location, such as house-to-house, party plan, or temporary kiosk sales)
Vending machines
Other
Describe
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
30
Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
5000025000
1. Retail sales of fresh meat and poultry
5000050000
2. Retail sales of fresh fish and seafood
5000075000
3. Retail sales of fresh fruit and vegetables
5000175000
4. Retail sales of frozen foods
5000100000
5. Retail sales of eggs and dairy, excluding ice cream
5000125000
6. Retail sales of baked goods
7. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and salad bars, and
prepared sandwiches, dishes, and entrees.)
8. Retail sales of candy, prepackaged cookies, and snack foods
5000150000
5000200000
5000250000
9. Retail sales of soft drinks and nonalcoholic beverages
10. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt, nondairy milk, and egg
and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies, pasta, and crackers.)
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
12. Alcoholic beverages, prepared and served or dispensed for immediate consumption
13. Retail sales of bottled, canned, or packaged alcoholic beverages
5000225000
7000025000
7000050000
5000300000
14. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids, and other
smoking supplies
5000325000
15. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements, including medicines used for
infusion services
5001350000
5001350003
a. Retail sales of prescriptions
5001350006
b. Retail sales of nonprescription medicines
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
31
c. Retail sales of vitamins, minerals, and other dietary supplements
5001350009
5001450000
16. Retail sales of cosmetics and fragrances
17. Retail sales of home health care equipment and supplies, including first aid products, prescription accessories, wheelchairs,
mobility assistance appliances, durable medical equipment, orthopedic equipment and appliances (excluding shoes), and orthotics
5001375000
5000775000
18. Retail sales of household cleaning supplies
5000350000
19. Retail sales of men's clothing
5000375000
20. Retail sales of women's clothing
21. Retail sales of men's and women's clothing accessories (Include hats, gloves, neckwear, rain accessories, etc.)
22. Retail sales of new children's wear, including boys', girls', and infants' and toddlers' clothing and accessories, including school
uniforms
5000450000
5000400000
5000475000
23. Retail sales of footwear and footwear accessories
24. Retail sales of fabrics, yarns, and other sewing materials and supplies
25. Retail sales of domestics and other textile home furnishings (except carpet and rugs) (Include furniture coverings, towels, sheets,
blankets, table linens and coverings, etc.)
26. Retail sales of major household appliances and related parts and accessories
5001775000
5000650000
5000700000
5000875000
27. Retail sales of televisions, audio and video equipment
5001875000
28. Retail sales of flooring and floor coverings
29. Retail sales of computers and peripheral equipment, communications equipment, and related products
5001550000
5000680000
30. Retail sales of other home furnishings and accessories
5000500000
31. Retail sales of fine jewelry and watches
5000925000
32. Retail sales of books
33. Retail sales of toys, games, and hobby and craft supplies
5001125000
5001400000
34. Retail sales of glasses and contact lenses
35. Retail sales of other sporting goods and equipment, excluding sport vehicles
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
5001105000
32
5001900000
36. Retail sales of plumbing, electrical, and HVAC supplies
37. Retail sales of hardware, nonpower hand tools, and other building materials and supplies (Include nontreated dimensional lumber,
treated lumber, boards, glue-lam, floor trusses, roof trusses, doors and moulding, windows, skylights, insulation, ladders and
scaffolding, welding supplies, lawn and garden tools, etc.)
5001930000
38. Retail sales of power tools and equipment, including portable electric power tools, power air tools, stationary/bench top power tools,
and accessories (blades, bits, etc.)
5001675000
39. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants (Include powered lawn and garden
tools, outdoor grills, pools, pool chemicals, and pool supplies, and outdoor nursery stock.)
5000805000
5001850000
40. Retail sales of paint and sundries
5001275000
41. Retail sales of automobiles and light-duty trucks
5001725000
42. Retail sales of automotive fuels
5001950000
43. Retail sales of automotive parts and supplies
44. Retail sales of household fuels, including oil, LP gas, wood, coal
5001750000
5001250000
45. Retail sales of pet foods and supplies
46. Retail sales of office and school supplies, packaging and packing materials and supplies, and other general industry and
miscellaneous materials and supplies
47. Retail sales of luggage and leather goods, including briefcases
48. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
5001935000
5001325000
5000860000
Add product/service not listed
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
33
Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Description
Value
Product Code
1. Retail sales of fresh meat and poultry
$
,000.00
5000025000
2. Retail sales of fresh fish and seafood
$
,000.00
5000050000
3. Retail sales of fresh fruit and vegetables
$
,000.00
5000075000
4. Retail sales of frozen foods
$
,000.00
5000175000
5. Retail sales of eggs and dairy, excluding ice cream
$
,000.00
5000100000
6. Retail sales of baked goods
$
,000.00
5000125000
7. Retail sales of perishable prepared foods purchased for future consumption (Include delicatessen items, soup and
salad bars, and prepared sandwiches, dishes, and entrees.)
$
,000.00
5000150000
8. Retail sales of candy, prepackaged cookies, and snack foods
$
,000.00
5000200000
9. Retail sales of soft drinks and nonalcoholic beverages
$
,000.00
5000250000
10. Retail sales of food dry goods and other foods purchased for future consumption, including nondairy yogurt,
nondairy milk, and egg and cheese substitutes (Include flour, sugar, fats and oils, coffee, honey, jams and jellies,
pasta, and crackers.)
