Form NC-99023 2012 Economic Census - General Classification Report

Attachment A
NC-99023 (draft)
Page 1 of 8

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

General Classification Report

FORM

NC-99023

OMB No. : Approval Expires

(DRAFT)

DUE DATE
30 DAYS AFTER
RECEIPT OF FORM

NC-99023

Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
Need help or have questions
about filling out this form?
Visit our Web site at
www.census.gov/econhelp
Call 1-800-233-6136, between
8:00 a.m. and 6:00 p.m., Eastern
time, Monday through Friday.
- OR Write to the address above.
Include your 11-digit Census File
Number (CFN) printed in the
mailing address.

(Please correct any errors in this mailing address.)

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations
that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau. By the same
law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality
of Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents'
files are immune from legal process.
• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Place an "X" inside the box.
1

• Please center numbers in their respective boxes.
• Do not put slashes through 0 or 7.

Examples:

0 1 2 3 4 5 6 7 8 9

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. box and rural route addresses are not physical locations.)
0031

0032

Yes - Go to line B
No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

-

99023012

B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0044

Do not know

C. In what type of municipality is this establishment physically located? (Mark "X" only ONE box.)
0229

City, village, or borough

PENALTY FOR FAILURE TO REPORT

USCENSUSBUREAU

0230

Town or township

0231

Other

0232

Do not know

CONTINUE ON PAGE 2

Attachment A
NC-99023 (draft)
Page 2 of 8
Form NC-99023
2

Page 2

(DRAFT)

PRINCIPAL BUSINESS OR ACTIVITY
In the past 12 months, what was this establishment's principal business or activity? (Find the Economic Sector
that best describes your business or activity. Within that sector, mark "X" only ONE box that best describes your
PRINCIPAL business or activity.)

0700

99023020

HEALTH CARE AND SOCIAL ASSISTANCE

ACCOMMODATIONS

624 410 00 1

Child Day Care Service

721 191 00 1

Bed-and-Breakfast Inn

621 410 00 1

Family Planning Center

721 120 00 1

Casino Hotel

621 493 00 1

Freestanding Ambulatory Surgical or
Emergency Center

721 110 00 1

Hotel, Motel, or Motor Hotel, except
Casino Hotel

621 610 00 1

Home Health Care Service

721 214 00 1

Overnight Recreation or Vacation Camp,
except Campground

621 310 00 1

Office of Chiropractor

721 310 00 1

Rooming and Boarding House

621 210 00 1

Office of Dentist

721 211 00 1

Trailer Park, RV (Recreational Vehicle)
Park, or Campground, except Residential

621 330 00 1

Office of Mental Health Practitioner, except
Physician

721 000 00 2

Other Traveler Accommodation - Specify

621 320 00 1

Office of Optometrist

621 340 20 1

Office of Physical, Occupational and Speech
Therapist, and Audiologist

FOOD SERVICES

621 111 00 1

Office of Physician (MD or DO), except Mental
Health

722 213 40 1

Bagel Shop

621 112 00 1

Office of Physician (MD or DO), Mental Health

722 410 00 1

Bar, Tavern, Pub, or Other Drinking Place
(Alcoholic Beverages)

621 391 00 1

Office of Podiatrist

722 212 00 1

Buffet, Grill Buffet, or Cafeteria

621 420 00 1

Outpatient Mental Health or Substance Abuse
Center

722 213 50 1

Coffee Shop

623 210 00 1

Residential Care for Developmentally Disabled

722 213 60 1

Cookie Shop

623 312 00 1

Residential Care for Elderly

722 213 30 1

Donut Shop

623 990 00 1

Residential Care for Youth or Offenders

722 310 00 1

Food Service Contractor

624 110 00 1

Social Assistance for Children and Youth

722 213 20 1

Frozen Yogurt Shop

624 120 00 1

Social Assistance for Elderly and Disabled

722 110 00 1

Full-Service Restaurant (Waiter/Waitress
Service; Pay After Eating)

624 190 00 1

Social Assistance for Families and All Others

722 213 10 1

Ice Cream Shop

620 000 00 7

Other Health Care and Social Assistance Specify

722 211 00 1

Limited-Service Restaurant (Pay Before
Eating; including Delivery-Only Locations)

722 320 00 1

Social Caterer for Banquets, Weddings, etc.

