Survey JAN Self-Employment Interview

SELF EMPLOYMENT OMB Control No. 1225-0059

NO changes made in this document

Section II. Outreach

1. How did you know to contact the Self Employment service?

(ALL THAT APPLY); [Interviewers FIELD CODE into the following categories]

a. Used JAN service before

b. Previous user of JAN service (specify if another employer)

c. JAN Website

d. Other website (not JAN website)

e. Internet search

f. Referral from:

Organization (list) ________________________

Government Agency (list) __________________

Company

DOL Call Center

EARN

JAN Self-employment

g. Friend/co-worker/word of mouth

h. Personal contact with JAN staff member

i. Rehabilitation professional

j. Medical professional

k. Educational institution

l. Union

m. Legal professional

n. Newspaper/magazine/book/professional journal article

o. Television (report or advertisement)

p. Listed in a directory

q. I&R Service

r. Conference

s. JAN Publication or Brochure

t. JAN presentation

u. Used JAN self-employment service before

v. Previous user ofJAN self-employment service

w. Self-employmentWebsite

x. Self-employment Publication or Brochure

y. Other (please specify): _____________________________________________________

2. Before you contacted the Self-employment service, what did you expect the Self-employment service to provide to you?

(Record response verbatim. Query for additional information so that sufficient detail to code into one or more of the following categories.)

a. Information on starting a small business

1. developing a business concept

2. market research

3. writing a business plan

4. obtaining capital

5. loan guarantees

b. Managing a Business

1. technical assistance resources

2. growing a business

3. personnel management

4. financial management

5. developing a marketing plan

c. Disability Issues

1. Social Security

2. PASS plans

3. health care

4. working at home

d. Other. Please specify:________________________________________________

Section III. Self-employment Interaction Outcomes

1. Self-Employment Information:

Where are you now in the process of self-employment?

[Interviewers to read information in parentheses only if asked] SELECT ONLY ONE RESPONSE

a. [Are you] Considering the idea of self-employment

b. Planning stages (Writing the business plan, exploring opportunities and ways agencies and organizations can help with a variety of issues in the planning process)

c. Initial start up stages (Submitting the business plan, organizing work incentive options, approval from VR or other micro enterprise or funding source, licensing, zoning and tax issues in place)

d. Near operation (Funding and operation is in place and business is about to open its doors)

e. Business established

f. Business expansion

5. Hiring other employees

6. DK

7. RF

2. Did the information you received from the Self-employment service help you to get in touch with local resources?

1. Yes (If Yes, Continue to question 3)

2. No (Go to Section IV)

3. DK (Go to Section IV)

4. RF (Go to Section IV)

3. Which of the following resources did you contact based on your consultation with the Self-employment service (YES/NO to each)

1. Financing, economic development, and/or microenterprise programs Yes No

2. Business planning and technical assistance organizations (includes business incubators, nonprofit organizations, local business development offices, community development offices, women’s business councils etc.) Yes No

3. State vocational rehabilitation (VR) program (includes programs providing small business development assistance within VR) Yes No

4. Small Business Administration (SBA) office (includes Small Business Development Centers, Women’s Business Centers, Service Corps of Retired Executives (SCORE) or other affiliated programs) Yes No

5. Veteran’s Business Development programs (includes SBA Veteran’s programs, Dept. of Veteran’s Affairs) Yes No

6. Social Security Administration and related programs (includes organizations that provide information on work incentive and benefits counseling) Yes No

7. Federal government business resources (includes IRS, Department of Commerce, Dept. of Housing and Urban Development) Yes No

8. Credit or personal financial counseling services Yes No

9. Health Insurance resources Yes No

10. Other __________________________________________________________

Section V. Self-employment Web site

A. User Satisfaction - Ease of Use

1. Have you visited the Self Employment Service website within the last year? [Interviewers may respond that the website is at http://www.jan.wvu.edu/sbses if asked]

1. YES [Go to Q 3]

2. NO [Skip to Section VI.]

3. DK [Skip to Section VI.]

4. RF [Skip to Section VI.]

2. On a scale from 1 to 5 with 1 being difficult and 5 easy, how was the website to navigate?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)

[If response = "1", query "So, the website was difficult to navigate?"]

3. On the same scale, how was it for you to obtain the information that you needed from the website?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)

[If response = "1", query "So, it was difficult for you to get the information that you needed from the website?"]

4. Using the same scale from 1 to 5, how was it for you to find information to contact relevant resources?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)

[If response = "1", query "So, it was difficult for you to find information to contact relevant resources?]

5. What did you hope to find on the website?

__________________________________________________________________________

6. Did you find it? __ Yes __No

If No, Please explain.

Section VI. General User Satisfaction

The last few questions are more general. Please tell me...

[In this section, interviewers will record comments that are provided but will not query for comments.]

1. On a scale from 1 to 5, with 1 being difficult to use and 5 as easy, how easy or difficult was it to contact the Self Employment service?

1 2 3 4 5 8. DK 9. RF

(difficult) (easy)

[If response = "1", query "So, it was difficult for you to contact the Small Business & Self Employment service?"]

Spontaneous Comments: ____________________________________________________________

2. On a scale of 1 to 5 with 1 being “not courteously” and 5 being “courteously,” how were you treated by the receptionist?

1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)

[If response = "1", query "So, the receptionist was not courteous?"

Spontaneous Comments: ____________________________________________________________

3. On that same scale, how were you treated by the consultant?

1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)

[If response = "1", query "So, the consultant was not courteous?"]

Spontaneous Comments: ____________________________________________________________

4. On a scale from 1 to 5 with 1 being "not understand" and 5 being "understood", how well did the consultant understand your needs?

1 2 3 4 5 8 = DK 9 = RF

(not understand) (understood)

[If response = "1", query "So, the consultant did not understand your needs?"]

Spontaneous Comments: ____________________________________________________________

5. On a scale from 1 to 5, with 1 being “did not meet my needs at all” and 5 being “met my needs exceptionally well”, how well did the information that you received meet your needs?

1 2 3 4 5 8. DK 9. RF

(not at all) (exceptionally well)

[If response = "1", query "So, the information you received did not meet your needs at all?"]

6. How could the services you received have better met your needs.

7. Would you use the service again, if you needed information?

a. Yes b. No 8 = DK 9 = RF

8. Where would you get this type of information if the Self Employment service did not exist?

9. Have you referred other people to the Self Employment service?

a. Yes

b. No

10. On a scale from 1 to 5, with 1 being "very unlikely to refer" and 5 being "very likely to refer", how likely would you be to refer other people to the Small Business and Self Employment service?

1 2 3 4 5 8. DK 9. RF

Very unlikely Very likely

11. We would appreciate any comments or suggestions that you may have about the Self Employment service.

Thank you for your participation.

Self Employment 6