$
,000.00
5000225000
11. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
12. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
13. Retail sales of bottled, canned, or packaged alcoholic beverages
$
,000.00
5000300000
14. Retail sales of tobacco products, electronic cigarettes, cannabis/marijuana dried buds, vapor cartridges and liquids,
and other smoking supplies
$
,000.00
5000325000
a. Retail sales of prescriptions
$
,000.00
5001350003
b. Retail sales of nonprescription medicines
$
,000.00
5001350006
15. Retail sales of prescription and nonprescription medicines, vitamins, minerals, and supplements, including
medicines used for infusion services
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
34
c. Retail sales of vitamins, minerals, and other dietary supplements
$
,000.00
5001350009
Subtotal
$
,000.00
5001350000
16. Retail sales of cosmetics and fragrances
$
,000.00
5001450000
17. Retail sales of home health care equipment and supplies, including first aid products, prescription accessories,
wheelchairs, mobility assistance appliances, durable medical equipment, orthopedic equipment and appliances
(excluding shoes), and orthotics
$
,000.00
5001375000
18. Retail sales of household cleaning supplies
$
,000.00
5000775000
19. Retail sales of men's clothing
$
,000.00
5000350000
20. Retail sales of women's clothing
$
,000.00
5000375000
21. Retail sales of men's and women's clothing accessories (Include hats, gloves, neckwear, rain accessories, etc.)
$
,000.00
5000450000
22. Retail sales of new children's wear, including boys', girls', and infants' and toddlers' clothing and accessories,
including school uniforms
$
,000.00
5000400000
23. Retail sales of footwear and footwear accessories
$
,000.00
5000475000
24. Retail sales of fabrics, yarns, and other sewing materials and supplies
$
,000.00
5001775000
25. Retail sales of domestics and other textile home furnishings (except carpet and rugs) (Include furniture coverings,
towels, sheets, blankets, table linens and coverings, etc.)
$
,000.00
5000650000
26. Retail sales of major household appliances and related parts and accessories
$
,000.00
5000700000
27. Retail sales of televisions, audio and video equipment
$
,000.00
5000875000
28. Retail sales of flooring and floor coverings
$
,000.00
5001875000
29. Retail sales of computers and peripheral equipment, communications equipment, and related products
$
,000.00
5001550000
30. Retail sales of other home furnishings and accessories
$
,000.00
5000680000
31. Retail sales of fine jewelry and watches
$
,000.00
5000500000
32. Retail sales of books
$
,000.00
5000925000
33. Retail sales of toys, games, and hobby and craft supplies
$
,000.00
5001125000
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
35
34. Retail sales of glasses and contact lenses
$
,000.00
5001400000
35. Retail sales of other sporting goods and equipment, excluding sport vehicles
$
,000.00
5001105000
36. Retail sales of plumbing, electrical, and HVAC supplies
$
,000.00
5001900000
37. Retail sales of hardware, nonpower hand tools, and other building materials and supplies (Include nontreated
dimensional lumber, treated lumber, boards, glue-lam, floor trusses, roof trusses, doors and moulding, windows,
skylights, insulation, ladders and scaffolding, welding supplies, lawn and garden tools, etc.)
$
,000.00
5001930000
38. Retail sales of power tools and equipment, including portable electric power tools, power air tools, stationary/bench
top power tools, and accessories (blades, bits, etc.)
$
,000.00
5001675000
39. Retail sales of home lawn and garden goods, excluding cut flowers and indoor potted plants (Include powered lawn
and garden tools, outdoor grills, pools, pool chemicals, and pool supplies, and outdoor nursery stock.)
$
,000.00
5000805000
40. Retail sales of paint and sundries
$
,000.00
5001850000
41. Retail sales of automobiles and light-duty trucks
$
,000.00
5001275000
42. Retail sales of automotive fuels
$
,000.00
5001725000
43. Retail sales of automotive parts and supplies
$
,000.00
5001950000
$
,000.00
5001750000
45. Retail sales of pet foods and supplies
$
,000.00
5001250000
46. Retail sales of office and school supplies, packaging and packing materials and supplies, and other general industry
and miscellaneous materials and supplies
$
,000.00
5001935000
47. Retail sales of luggage and leather goods, including briefcases
$
,000.00
5001325000
$
,000.00
5000860000
$
,000.00
9900000000
44. Retail sales of household fuels, including oil, LP gas, wood, coal
48. Retail sales of household goods, not elsewhere classified (Include souvenirs and novelty items.)
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
Add product/service not listed
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
36
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
37
Item 28: Special Items
ITEM 28: SPECIAL ITEMS
Floor Space
Include:
Only the floor space used/controlled by this company.
All space occupied by this establishment on every floor of multi-story buildings.
EXAMPLE: How to compute floor space in square feet
(1) Under-roof selling space is:
200 ft. x 80 ft. = 16,000 sq. ft.
(2) Total under-roof floor space is:
200 ft. x 100 ft. = 20,000 sq. ft.
1. What was the under-roof selling space?
(Enter the square footage of in-store selling space at the end of 2022. Include all store areas open to customers, including aisles,
elevators, etc. Exclude display windows fronting onto streets or walks, outdoor entrance ways, or other outdoor space.)
Square feet as of
December 31,
2022
2. What was the total under-roof floor space?
(Enter the total square footage of all under-roof selling space plus all other space available at the end of 2022. Include dry storage,
refrigerated space, offices, workrooms, display windows, and enclosed entrance ways. Exclude outdoor space, even if covered.)
Shopping Center or Mall
Was this establishment physically located in a shopping center or mall?
Yes
No
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
38
Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
39
Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
40
Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
41
Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
42
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
1000
characters remaining
43
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-94404_su.pdf Generated 2022-02-23 17:34:28
,000.00
44
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
1
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
14
Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Publishing
Newspaper publisher except Internet-exclusive publisher
511110 001
Periodical publisher and shopping news publisher except Internet-exclusive publisher
511120 001
Book publisher, atlas/map publisher except Internet-exclusive publisher
511130 001
Database and directory publisher except Internet-exclusive publisher
511140 001
Software publisher
511210 005
Other publishers except Internet-exclusive publishers
511190 001
Internet-exclusive publishers including newspapers, books, periodicals, greeting cards, databases, etc.