722 000 00 2

Other Food Service - Specify

CONTINUE ON PAGE 3

Attachment A
NC-99023 (draft)
Page 3 of 8
Form NC-99023

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2

PRINCIPAL BUSINESS OR ACTIVITY - Continued

0700

REPAIR AND MAINTENANCE SERVICES
811 412 00 1

Appliance (Household) Repair and
Maintenance

811 122 00 1

Automotive Glass Replacement Shop

811 191 00 1

541 219 00 1

Accounting and Bookkeeping Service,
except CPA

541 611 00 1

Administrative and General Management
Consulting Service

Automotive Oil Change and Lubrication Shop

541 810 00 1

Advertising Agency

811 113 00 1

Automotive Transmission Repair Shop

541 310 00 1

Architectural Service

811 192 00 1

Carwash

541 211 00 1

Certified Public Accountant (CPA)

811 310 90 1

Commercial and Industrial Equipment Repair
Shop

541 512 20 1

Computer Systems Consultant

811 212 30 1

Computer Repair and Maintenance

541 511 00 1

Custom Computer Programming Service

811 490 40 1

Garment Repair and Alteration Service

541 330 00 1

Engineering Service

811 111 00 1

General Automotive Repair Shop

541 620 00 1

Environmental Consulting Service

811 121 10 1

Paint or Body Repair Shop

541 430 00 1

Graphic Design Service

811 420 00 1

Reupholstery and Furniture Repair Shop

541 410 00 1

Interior Design Service

811 000 00 5

Other Repair and Maintenance Service - Specify

541 320 00 1

Landscape Architectural Service

541 110 10 1

Law Office

541 613 00 1

Marketing Consulting Service

541 910 00 1

Marketing Research or Public Opinion
Polling Service

ADMINISTRATIVE AND SUPPORT SERVICES

99023038

PROFESSIONAL, SCIENTIFIC, AND TECHNICAL SERVICES

561 740 00 1

Carpet and Upholstery Cleaning Service

561 310 00 1

Employment Placement Agency

541 921 00 1

Photographic Studio, Portrait

561 710 00 1

Exterminating and Pest Control Service

541 820 00 1

Public Relations Agency

561 611 00 1

Investigation Service

541 370 00 1

Surveying or Mapping Service, except
Geophysical

561 720 00 1

Janitorial Service

541 213 00 1

Tax Return Preparation Service

561 730 00 1

Landscape Service

541 191 00 1

Title Abstract and Settlement Office

561 439 00 2

Photocopying and Duplicating Service

541 940 00 1

Veterinarian's Office

561 990 90 1

Printing Broker

541 000 00 7

Other - Specify

561 330 00 1

Professional Employer Organization (PEO)

561 621 00 1

Security Systems Service

561 790 20 1

Swimming Pool Cleaning and Maintenance

561 320 00 1

Temporary Help Service

561 000 00 4

Other Administrative and Support Service - Specify

CONTINUE ON PAGE 4

Attachment A
NC-99023 (draft)
Page 4 of 8
Form NC-99023
2

Page 4

(DRAFT)

