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OMB No. 0607-0907 Approval Expires 08/31/2015 U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU QUARTERLY SERVICES SURVEY FORM QSS-4E First Quarter 2015 10-18-2012 Due Date Need help or have questions Call 1-800-772-7851 8 30 a.m. - 5 00 p.m. ET M-F 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 statis.

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