519130 002
Motion pictures and sound industries
Producer of motion pictures, television programs, or other videos, including commercials, infomercials, and music videos (except
independent production)
512110 008
Motion picture, television film, and video distribution (without production)
512120 006
Motion picture theater and drive-in
512130 001
Postproduction and other services for film and video production and distribution
512190 001
Sound recording studio, including independent establishments recording musical performances, but not engaged in production or distribution
512240 001
Broadcasting
Radio broadcasting
515110 001
Television broadcasting
515120 001
Cable and other subscription programming
515210 001
Internet publishing and broadcasting, web search portals, publishing exclusively on the Internet
519130 001
Telecommunications
Wired and wireless telecommunications carriers, including cable distribution, Internet service providers, and cellular telecommunications.
517310 001
Satellite telecommunications
517410 001
Other telecommunications services
517919 902
Other information services
Data processing, hosting, and related services (except software publishing)
518210 001
News syndicates supplying the news media with information such as news, reports, and pictures
519110 001
Libraries and archives
519120 001
Other information services
519190 002
Professional, scientific, and technical services
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
15
Offices of lawyers
541110 001
All other legal services
541190 001
Accounting services including auditing, tax preparation, payroll, etc.
541210 001
Architectural services, excluding landscape
541310 001
Landscape architectural services
541320 001
Engineering services
541330 007
Drafting services
541340 004
Home or building inspection services
541350 001
Geophysical surveying and mapping services
541360 001
Surveying and mapping services excluding geophysical
541370 008
Testing laboratories, excluding medical and veterinary
541380 004
Interior design services and consulting
541410 005
Industrial design services and consulting
541420 003
Graphic design and commercial art services
541430 003
Fashion design and other specialized design services
541490 003
Computer systems design and related services, including custom computer programming services, computer systems integrators, computer
systems consultants, and computer facilities management services
541510 001
Management consulting services
541610 001
Environmental consulting services excluding engineering
541620 003
Other scientific or technical consulting services
541690 001
Research and development in physical, engineering, and life sciences
541710 001
Research and development in the social sciences and humanities
541720 001
Advertising agencies
541810 002
Public relations agency
541820 001
Media buying services - purchasing advertising time or space and reselling
541830 001
Radio, television, or publishers' advertising representatives independent of media owners
541840 001
Display advertising
541850 004
Direct mail advertising
541860 003
Advertising material direct distribution
541870 002
Welcoming services, advertising distribution, sign shops, and other advertising related services
541890 001
Marketing research and public opinion polling
541910 003
Photographic services including portrait and commercial
541920 001
Translation and interpretation services including sign language
541930 003
Veterinary services including veterinary testing laboratories
541940 003
All other professional, scientific, and technical services excluding real estate
541990 001
Management of companies and enterprises
Corporate, subsidiary, and regional managing offices and offices of bank and other holding companies
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
551110 001
16
Administrative and support services
Office administrative services
561110 003
Facilities support services
561210 003
Employment services
Temporary help support services
561320 002
Employment placement office (agency)
561311 001
Professional employer organizations, including employee leasing services
561330 001
Business support services including document preparation services, telephone call centers, telemarketing bureaus, etc.
Document preparation services
561410 002
Telephone answering services
561421 001
Business service centers including copy and private mail centers
561430 001
Collection agencies
561440 001
Credit bureaus
561450 001
Other business support services including court reporting or stenotype
561490 001
Travel arrangement and reservation services
Travel agency
561510 001
Tour operator - assembling tour packages and selling directly to travelers or through other travel agencies
561520 001
Other travel arrangement and reservation services
561590 001
Investigation and security services
Investigation, guard, and armored car services
561610 001
Security system services including locksmiths
561620 001
Cleaning services, excluding carwash
Exterminating and pest control services, except agricultural
561710 001
Janitorial services
561720 001
Landscaping services including lawn, garden, ornamental shrub, and tree services
561730 004
Carpet, rug, and upholstery cleaning services
561740 001
Other specialized cleaning services including ventilation; drain, gutter and duct cleaning; and swimming pool cleaning and maintenance
services
561790 001
Other support services to businesses or organizations
Packaging and labeling services (i.e., apparel folding and packaging, shrink wrapping), excluding aerosol packaging
561910 001
Convention and trade show organizers or management services
561920 001
All other support services to businesses or organizations
561990 001
Waste management and remediation services
Waste collection
562110 001
Waste treatment or disposal
562210 001
Remediation services including remediation or cleaning up of contaminated sites, asbestos abatement, and lead paint removal
562910 001
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17
Materials recovery facilities
562920 002
All other waste management services including cesspool and septic tank cleaning as well as portable toilet rental
562990 001
Educational services
Business and secretarial schools, e.g., clerical, secretarial, or court reporting
611410 001
Computer training services, excluding computer repair training
611420 003
Professional and management development training
611430 001
Technical or vocational schools for learning a trade (plumbing, electrical, barber, etc.)
611510 001
Fine art schools including dance, art, drama, and music
611610 001
Sports and recreation instruction
611620 004
Language schools
611630 002
All other schools and instruction including tutoring and automobile driving schools
611690 001
Educational consulting and other educational support services
611710 001
Offices of health practitioners
Office of physician(s) (M.D. or D.O.)
