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pdfLocation 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
Please update the mailing address if needed.
ATTN
Name 1
Name 2
Store/Plant Number
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?
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
Other primary business or activity
(Describe and click the “Save and Continue” button to search.)
Select Sector
779000 001
Describe primary business or activity
You selected:
9-character Code:
6-digit NAICS:
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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 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
EXAMPLE - if a dollar figure is "0" (or less than $500.00), check the None box:
2022
$
,000.00
How to Report Percents:
Percents should be rounded to whole percents. 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 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
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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
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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 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)?
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2022
$
,000.00
$
,000.00
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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 - 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.
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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
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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 those 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
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| File Type | application/pdf |
| File Modified | 2023-02-14 |
| File Created | 2022-12-14 |