Form As-56290 - 2012 Economic Census Classification Form

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2012 ECONOMIC CENSUS
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
Classification Form
FORM
AS-56290
OMB No. 0607-0934: Approval Expires 12/31/2013
(11-16-2011)
(Please correct any errors in this mailing address.)
DUE DATE
30 DAYS AFTER
RECEIPT OF FORM
Need help or have questions?
AS-56290
• Visit econhelp.census.gov
• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.
U.S. CENSUS BUREAU
Report Online - It's fast and secure!
Mail your
- OR -
completed
1201 East 10th Street
Go to:
econhelp.census.gov
form to:
Jeffersonville, IN 47134-0001
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.
•
Please center numbers in
Examples:
their respective boxes.
•
Do not use pencil or felt-tip pen.
•
Place an "X" inside the box.
•
Do not put slashes through 0 or 7.
The reporting unit for this form is an establishment. An establishment is generally a single physical location where
business is conducted or where services or industrial operations are performed.
1
Not Applicable.
2
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.)
Yes - Go to line B
0031
Number and street
0035
No - Enter
0032
physical
location
City, town, village, etc.
State
ZIP Code
0036
0037
0038
-
CONTINUE WITH
ON PAGE 2
2
PENALTY FOR FAILURE TO REPORT
CONTINUE ON PAGE 2

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