621110 001
Office of dentist(s)
621210 002
Chiropractor(s)
621310 001
Optometrist(s)
621320 003
Mental health practitioner(s) excluding physicians
621330 005
Physical, occupational, or speech therapist or audiologist
621340 001
Other health practitioners
621390 001
Outpatient care facilities and medical and diagnostic laboratories
Family planning centers
621410 003
Outpatient mental health and substance abuse treatment clinics
621420 006
Medical laboratories and diagnostic imaging centers
621510 001
Home and ambulatory health services
Home health care providers
621610 006
Ambulance or emergency rescue services, air or ground
621910 003
All other ambulatory health care services
621990 001
Hospitals
General medical and surgical hospitals
622110 001
Psychiatric and substance abuse hospitals
622210 001
Specialty (except psychiatric and substance abuse) hospitals
622310 001
Nursing and residential care facility
Nursing care facilities (skilled nursing facilities)
623110 005
Residential intellectual and developmental disability facility
623210 005
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Residential mental health and substance abuse facility
623220 006
Continuing care retirement communities and assisted living facilities for the elderly without onsite nursing care
623310 001
Other residential care facilities of social or personal assistance including homes for children, orphanages, etc.
623990 006
Social services to individuals and families
Child and youth services (except scouting and related youth development organizations)
624110 00B
Services for the elderly and persons with disabilities
624120 00D
Other individual and family services including alcoholism and drug addiction self-help organizations, hotline centers, community health
education and social work case management services for families or individuals
624190 00O
Social services to the community
Community food services
624210 006
Community housing services including temporary shelters
624220 001
Emergency and other relief services
624230 003
Vocational rehabilitation services
624310 007
Child care services
624410 007
Artistic, sports, and other related services
Theater companies and dinner theaters
711110 001
Dance companies engaged in producing all types of live theatrical dance (e.g., ballet, contemporary dance, folk dance) presentations
711120 001
Musical groups and artists
711130 001
Other performing arts companies
711190 001
Sports teams or clubs, racetracks, trainers, racing stables, and individual sports professionals
711210 001
Promoters with facilities, live performing arts productions (except popular music)
711310 101
Promoters without facilities, live performing arts productions (except popular music)
711320 101
Agents or managers for artists, performers, individual sports professionals, authors, speakers, and other public figures
711410 002
Independent artists, writers, and performers
711510 008
Museums, historical sites, and similar institutions
Museums
712110 003
Zoos, aquariums, and other live animal exhibits (e.g., wild animal or safari parks, petting zoos, etc.)
712130 101
Nature parks and other similar natural wonder tourist attractions
712190 004
Amusement, gambling, and recreation industries
Amusement and theme parks, including water or kiddie parks
713110 001
Arcade and family fun centers
713120 002
Casinos (gambling) without guestrooms for lodging
713210 004
Other gambling services or games, including slot machine operators, lotteries, off-track betting, and other betting operation (excluding
casinos or hotels with casinos)
713290 001
Golf courses and country clubs
713910 002
Marinas, yacht clubs, or boat docks
713930 003
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19
Fitness center, gymnasium, or athletic club
713940 001
Bowling center
713950 001
Other amusement attractions including billiard parlors, mini golf, etc.
713990 001
Repairs and maintenance of automobiles, machinery, and equipment
General or specialized motor vehicle mechanical and electrical repair and maintenance
811110 001
Motor vehicle body, paint, interior, and glass repair and maintenance
811120 001
Other motor vehicle care and maintenance including oil change and lubrication, air conditioning repair, carwash, rustproofing services, etc.
811190 001
Electronic and precision equipment repair and maintenance
811210 001
Commercial and industrial machinery repair, including construction, farm, and material handling equipment repair
811310 001
Home and garden equipment and appliance repair and maintenance
811410 001
Furniture repair, refinishing, and reupholstery
811420 001
Footwear, luggage, handbag, briefcase and leather goods repair
811430 001
Other personal and household goods repair and maintenance
811490 001
Personal services
Beauty shops, barber shops, unisex hair shops, facial salons, or nail salons
812110 001
Other personal care services including weight loss centers, massage salons, permanent make-up clinics
812190 001
Funeral homes and funeral services
812210 001
Cemeteries or crematories
812220 004
Coin operated laundries and drycleaners
812310 001
Drycleaning and laundry services (except coin-operated)
812320 001
Laundry services in combination with linen or uniform rental services
812331 002
Pet care excluding veterinary services
812910 001
Photofinishing
812920 001
Parking lots or garages
812930 004
Other personal services including bail bonding, dating services, wedding planning, etc.
812990 001
Religious, grantmaking, civic, professional, and similar organizations
Religious organizations
813110 002
Philanthropic trusts, fundraising organizations, or grantmaking foundations
813210 001
Social advocacy organizations promoting a specific social or political cause, including human rights organizations, environment and
conservation advocacy, and peace advocacy organizations
813311 001
Civic, social, or fraternal organizations
813410 002
Business associations
813910 002
Professional organizations
813920 002
Labor unions or similar labor organizations
813930 001
Property owners' associations, including tenants' and condominium associations
813990 001
Other primary business or activity
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
20
Private households employing cooks, maids, housekeepers, nannies, gardeners, etc.
814110 001
Other primary business or activity
779000 001
Select Sector
Describe
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
21
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
%
22
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
2022
$
A. What were the operating receipts of this establishment in 2022?
,000.00
B. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
C. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
D. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
2022
%
23
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
Check
if
None
2022
$
,000.00
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
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24
Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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25
Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
End of 2021
$
,000.00
26
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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27
Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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28
Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
$
,000.00
C. TOTAL (Add lines A and B)
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29
Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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30
Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
$
,000.00
C. Interest paid
$
,000.00
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
$
,000.00
A. Cost of products bought for resale without further processing
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31
Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line D, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
32
Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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33
Item 28: Special Items
ITEM 28: SPECIAL ITEMS
Support Services
Was this establishment primarily engaged in providing management, administrative, or support services to other establishments of the same company (rather than for the general public or
other business firms) in 2022?
Yes
No
Merchandise Sold
Did the sale of merchandise account for more than half of the total receipts of this establishment in 2022?