PRINCIPAL BUSINESS OR ACTIVITY - Continued

0700

99023046

OTHER SERVICES

TRANSPORTATION

711 510 00 1

Actor/Actress, Artist, Writer, or Performer,
except Musicians

484 220 20 1

Agricultural Products Trucking, Local

711 130 00 1

Musical Group or Artist

484 230 20 1

Agricultural Products Trucking, Long Distance

713 120 00 1

Arcade or Family Fun Center

488 119 00 1

Airport Operation and Terminal Service

812 111 00 1

Barber Shop

621 910 00 1

Ambulance or Rescue Service, except Air

812 112 00 1

Beauty Shop

488 510 20 1

Arrangement of Transportation of Freight/Cargo

813 910 00 1

Business Trade Association

492 110 20 1

Courier Service, Air

813 410 40 1

Civic or Social Club, except Scouting Organization

492 110 10 1

Courier Service, except Air or Local

812 310 20 1

Coin-Operated Laundry and Drycleaning

484 220 30 1

Dump Trucking

611 610 10 1

Dance School

488 510 10 1

Freight Forwarding

812 320 20 1

Drycleaning Plant

484 110 20 1

General Freight Trucking, LTL, Local, Without
Storage

813 312 00 1

Environment, Conservation, and Wildlife
Organization

484 122 00 1

General Freight Trucking, LTL, Long Distance

611 691 00 1

Exam Preparation and Tutoring Service

484 110 10 1

General Freight Trucking, TL, Local, Without
Storage

713 940 90 1

Fitness Center or Gymnasium

484 121 00 1

General Freight Trucking, TL, Long Distance

713 910 00 1

Golf Course or Country Club

493 110 00 1

General Warehousing and Storage

813 211 00 1

Grantmaking Foundation

562 112 00 1

Hazardous Waste Collection

512 110 00 1

Motion Picture or Video Production

485 320 00 1

Limousine Service

812 113 00 1

Nail Salon

492 210 00 1

Local Messenger and Local Delivery

812 910 00 1

Pet Care Services, except Veterinary

485 410 00 1

School Bus Service

813 940 00 1

Political Organization

562 111 00 1

Solid Waste Collection, Nonhazardous

711 310 00 1

Promoters of Performing Arts, Sports, and
Similar Events With Facilities

485 991 00 1

Special Needs Transportation

711 320 20 1

Promoters of Performing Arts, Sports, and
Similar Events Without Facilities

484 220 40 1

Specialized Freight (except Waste), Local,
Without Storage

813 990 40 1

Property Owners' Association

484 230 30 1

Specialized Freight (including Waste),
Long Distance

511 210 00 1

Software Publishing

485 310 00 1

Taxicab Service

611 620 00 1

Sports and Recreation Instruction

488 410 00 1

Towing Service, Motor Vehicle

711 110 20 1

Theater Company

561 510 00 1

Travel Agency

813 212 00 1

Voluntary Health Organization

484 210 10 1

Used Household and Office Goods Moving,
Local, Without Storage

777 812 02 2

Other Service - Specify

484 210 20 1

Used Household and Office Goods
Moving, Long Distance

485 999 20 1

Other Transportation - Specify

CONTINUE ON PAGE 5

Attachment A
NC-99023 (draft)
Page 5 of 8
Form NC-99023

Page 5

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2

PRINCIPAL BUSINESS OR ACTIVITY - Continued

0700

99023053

RETAIL TRADE

RETAIL TRADE - Continued

453 310 10 1

Antique Store

453 220 00 1

Gift, Novelty, Craft, and Souvenir Store

453 920 00 1

Art Dealer or Art Auction

444 130 00 1

Hardware Store

441 310 40 1

Automotive Parts and Accessories Store,
except Used

443 111 00 1

Household Appliance Store

441 310 50 1

Automotive Parts and Accessories Store, Used

442 299 00 1

Houseware and Kitchenware Store

445 310 00 1

Beer, Wine, and Liquor Store

448 310 00 1

Jewelry Store

451 110 21 1

Bicycle Shop

454 113 22 1

Mail-Order Pharmacy

441 110 00 1

Car Dealer, New and Used

454 113 10 1

Mail-Order Shopping, General Merchandise

441 120 00 1

Car Dealer, Used Only

454 113 21 1

Mail-Order Shopping, Computer
Hardware and/or Software

453 991 00 1

Cigarette, Pipe, and Tobacco Store

454 113 23 1

Mail-Order Shopping, Specialized Merchandise

448 150 00 1

Clothing Accessories Store

445 210 00 1

Meat Market

448 140 00 1

Clothing Store, Family

444 220 40 1

Nursery and Garden Center

448 110 00 1

Clothing Store, Men's

453 210 00 1

Office Supplies and Stationery Store

448 120 00 1

Clothing Store, Women's

446 130 00 1

Optical Goods Store

443 120 30 1

Computer Software Store

444 210 00 1

Outdoor Power Equipment Store

443 120 10 1

Computer Store, Custom Assembly

453 910 00 1

Pet and Pet Supplies Store

443 120 20 1

Computer Store, except Custom Assembly

446 110 10 1

Pharmacy and Drug Store

445 120 00 1

Convenience Food Store

443 112 40 1

Radio, TV, and Other Electronics Store

446 120 00 1

Cosmetics, Beauty Supplies, and Perfume Store

453 310 20 1

Second-Hand Store, except Pawn Shop

454 111 21 1

Electronic Shopping, Computer Hardware and/or
Software

451 130 00 1

Sewing, Needlework, and Piece Goods
Store

454 111 10 1

Electronic Shopping, General Merchandise

445 110 00 1

Supermarket or Grocery Store

454 111 22 1

Electronic Shopping, Pharmacy

443 112 20 1

Telephone Store

454 111 23 1

Electronic Shopping, Specialized Merchandise

441 320 00 1

Tire Dealer

444 220 20 1

Farm Supply Store

447 190 20 1

Truck Stop

442 210 00 1

Floor Coverings Store

452 990 10 1

Variety Store

453 110 00 1

Florist

454 210 00 1

Vending Machine Operator

446 191 00 1

Food (Health) Supplement Store

442 291 00 1

Window Treatment Store, except Custom

442 110 10 1

Furniture Store

448 210 20 1

Women's Shoe Store

447 190 10 1

Gasoline Station Without Convenience Store

772 000 00 1

Other Retail Business - Specify

451 110 10 1

General-Line Sporting Goods Store
CONTINUE ON PAGE 6

Attachment A
NC-99023 (draft)
Page 6 of 8
Form NC-99023
2
0700

Page 6

(DRAFT)

PRINCIPAL BUSINESS OR ACTIVITY - Continued
WHOLESALE TRADE
(Mark "X" only ONE box in part 1 and ONE box in part 2.)

