SBA Form 2214 Impa Impact Economic Study Follow-up Survey

U.S. Small Business Administration

Office of Entrepreneurial Development

Follow-up Economic Impact Survey

OMB Number 3245-0351

Expiration 06/30/2012

Dear Small Business Client:

Within the last twelve months you were kind enough to respond to our request for some initial data regarding your visit(s) to SBA’s Entrepreneurial Development resource partner, the [Small Business Development Center (SBDC), Women’s Business Center (WBC), SCORE]. To continually understand the impact our programs and services are having on the economy it would be helpful to know if our assistance to you regarding starting and managing a business resulted in job creation, increases in your business’ revenues or other results.

We understand that you responded to a thorough survey not so long ago, but we ask that you help us in answering a few questions for this online follow-up questionnaire by clicking on the following URL: http://www.surveytracker.com/survey/survey

After completing this online survey, you will receive a confirmation page indicating your survey was accepted. All responses to these questions are voluntary and will be held in confidence. If you have trouble accessing the survey, please contact Joe Survey at (email address) or (telephone number). The data will not be released to any other government agency or private firm. Based on your visit to the [SBDC, WBC, SCORE], please use that experience as a benchmark to answer the following:

1. Are you currently in business?

Yes □ No □

If YES when was the business started? _ _/_ _ _ _

mm/ yyyy

1a. If NO, when do you plan on starting a business?

Within 30 days □ 31-90 days □

91-120 days □ No idea at this time □

1a. If NO, when do you plan on starting a business?

Have you ever been in business? Yes □ No □

If YES, when was the business started? _ _/_ _ _ _

mm/ yyyy

2. As a result of the assistance received from the [SBDC/WBC/SCORE] Counselor which of the following were you able to develop [i.e., Business Plan] in order to start or better manage your business. [Check all that apply]

Business Plan □ Loan Package □ Purchasing Strategy □

Marketing Plan □ Hiring Plan □ Feasibility Plan □

Promotional Plan □ Training Plan for Staff □ Production Plan □

Pricing Strategy □ Financial Strategy □ Distribution Plan □

Cash Flow Analysis □ E-Commerce Strategy □ Other ________________

3. What was the approximate annual gross revenue for each of the calendar years below:

2007: __________________________

2008: __________________________

4. Counting yourself, how many people full-time employees (35 hours or more per

week) and part-time employees (less than 35 hours per week), did you have at the end of the following years you were in business? If you were not in business, just write N/A in the appropriate blank.

2007 _______________ Number of Full-time employees

2008 _______________ Number of Full-time employees

2007 _______________ Number of Part-time employees

2008 _______________ Number of Part-time employees

5. If you were projecting to reduce your total number of employees prior to counseling, how many positions do you/have you retained due to the counseling?

Existing Full-time jobs saved ___________

Existing part-time jobs saved ___________

6. I would refer the counseling services I received to other small businesses.

Strongly Agree □ Agree □ No Opinion □ Disagree □ Strongly Disagree□

7. Have you utilized any other SBA resources/program?

Yes □ No □

If YES, select those you used [Check all that apply]

SCORE □ SBA’s guarantee loan programs □

SBDC □ SBIC Venture Capital Program □

Women Business Center □ SBA’s Surety Bond Program □

Small Business Training Network □ SBA’s Disaster Assistance Program □

PLEASE NOTE: The estimated burden for completing this form is less than 8 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3^rd St., S.W., Washington, D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-0351). PLEASE DO NOT SEND FORMS TO OMB.

SBA Form 2214 THANK YOU