Yes - Describe merchandise sold
Describe
No
Shopping Center or Mall
Was this establishment physically located in a shopping center or mall?
Yes
No
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34
Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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35
Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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36
Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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37
Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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38
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
1000
characters remaining
39
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-95104_su.pdf Generated 2022-02-23 17:39:06
,000.00
40
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
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1
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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
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3
Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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4
Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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5
Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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6
Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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7
Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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8
Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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9
Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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10
Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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11
Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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12
Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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13
Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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14
Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Depository credit intermediation
Commercial Banking
522110 001
Saving institution, remedial loan society or mutual benefit association accepting deposits
522120 001
Credit Union
522130 001
Finance companies, consumer credit, and credit card issuance
Bank primarily issuing credit cards, or personal credit card issuance by personal credit institution or nondepository credit institution
522210 001
Sales finance including automotive, commercial and inventory finance (except trade finance), and insurance premium finance
522220 001
Consumer (personal) finance or small loan company, including nondepository industrial bank or Morris Plan, pawn shop, federally-sponsored
credit agency, mortgage banker, mortgage company, or loan correspondent, international trade credit loan, finance company or other
nondepository credit intermediation
522290 002
Loan or mortgage broker or agent
522310 003
Reserve and clearinghouse activities including automated teller machine (ATM) or automated loan machine (ALM) network, electronic funds
transfer network, electronic payment service, and credit card processing service
522320 001
Check cashing agency, money order or traveler's check issuance, loan/mortgage loan servicing, or credit related services
522390 003
Investment banking, dealing, and brokerage
Investment banking and securities dealing
523110 001
Securities brokerage (full service and discount)
523120 003
Commodity brokerage
523140 001
Securities or commodities exchange
523210 003
Trading/dealing (except securities and commodities), oil royalty trader (investing on own account), venture capital company, investment club,
or other investor for own account
523910 001
Asset/portfolio manager
523920 002
Investment advice
523930 004
Other financial investment activities
523990 001
Insurance carriers and related activities
Life, accident, health, and medical insurance carrier
524110 001
Insurance carrier excluding life, accident and health, and medical
524120 001
Reinsurance carrier including life, accident and health, property and casualty, surety, fidelity and liability, title or other reinsurance carrier
524130 005
Insurance agent or broker, not owned or operated by any insurance carrier, including risk finance consulting
524210 007
Insurance claims adjusting, appraiser, third party administrator of workers' compensation or other self insurance, pension, health, or welfare
fund, insurance advisory services, insurance rate making organization, or other insurance services
524290 001
Lessor of real estate (property owned by you)
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15
Lessor of residential real estate
531110 002
Lessor of nonresidential buildings including office/professional buildings, industrial buildings, shopping centers and retail stores, except
miniwarehouses
531120 001
Lessor of self-service storage or miniwarehouses
531130 001
Lessor of other real estate property including manufactured or mobile home sites and vacant lots
531190 001
Real estate agent or broker including time share sales
531210 001
Property manager including residential and nonresidential, resort/vacation, and time share
531310 001
Real estate appraiser
531320 001
Real estate listing or auction service, escrow or fiduciary agent, real estate consultant, or other real estate related service
531390 007
Consumer goods rental or leasing
Renting or leasing without drivers and on a short term basis: passenger cars, passenger vans, and sport utility vehicles
532110 001
Renting or leasing without drivers and on a short term basis: trucks including nonpassenger vans, truck tractors, truck trailers, semi trailers,
and storage semi trailers
532120 001
Consumer electronics and appliances rental
532210 001
General rental center - wide range of consumer items and equipment
532310 002
Other consumer goods rental, including formal wear and costume rental, video rental store, home health equipment rental, and recreational
goods rental
532280 001
Commercial and industrial machinery and equipment rental and leasing
Construction, transportation, mining, and forestry machinery and equipment rental and leasing
532410 001
Office furniture and machines including computers and computer peripheral equipment rental and leasing
532420 001
Medical machinery and equipment, traffic equipment including barricades, cones and signage, motion picture equipment, theatrical
equipment or other nonconsumer type machinery or equipment rental and leasing
532490 001
Intangible assets (except copyrighted works) leasing or licensing
Franchise, trademarks, and patents leasing/licensing (except copyrighted works)
533110 001
Other primary business or activity
779000 001
Other primary business or activity
Select Sector
Describe
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16
General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-95204_su.pdf Generated 2022-02-23 17:43:00
%
17
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Check
if
None
2022
$
A. What was the revenue for this establishment in 2022?
,000.00
B. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
C. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
D. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
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2022
%
18
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
Check
if
None
2022
$
,000.00
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
$
,000.00
TOTAL (Add lines C1 and C2)
$
,000.00
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Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
2022_IA-95204_su.pdf Generated 2022-02-23 17:43:00
End of 2021
$
,000.00
21
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
$
,000.00
C. TOTAL (Add lines A and B)
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Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
$
,000.00
C. Interest paid
$
,000.00
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
$
,000.00
A. Cost of products bought for resale without further processing
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line D, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
%
3. Retailers for resale
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
9. Construction contractors
%
10. Federal government
%
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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32
Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
2022_IA-95204_su.pdf Generated 2022-02-23 17:43:00
1000
characters remaining
33
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
2022_IA-95204_su.pdf Generated 2022-02-23 17:43:00
,000.00
34
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.
MAILING ADDRESS
ATTN
Name 1
Store/Plant
Name 2
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
PHYSICAL LOCATION
Please provide information on the establishment’s physical location. The physical location is where business is conducted or where services or industrial operations are performed, as
opposed to the establishment’s mailing address. P.O. Boxes are not physical locations.
In which village is this establishment physically located?