REAL ESTATE AND RENTAL AND LEASING

1. Kind of Business or Activity

532 411 90 1

Aircraft Rental and Leasing Without Pilot

423 430 12 1

Computers and Peripheral Equipment, Sold
for End Use

532 111 00 1

Car (Passenger) Rental Without Driver

423 430 11 1

Computers and Peripheral Equipment, Sold
for Resale

238 910 00 2

Construction Equipment, except Crane,
Rental With Operator

423 610 00 1

Electrical Apparatus and Equipment

238 990 00 2

Crane Rental With Operator

424 210 10 1

General Line Drugs, Cosmetics, and Toiletries

532 220 00 1

Formal Wear Rental

423 210 10 1

Household and Outdoor Furniture

532 310 00 1

General Rental Center

423 940 10 1

Jewelry, Watches, and Gemstones

532 291 00 1

Home Health Equipment Rental

424 320 00 1

Men's and Boys' Clothing and Furnishings

532 490 20 1

Industrial Equipment Rental and Leasing

424 210 20 1

Specialty-Line Drugs, Cosmetics, and Toiletries

531 110 10 1

Lessor of Apartment Buildings

423 910 00 1

Sporting and Recreational Goods and Supplies

531 120 20 1

Lessor of Manufacturing and Industrial Buildings

423 450 10 1

Medical, Dental, Hospital Equipment/Supplies

531 120 90 1

Lessor of Other Nonresidential Buildings

424 330 00 1

Women's, Children's, and Infants' Clothing and
Accessories

531 110 90 1

Lessor of Other Residential Buildings

771 000 00 1

Other Wholesale Trade - Specify

531 120 10 1

Lessor of Professional and Other Office Buildings

531 120 30 1

Lessor of Shopping Centers and Retail Stores

532 490 10 1

Medical Equipment Rental and Leasing

0600

2. Type of Operation

99023061

0601

11

Merchant Wholesaler

532 420 10 1

Office Furniture and Machines, except
Computer Rental and Leasing

42

Broker, Representing Buyers and Sellers

532 412 90 1

Oilfield and Well Drilling Equipment Rental
and Leasing

46

Manufacturers' Agent

531 312 00 1

Property Management, Nonresidential Real Estate

49

Electronic Marketer

531 311 00 1

Property Management, Residential Real Estate

77

Other Type of Operation - Specify

531 210 90 1

Real Estate Agent or Broker, Nonresidential

531 210 10 1

Real Estate Agent or Broker, Residential

531 320 00 1

Real Estate Appraiser

532 292 00 1

Recreational Goods Rental

531 130 00 1

Self-Storage and Mini-Warehousing

532 120 20 1

Truck Leasing Without Driver

532 120 10 1

Truck Rental Without Driver

532 230 00 1

Video Tape and Disc Rental

777 530 00 3

Other Real Estate and Rental and Leasing Specify

CONTINUE ON PAGE 7

Attachment A
NC-99023 (draft)
Page 7 of 8
Form NC-99023

Page 7

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
2

PRINCIPAL BUSINESS OR ACTIVITY - Continued

0700

MANUFACTURING
323 110 00 1

Commercial Lithographic Printing

238 350 00 1

Carpentry Finishing Contractor

323 113 00 1

Commercial Screen Printing

238 130 00 1

Carpentry Framing Contractor

323 115 00 1

Digital Printing

238 110 00 1

Concrete Contractor, except Paving and Precast

332 710 00 1

Machine Shop

238 990 00 1

Paving Contractor, except Highways,
Bridges, and Airport Runways

323 114 00 1

Quick Printing

238 120 00 1

Structural Steel and Precast Concrete
Contractor

339 950 00 1

Sign Manufacturing

238 310 00 1

Drywall or Insulation Contractor

337 110 00 1

Wood Kitchen Cabinet or Counter Top
Manufacturing

238 210 00 1

Electrical Contractor

339 990 00 1

Other Manufacturing - Specify

238 910 00 1

Excavation Contractor, except Highways
and Bridges

238 330 00 1

Flooring Contractor

238 150 00 1

Glass, Glazing, and Tinting Contractor

238 140 00 1

Masonry, Stone Setting, and Other Stone
Work Contractor

238 390 00 1

Modular Furniture, Window Fixtures,
and Trade Show Exhibits Installation
Contractor

