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U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
FORM
SBO-1
2012 SURVEY OF BUSINESS OWNERS AND
SELF-EMPLOYED PERSONS
OMB No. 0607-0943: Approval Expires xx/xx/xxxx
(08-26-2011) Draft 1
DUE DATE
30 days after receipt of form
Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
- OR -
Report online at:
www.census.gov/econhelp/sbo
Need help or have questions
about completing this form?
Visit www.census.gov/econhelp
Call 1-888-824-9954, between
8 a.m. and 6 p.m., Eastern time,
Monday through Friday.
- OR -
Write to the address above.
Include your 11-digit Census
File Number (CFN) printed in
the mailing address.
(Please correct any errors in this mailing address.)
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.
➜
Start Here
Please PRINT the first and last name of the person who
is filling out this form.
Name
The Census Bureau is responsible for
collecting information on the U.S. economy.
• The data that you provide will be combined with
the responses from other businesses and
business owners.
Include today’s date and a telephone number so we can
contact you if there is a question.
• Survey results will contain information on the
demographic and economic composition of
businesses in the United States.
MM
DD
YYYY
• Your response is important, and we keep your
answers confidential.
Area code
This form asks for two types of information:
• specific information about the business
Number
–
–
• information about the principal business owners
Extension
INSTRUCTIONS
Please read the enclosed insert before
answering the questions.
• Use blue or black ink.
• Place an "✘" inside the box.
✘
• Center numbers in boxes.
• Do not put slashes through 0 or 7.
7 0
➜
Please turn to the next page to continue.
§+"5,¤
10012029
2
Please answer the following questions for the self-employment or business activity of the person(s) or
business named in the mailing label even if the business has since been sold, reorganized, or discontinued.
You may use estimates if this form requests information that is not available in your business records.
An enclosure with answers to the most frequently asked questions regarding this survey has been provided.
1 In 2012, did another company or organization own more
than 50% of this business?
Yes - Go to 65 on Page 7
No
C. As of December 31, 2012, how many owners were
there in this business?
• Do not combine two or more owners to create
one owner.
• Count spouses and partners as separate owners.
2 In 2012, did employees under an Employee Stock
Ownership Plan (ESOP) own more than 50% of this
business?
Yes - Go to 65 on Page 7
No
3 In 2012, did members in a cooperative or club own more
than 50% of this business?
Yes - Go to 65 on Page 7
No
4 In 2012, did an estate or trust own more than 50% of this
business?
Yes - Go to 65 on Page 7
No
5 In 2012, did an Alaska Native Regional or Village
Corporation or an American Indian tribal entity own
more than 50% of this business?
Yes - Go to 65 on Page 7
1
5–9
2
10 – 49
3
50 or more
4
Unknown
D. For the person(s) owning the largest percentage(s)
in this business in 2012, please list the percentage
owned by each person and his or her position title.
• Do not report percentages owned by parent
companies, estates, trusts, etc.
• If more than 4 persons owned this business equally,
select any 4.
• Round percentages to whole numbers. For example,
report 1/3 ownership (33.3%) as:
3 3. 0 %
No
6 In 2012, was this business a nonprofit organization?
Position Title
Yes - Go to 65 on Page 7
No
Percentage Owned
(Estimates are
acceptable)
7 In 2012, was this business a publicly held corporation?
Yes
No
Owner 1:
. 0 %
Owner 2:
. 0 %
Owner 3:
. 0 %
Owner 4:
. 0 %
(Example: sole owner,
co-owner, shareholder,
president,
vice president, etc.)
8 In 2012, did any individual own 10% or more of the
rights, claims, interests, or stock in this business?
Yes
No - Go to 65 on Page 7
9 A. In 2012, was this business jointly owned by a
husband and wife?
Yes, equally operated by husband and wife
Yes, but primarily operated by husband
Yes, but primarily operated by wife
No
B. In 2012, did two or more members of the same family
own the majority of this business? (Family refers to
spouses, parents/guardians, children, siblings, or
close relatives.)
Yes
FORM SBO-1 (08/26/2011)
No
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10012037
19 Was Owner 1 born in the United States?
Owner 1
Yes
Please answer the following questions about Owner 1
listed in 9 D on Page 2.