Village
Select Village
Please describe this establishment’s physical location, such as number and name of street (if applicable), nearby landmarks, etc.
For Census Bureau Use Only
CFN
2022_IA-97204_su.pdf Generated 2022-02-23 17:46:57
1
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2
Item 1: Employer Identification Number
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) used on this establishment's latest 2022 Internal Revenue Service Form 941-SS, Employer's Quarterly Federal Tax Return or Form 944-SS,
Employer's Annual Federal Tax Return?
Yes
No
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Item 1: Employer Identification Number - Enter/Update EIN
ITEM 1: EMPLOYER IDENTIFICATION NUMBER
What is this establishment’s 9-digit Employer Identification Number (EIN) used on its latest 2022 Internal Revenue Service Form 941-SS, Employer’s Quarterly Federal Tax Return or
Form 944-SS, Employer's Annual Federal Tax Return?
EIN
99-9999999
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Item 2A: Ownership or Control
ITEM 2A: OWNERSHIP OR CONTROL
Is your company owned or controlled by another domestic company?
Yes
No
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Item 2B: Ownership or Control - Voting Stock Validation
ITEM 2B: OWNERSHIP OR CONTROL - VOTING STOCK VALIDATION
Does another domestic company own more than 50 percent of the voting stock of your company?
Yes
No
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Item 2C: Ownership or Control - Management and Policy
ITEM 2C: OWNERSHIP OR CONTROL - MANAGEMENT AND POLICY
Does another domestic company have the power to control the management and policies of your company?
Yes
No
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Item 2D: Ownership or Control - Percent of Voting Stock Held
ITEM 2D: OWNERSHIP OR CONTROL - PERCENT OF VOTING STOCK HELD
What percent of voting stock was held by the owning or controlling company?
Less than 50%
50%
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Item 2E: Ownership or Control - Company Information
ITEM 2E: OWNERSHIP OR CONTROL - COMPANY INFORMATION
What is the name, address, and 9-digit Employer Identification Number (EIN) of the owning or controlling company?
Name of owning or controlling company
Home office address (Number and street)
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
EIN
99-9999999
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Item 2F: Number of Establishments
ITEM 2F: NUMBER OF ESTABLISHMENTS
2022
How many establishments operated under EIN at the end of 2022?
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Item 3A: Operational Status
ITEM 3A: OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2022?
In operation
Temporarily or seasonally inactive
Ceased operation
Sold or leased to another operator
Other
Describe
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Item 3A: Operational Status - Ceased Operation Date
ITEM 3A: OPERATIONAL STATUS - CEASED OPERATION DATE
What was the date this establishment ceased operation?
MMDDYYYY
MMDDYYYY
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Item 3A: Operational Status - New Owner or Operator Information
ITEM 3A: OPERATIONAL STATUS - NEW OWNER OR OPERATOR INFORMATION
What date was this establishment sold or leased to a new owner or operator?
MMDDYYYY
MMDDYYYY
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.
ZIP Code
State
Select State or Territory
99999-9999
EIN
99-9999999
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Item 3B: Months in Operation
ITEM 3B: MONTHS IN OPERATION
2022
What was the number of months in operation during 2022?
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Item 4: Primary Business or Activity Additional Information
ITEM 4: PRIMARY BUSINESS OR ACTIVITY
Which ONE of the following best describes this establishment's primary kind of business or activity in 2022?
If none of the provided options seem appropriate, please select Other primary business or activity and enter a description that most closely matches the establishment's primary
business or activity.
Select only ONE.
Hotel with casino
721120 002
Hotel (except with casino), motel, or motor hotel
721110 002
Other traveler accommodation including tourist villa, or parador
721190 001
Travel trailer park, recreational vehicle park, or campground except residential
721211 003
Recreation or vacation camp (except campground)
721214 004
Rooming and boarding house including lodging house operated by membership organization
721310 001
Apartment building operator
531110 001
Property owners' associations, including tenants' and condominium associations
813990 001
Bar or restaurant operated by social or fraternal organization for members
813410 001
Bar, tavern, pub, or other drinking place, selling alcoholic beverages for consumption on premises
722410 001
Full-service restaurant, patrons order through waiter/waitress service and pay after eating
722511 001
Fast food restaurant
722513 002
Cafeterias, grill buffets, and buffets
722514 002
Snack and nonalcoholic beverage shops serving specialty snacks such as ice cream, doughnuts, bagels, coffee, popcorn, and cookies for
consumption on or near the premises
722515 001
Food service contractors
722310 006
Caterer for banquets, weddings, conferences, seminars, etc.
722320 002
Mobile food service, including ice cream, snacks, sandwiches, and meals distributed from motorized vehicles or nonmotorized carts
722330 002
Other primary business or activity
779000 001
Select Sector
Describe
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General Reporting Guidelines
GENERAL REPORTING GUIDELINES
Reporting Period
Responses should cover calendar year 2022.
If your fiscal year covers at least 10 months of calendar year 2022, you may report by fiscal year on all items EXCEPT payroll.
Calendar year figures for payroll may be available from:
IRS Form 941-SS (Employer’s Quarterly Federal Tax Return)
IRS Form 944-SS (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.
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
2022
$
EXAMPLE - if a dollar figure is $2,036,355.25, report 2036:
How to Report Percents:
Percents should be rounded to whole percents.
2036
,000.00
EXAMPLE - DO NOT ENTER DATA
2022
39
EXAMPLE - if figure is 38.76% of total sales, report 39:
2022_IA-97204_su.pdf Generated 2022-02-23 17:46:57
%
16
Item 5: Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 5: SALES, SHIPMENTS, RECEIPTS, OR REVENUE
A. What were the merchandise sales and operating receipts in 2022?
(Exclude sales and other taxes collected. Include shipping and handling charges.)
