Community survey business survey cover letter and questi

NOAA Fisheries
Northwest Fisheries Science Center
2725 Montlake Blvd East
Seattle, WA 98112

Mr. John Doe
Acme Grocers
123 Oceanside Drive
Newport, OR 97365

Dear Mr. Doe,
Last week I sent you a letter inviting Acme Grocers to participate in a community economic
survey being conducted by NOAA Fisheries. This letter contains the survey questionnaire,
which will take about 45 minutes to complete. After completing the survey questionnaire, please
place it in the enclosed self-addressed stamped envelope and deposit the envelope in the mail.
This survey is being conducted in eight coastal communities, including Newport. This survey
will include collection of data from households, businesses, and visitors to the community. Data
collected through this survey will enable the NOAA Fisheries to better estimate the impact of the
fishing industry on coastal community economies and estimate the community economic impact
of fishery management policies.
I hope you choose to participate in this voluntary survey. By collecting information from
businesses such as yours, we can better understand the role of fisheries in coastal economies and
the economic impact of fishery management policies. Data collected through this survey will be
held confidential under the provisions of Exemption 4 of the Freedom of Information Act.
Thank you for your consideration.

Sincerely,

Carl Lian
Economist
NOAA Fisheries
[email protected]
(206)-302-2414

WEST COAST COMMUNITY BUSINESS SURVEY
NOAA Fisheries – Northwest Fisheries Science Center
Please provide the following information about the person completing this
questionnaire:
Name:________________________________________________________________
Title/Position:__________________________________________________________
Address:______________________________________________________________
Phone: _____________________________ Email:____________________________
I. Business Characteristics and Ownership
1. Please provide the following information about this business.
Name of Business
Business Address (Street, City,
State, Zip Code)
Business Telephone Number
If know, please provide the NAICS
or SIC code of this business.
What are the primary goods or
services that your business sells?

2. Please provide the most recent assessed value of the capital associated with this business.
a. Buildings
$___________
b. Industrial Equipment
$___________
c. Office equipment/Computers
$___________
d. Vehicles
$___________
e. Other__________________________
$___________
What year was the most recent assessment? ____________ (year)

II. Expenditure Data
3. Please provide the number of full and part time employees you employed in 2006.
a. Full Time Employees (25+ hours/week)
___________(employees)
b. Part Time Employees (Less than 25 hours/week)
___________(employees)
4. Please provide the total wages paid to employees in 2006.
a. Total wages paid in 2006

CONFIDENTIAL
NOAA Fisheries – Northwest
Fisheries Science Center

$___________

OMB Control #xxxx-xxxx expires xx/xx/xx. Notwithstanding any other provisions of the law; no person is required
to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information
subject to the requirement of the Paperwork Reduction Act, unless that collection of information displays a currently
valid OMB Control Number. Public reporting burden for this survey is estimated to average 45 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden, to Carl Lian,
NWFSC FRAM, 2725 Montlake Blvd. E, Seattle, WA 98112-2097

West Coast Community Business Survey

5. Please provide the following information about amount and location of non-labor related expenditures in
2006. The sum of the Total Expenditure column should equal your total non-labor related expenditures.
Amount or %
Amount or
Amount or %
Amount or
Input
Total
purchased
in
%
purchased
Amount
or
%
purchased
%
Expenditure
the city this
business is
located

Wholesale
Merchandise
Wholesale Inputs or
Ingredients
Solid Waste
Electricity
Water
Sewer
Packing Materials
Shipping Expenses
Financial Services
and Insurance
Maintenance or
Repairs
State property taxes
State income taxes
State sales taxes
Local property taxes
Local sales taxes
Local utility taxes
Other local taxes
Other Operational
Expenses

in same state
but not same
city

purchased on
West Coast but
not same state

outside of West
Coast but within
the U.S.

purchased
outside the
U.S.

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

III. Revenue Data
6. Please provide the Total 2006 revenue associated with this business.
a. Total Sales

$___________

7. Please provide the 2006 revenue associated with each category listed below. The sum of all the
categories should equal total revenue of this business, or if percentages are reported, then the sum of all
categories will sum to 100%.
Revenue from:
Direct sales to
consumers in
the city this
business is
located
($) or (%)

Sales to
retailers in the
city this
business is
located
($) or (%)

Sales to
distributors or
processors in the
city this business
is located
($) or (%)

Sales in the
state, but
outside the city
this business is
located
($) or (%)

Sales in CA, OR,
or WA, but
outside the state
this plant is
located
($) or (%)

Sales inside
the U.S. but
outside CA,
OR, or WA
($) or (%)

Sales

Confidential

Page 2 of 2

8/20/2008

Sales
outside the
U.S.
($) or (%)