RESIDENTIAL AND NONRESIDENTIAL BUILDING
CONSTRUCTION
236 220 00 1

Commerical and Institutional Building
Construction

236 210 00 1

Industrial Building Construction

236 117 00 1

New Single-Family and Multifamily Housing
Construction (Built On Land You Own Or
Control, For Sale)

238 190 00 1

Ornamental Metal Work Installation

236 115 00 1

New Single-Family Housing Construction (Built
On Land Customer Owns)

238 320 00 1

Painting and Wall Covering Contractor

236 116 00 1

New Multifamily Housing Construction (Built
On Land Customer Owns)

238 220 00 1

Plumbing, Heating, and Air-Conditioning
Contractor

236 118 00 1

Residental Remodelers (Single-Family and
Multifamily)

238 160 00 1

Roofing Contractor

236 000 00 1

Other Building Construction - Specify

238 390 00 2

Sheet Metal Contractor, except HVAC,
Roofing, and Siding

238 170 00 1

Siding Contractor, including Gutters and
Downspouts

238 340 00 1

Tile, Marble, Terrazzo, and Mosaic Contractor

238 000 00 1

Other Specialty Trade Contractor - Specify

HEAVY AND CIVIL ENGINEERING CONSTRUCTION

99023079

SPECIALTY TRADE CONTRACTORS

237 310 00 1

Highway, Street, Bridge, and Airport Runway
Construction, including Traffic Line Painting

237 210 00 1

Land Subdivision of Lots for Sale to Builders

237 120 00 1

Oil and Gas Pipelines, Mains, and Related
Structures Construction

237 130 00 1

Power and Communication Transmission Line
and Related Structures Construction

237 110 00 1

Water and Sewer Lines, Mains, and Related
Structures, including Water Well Drilling

237 000 00 1

Other Heavy Construction - Specify

CONTINUE ON PAGE 8

Attachment A
NC-99023 (draft)
Page 8 of 8
Form NC-99023
2
0700

3

Page 8

(DRAFT)

PRINCIPAL BUSINESS OR ACTIVITY
FINANCE AND INSURANCE

FINANCE AND INSURANCE - Continued

523 991 00 1

Administrator of Private Estate

523 991 00 2

Trustees in Bankruptcy

525 920 00 1

Trust or Estate

520 000 00 1

Other Finance and Insurance - Specify

524 210 00 1

Insurance Agency and Brokerage

524 291 00 1

Insurance Claims Adjusting

OTHER

523 930 00 1

Investment Advice, Without Portfolio
Management

814 110 00 1

Private Household (Employing Domestic
Help, e.g., Cooks, Maids, Gardeners, etc.)

522 310 00 1

Mortgage and Other Loan Brokers

813 110 00 1

Churches and Other Religious Organizations

523 920 00 1

Portfolio Management

113 310 00 1

Logging

523 120 00 1

Securities Brokerage

773 000 00 2

Other Business or Activity - Specify

524 292 00 1

Third-Party Administration of Insurance Funds

524 292 00 2

Third-Party Administration of Pension, Health, and Welfare Funds

CLASS OF CUSTOMER
A. Was a box marked under Retail Trade or Wholesale Trade headings in
0284

Yes - Go to line B

0285

No - Go to

2

?

4

B. As a general business practice, did this establishment sell to household consumers and individual users in the past
12 months?
0251

Yes - Go to line C

0252

No - Go to line D

C. Were 10 percent or more of your sales to household consumers and individual users in the past 12 months?
0288

Yes

0289

No

D. Were 75 percent or more of this establishment's sales to retailers or wholesalers for resale in the past 12 months?
0256

Yes

0257

No

E. Did this establishment require proof of business or professional license from new customers in the past 12 months?
0276

4

Yes

0277

No

DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Report sales for the principal merchandise lines sold, type of construction work done, products produced, or services
provided by this establishment as a whole percent of the total dollar volume of business (e.g., gasoline 85%, auto
repairs 10%, oil 5%) in the past 12 months.
Description of sales, shipments, receipts, or revenue

99023087

0723

Whole percent
of sales and
receipts in the
past 12 months

0720

0722

1.

19811

%

2.

19812

%

3.

19813

%

4.

29811

%

5. TOTAL
5

Census
use

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 0 0 %

CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.
0072

Name of person to contact regarding this report

Area code
Telephone
0074

Number

-

Extension