Check
if
None
2022
$
,000.00
B. Were any of the sales, shipments, receipts, or revenue reported in line A a result of e-commerce transactions?
(E-commerce includes sales, commissions, rent, or fees collected from any transactions completed online. Transactions are agreements between buyers and sellers to transfer
ownership of, or rights to use, goods or services. Payment for these goods or services may or may not be made online.)
E-commerce transactions include:
Electronic Data Interchange (EDI)
E-mail
Internet
Extranet
Other online systems
Yes
No
Check
if
None
2022
C. What was the percent of total sales, shipments, receipts, or revenue reported in line A that were a result of e-commerce
transactions?
%
Check
if
None
D. What is the percent of total sales, shipments, receipts, or revenue reported in line A that were generated from exports?
(Include all exports to foreign countries, the United States, and other U.S. territories)
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2022
%
17
Item 7: Employment and Payroll Additional Information
ITEM 7: EMPLOYMENT AND PAYROLL
Include full- and part-time employees working at this establishment (including employees working from home) whose payroll was reported on Internal Revenue Service (IRS) Form 941SS, Employer's Quarterly Federal Tax Return, or Form 944-SS, Employer's Annual Federal Tax Return, and filed under the Employer Identification Number (EIN) in Item 1. For further
clarification, see Additional Information.
A. Number of Paid Employees
Check
if
None
2022 Number
1. What was the number of paid employees for the pay period including March 12, 2022?
B. Payroll Before Deductions
(Exclude employer's cost for fringe benefits)
Check
if
None
1. What was the annual payroll for 2022 before deductions?
2. What was the first quarter payroll (January-March, 2022)?
2022
$
,000.00
$
,000.00
C. Employer's Annual Cost for Fringe Benefits
1. What were the legally required fringe benefits?
(Include employer payments for Social Security, Medicare, unemployment compensation, workmen's
compensation, and State disability programs, if required.)
2. What were the voluntarily provided fringe benefits?
(Include such items as payments for life insurance, medical insurance, pensions, welfare benefits, and unionnegotiated benefits.)
TOTAL (Add lines C1 and C2)
2022_IA-97204_su.pdf Generated 2022-02-23 17:46:57
Check
if
None
2022
$
,000.00
$
,000.00
$
,000.00
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Item 9: Value of Inventories Additional Information
ITEM 9: VALUE OF INVENTORIES
A. Did this establishment own inventories, regardless of where held, at the end of 2022 and/or 2021?
Yes
No
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Item 9: Value of Inventories - Continued Additional Information
ITEM 9: VALUE OF INVENTORIES
Check
if
None
B. What was the total value of inventories owned by this
establishment?
Check
if
None
End of 2022
$
,000.00
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End of 2021
$
,000.00
20
Item 12A: Legal Form of Organization
ITEM 12A: LEGAL FORM OF ORGANIZATION
A. What legal form of organization best describes this establishment at the end of 2022?
Individual (sole) proprietorship
Partnership
Cooperative organization
Corporation
Other
Describe
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Item 12B: Legal Form of Organization - Corporation Type
ITEM 12B: LEGAL FORM OF ORGANIZATION - CORPORATION TYPE
B. Which of the following is this type of corporation?
Private (nonprofit)
Private (for-profit)
Public
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Item 13: Capital Expenditures Additional Information
ITEM 13: CAPITAL EXPENDITURES
What were the capital expenditures in 2022 for the following?
(Report the dollar value of capital expenditures including value of acquisitions under capital leases. Include capitalized repairs and improvements that increased the value of the building
or equipment or adapted it for a different use. Do not include costs of routine maintenance and repairs. Do not include rental payments made under operating leases.)
Check
if
None
2022
A. Buildings and structures, including building and leasehold improvements
(Exclude land.)
$
,000.00
B. Machinery and equipment
(Include vehicles.)
$
,000.00
C. TOTAL (Add lines A and B)
$
,000.00
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Item 14: Rental Payments Additional Information
ITEM 14: RENTAL PAYMENTS
What were the total costs for rental or lease of the following?
(Exclude capital leases, i.e., leases with a contract to own at the end of the lease)
Check
if
None
2022
$
,000.00
$
,000.00
A. Machinery, equipment, and other items, excluding computer software
B. Land, buildings, structures, store space, and offices
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Item 16: Selected Expenses Additional Information
ITEM 16: SELECTED EXPENSES
What were the operating expenses paid by this establishment in 2022 for the following?
Check
if
None
2022
$
,000.00
B. All other operating expenses
(Include payroll, benefits, utilities, office supplies, communication services, computer services, and routine maintenance
and repair. Exclude cost of products bought for resale, interest, depreciation, bad debt, and capital expenditures as
reported in Item 13.)
$
,000.00
C. Interest paid
$
,000.00
$
,000.00
A. Cost of products bought for resale without further processing
D. Depreciation charges
(Include depreciation charges in 2022 for buildings, structures, and leasehold improvements, equipment and machinery
that your company owns or acquired under a capital lease agreement.)
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Item 20: Class of Customer Additional Information
ITEM 20: CLASS OF CUSTOMER
A. Excluding the exports reported in Item 5, line D, what was the estimated percentage of this establishment's total sales (reported in Item 5, line A) by class of customer?
2022
1. Household consumers and individuals
(Exclude visiting tourists)
%
2. Visiting tourists
(Include business travelers)
%
3. Retailers for resale
%
4. Wholesalers/distributors for resale
%
5. Manufacturing and mining industrial users for use as input goods in production
%
6. Hotels, restaurants, food services, and drinking places
%
7. Other services not included above
(Include banks, insurance, real estate, travel agencies and other passenger transportation services, and other service
establishments including truck and passenger car rental and leasing)
%
8. Businesses for end use in their own operation, not for resale or production
%
%
9. Construction contractors
%
10. Federal government
11. Commonwealth or territorial government
%
12. Local government
(Include county, town, village, and municipio)
%
13. Other - Describe
%
Describe
%
14. TOTAL (Sum of lines 1 through 13 should equal 100%)
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue Additional Information
ITEM 22: DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Of the $,000.00 of Sales, Shipments, Receipts, or Revenue reported in Item 5, what products and services were included?
