Form Ma 3000 – Fill Out and Use This PDF

DUE DATE:

Report by mail:

U.S. CENSUS BUREAU

1201 East 10th Street

Jeffersonville, IN 47132-0001

OR

Report electronically:

econhelp.census.gov/ufo

User ID:

Password:

Need help or have questions about completing this form?

Call: (301) 763-1779

Please correct errors in name, address, and ZIP code. ENTER street and number if not shown.

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YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations that receive this form to answer the questions and return the report to the U.S. Census Bureau. By the same law, YOUR U.S. CENSUS BUREAU REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality of U.S. Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents’ files are immune from legal process.

Name of person to be contacted regarding this report (Please print or type)	Title

Area Code

Number

Extension

Area Code

Number

Telephone

Fax

IMPORTANT - Please read the instructions included with this form, then complete the survey below.

CHANGE IN OPERATIONAL STATUS

Provide company name (sold or acquired), address, and EIN (if applicable) below.

➤

Ceased operations

Sold to another company

Period covered by data (if other than calendar year)

–Provide company name (sold or acquired), address, and

EIN (if applicable) at right

2012

2011

Acquired another company

Month

Day

Year

Month

Day

Year

FROM

FROM

– Provide company name and address at right

DATE OF OPERATIONAL

TO

Month

Day

Year

TO

Month

Day

Year

STATUS CHANGE:

U.S. Annual Sales

Unfilled Orders

U.S. Annual Sales

Unfilled Orders

Line

Selected Major Manufacturing Activities

2012

(Order Backlog) as

2011

(Order Backlog) as

No.

(See Instructions)

(in thousands

of Dec. 31, 2012

(in thousands

of Dec. 31, 2011

of dollars)

(in thousands

of dollars)

(in thousands

of dollars)

of dollars)

(a)

(b)

(c)

(d)

(e)

1

2

3

4

Please continue on the reverse side for additional manufacturing activities and/or remarks.

30003016

2

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		Selected Major Manufacturing Activities	U.S. Annual Sales	Unfilled Orders		U.S. Annual Sales	Unfilled Orders
Line			2012	(Order Backlog) as		2011	(Order Backlog) as
No.		(See Instructions)	(in thousands	of Dec. 31, 2012		(in thousands	of Dec. 31, 2011
			of dollars)	(in thousands		of dollars)	(in thousands
				of dollars)			of dollars)
		(a)	(b)	(c)		(d)	(e)
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Remarks

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

Signature of authorized person	Date

BURDEN HOUR ESTIMATE: Public reporting burden for this collection is estimated to vary from 15 minutes to 1 hour per response, with an average of 35 minutes per response including the time for reviewing instructions, searching existing data sources, gathering and maintain- ing the data needed, and completing and reviewing the collection of information. Response to this collection of information is not required unless it displays a valid approval number from the Office of Management and Budget (OMB). The eight-digit OMB Number appears in the upper right corner of this report form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Paperwork Project, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may email comments to Paperwork@census.gov; use "Paperwork Project 0607-0561" as the subject.

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