Select ALL that apply.
Description
Select
Product Code
7003825000
1. Room or unit accommodation for travelers
7002375000
2. Gambling machine products
7002450000
3. Lotteries
7002400000
4. Pari-mutuel sports gambling
7002350000
5. Table wagering games
7006550000
6. Hosting of coin-operated self-service gambling machines
7. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate consumption
8. Alcoholic beverages, prepared and served or dispensed for immediate consumption
9. Rental of space for meetings, conventions, and similar short-term business uses
10. Rental of space for weddings, banquets, parties, and similar short-term social uses
11. Retail sales of bottled, canned, or packaged alcoholic beverages
7000025000
7000050000
7006425000
7006475000
5000300000
Add product/service not listed
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Item 22: Detail of Sales, Shipments, Receipts, or Revenue - Continued Additional Information
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 for each product or service?
Description
Value
Product Code
1. Room or unit accommodation for travelers
$
,000.00
7003825000
2. Gambling machine products
$
,000.00
7002375000
3. Lotteries
$
,000.00
7002450000
4. Pari-mutuel sports gambling
$
,000.00
7002400000
5. Table wagering games
$
,000.00
7002350000
6. Hosting of coin-operated self-service gambling machines
$
,000.00
7006550000
7. Meals, snacks, other food items, and nonalcoholic beverages, prepared and served or dispensed, for immediate
consumption
$
,000.00
7000025000
8. Alcoholic beverages, prepared and served or dispensed for immediate consumption
$
,000.00
7000050000
9. Rental of space for meetings, conventions, and similar short-term business uses
$
,000.00
7006425000
10. Rental of space for weddings, banquets, parties, and similar short-term social uses
$
,000.00
7006475000
11. Retail sales of bottled, canned, or packaged alcoholic beverages
$
,000.00
5000300000
TOTAL - Sum of lines should equal total Sales, Shipments, Receipts, or Revenue reported in Item 5
$
,000.00
9900000000
Add product/service not listed
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Item 25: Franchise
ITEM 25: FRANCHISE
A. Was this establishment operating under any trademark(s) or brand name(s) authorized by a franchisor in 2022?
Yes - franchisee-owned establishment
Yes - franchisor-owned establishment
No
B. If yes, what was the trademark(s) or brand name(s) operated under?
Describe
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Item 28: Special Items
Number and Type of Accommodations
A. What was the number of rooms, units, or quarters primarily rented as transient as of December 31, 2022?
(Consists of the number which can be rented as single units. Suites of rooms which cannot be subdivided should be counted as a
single unit.)
Number as of
December 31,
2022
B. Were more than half of guestroom or unit rental receipts from transient guests?
Yes
No
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Item 30A: Majority Ownership - Ethnicity
ITEM 30A: MAJORITY OWNERSHIP - ETHNICITY
Is the majority ownership of this establishment of Hispanic, Latino, or Spanish origin?
(Select only ONE)
No, not of Hispanic, Latino, or Spanish origin
Yes, Puerto Rican
Yes, Mexican, Mexican American, Chicano
Yes, another Hispanic, Latino, or Spanish origin - Describe origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.
Describe
Not known / not determinable, such as publicly traded
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Item 30B: Majority Ownership - Race
ITEM 30B: MAJORITY OWNERSHIP - RACE
B. What is the race of the majority ownership of this establishment?
(Select ALL that apply)
White
Black or African American
American Indian or Alaska Native - Describe name of enrolled or principal tribe
Describe
Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - Describe race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Describe
Other Pacific Islander - Describe race, for example, Fijian, Tongan, etc.
Describe
Some other race - Describe race
Describe
Not known / not determinable, such as publicly traded
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Item 30C: Majority Ownership - Citizenship
ITEM 30C: MAJORITY OWNERSHIP - CITIZENSHIP
C. What is the citizenship of the majority ownership of this establishment?
(Select only ONE)
Born in this territory
Born in the United States or another U.S. territory or commonwealth
Naturalized citizen
Not known / not determinable, such as publicly traded
Not a U.S. citizen or national
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Item 30D: Majority Ownership - Gender
ITEM 30D: MAJORITY OWNERSHIP - GENDER
D. What is the gender of majority ownership of this establishment?
(Select only ONE)
Male-owned
Female-owned
50/50 Male/Female - Equal percent of ownership
Not known/not determinable (such as publicly traded)
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Item 31: Remarks
ITEM 31: REMARKS
Please use this space for any explanations that may be essential in understanding your reported data. (Maximum length is 1,000 characters.)
You have
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1000
characters remaining
35
Item 32: Establishment Information
ITEM 32: ESTABLISHMENT INFORMATION
Name
Secondary Name
Store/Plant
Number and Street
Village
State
Select Village
Select State or Territory
ZIP Code
99999-9999
Describe kind of business at this location
2022
What is the number of rooms in this hotel, motel, or other lodging facility?
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.
2022
What was the number of employees for pay period including March 12?
2022
$
What was the annual payroll?
,000.00
2022
$
What was the first quarter payroll (January - March 2022)?
,000.00
2022
$
What were the sales, shipments, receipts, or revenue?
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,000.00
36
| File Type | application/pdf |
| Author | Blynda K Metcalf (CENSUS/EWD FED) |
| File Modified | 2022-03-01 |
| File Created | 2022-03-01 |