10 How did Owner 1 initially acquire ownership of this business?
Founded
Inherited
Purchased
Received transfer of
ownership/gift
11 When did Owner 1 acquire ownership of this business?
No
Please answer BOTH Question 20 about
☞ NOTE:
Hispanic origin and Question 21 about race. For
this survey, Hispanic origins are not races.
20 Is Owner 1 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Before 1984
2010
Yes, Puerto Rican
1985 – 1994
2011
Yes, Cuban
1995 – 2004
2012
2005 – 2009
Don’t know
12 In 2012, which of the following best represents Owner 1’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods
Financial control with
the authority to sign
loans, leases, and
contracts
Managing day-to-day
operations
None of the above
13 In 2012, what was the average number of hours per week that
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
21 What is Owner 1’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Owner 1 spent managing or working in this business?
None
40 hours
Less than 20 hours
41 – 59 hours
20 – 39 hours
60 hours or more
14 In 2012, did this business provide Owner 1’s primary source
of personal income?
Yes
Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C
No
15 Prior to establishing, purchasing, or acquiring this business,
had Owner 1 ever owned a business or been self-employed?
Yes
No
Native Hawaiian
Guamanian or Chamorro
16 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 1
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate
Associate Degree
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Some college,
but no degree
Some other race - Print race C
service including the Coast Guard?
Yes
Female
18 What was the age of Owner 1 as of December 31, 2012?
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
FORM SBO-1 (08/26/2011)
Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C
22 A. Is Owner 1 a veteran of any branch of the U.S. military
17 What is the sex of Owner 1?
Male
Samoan
No - Go to 23
B. (If Yes) Was Owner 1 disabled as the result of injury
incurred or aggravated during active military service?
Yes
No
23 Was more than 1 owner listed in 9 D on Page 2?
Yes
No - Go to 65 on Page 7
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3
10012045
4
33 Was Owner 2 born in the United States?
Owner 2
Yes
Please answer the following questions about Owner 2
listed in 9 D on Page 2.
24 How did Owner 2 initially acquire ownership of this business?
Founded
Inherited
Purchased
Received transfer of
ownership/gift
25 When did Owner 2 acquire ownership of this business?
No
Please answer BOTH Question 34 about
☞ NOTE:
Hispanic origin and Question 35 about race. For
this survey, Hispanic origins are not races.
34 Is Owner 2 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Before 1984
2010
Yes, Puerto Rican
1985 – 1994
2011
Yes, Cuban
1995 – 2004
2012
2005 – 2009
Don’t know
26 In 2012, which of the following best represents Owner 2’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods
Financial control with
the authority to sign
loans, leases, and
contracts
Managing day-to-day
operations
None of the above
27 In 2012, what was the average number of hours per week that
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
35 What is Owner 2’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Owner 2 spent managing or working in this business?
None
40 hours
Less than 20 hours
41 – 59 hours
20 – 39 hours
60 hours or more
28 In 2012, did this business provide Owner 2’s primary source
of personal income?
Yes
Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C
No
29 Prior to establishing, purchasing, or acquiring this business,
had Owner 2 ever owned a business or been self-employed?
Yes
No
Native Hawaiian
Guamanian or Chamorro
30 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 2
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate
Associate Degree
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Some college,
but no degree
Some other race - Print race C
service including the Coast Guard?
Yes
Female
32 What was the age of Owner 2 as of December 31, 2012?
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
FORM SBO-1 (08/26/2011)
Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C
36 A. Is Owner 2 a veteran of any branch of the U.S. military
31 What is the sex of Owner 2?
Male
Samoan
No - Go to 37
B. (If Yes) Was Owner 2 disabled as the result of injury
incurred or aggravated during active military service?
Yes
No
37 Was more than 2 owner listed in 9 D on Page 2?
Yes
No - Go to 65 on Page 7
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10012052
47 Was Owner 3 born in the United States?
Owner 3
Yes
Please answer the following questions about Owner 3
listed in 9 D on Page 2.
38 How did Owner 3 initially acquire ownership of this business?
Founded
Inherited
Purchased
Received transfer of
ownership/gift
39 When did Owner 3 acquire ownership of this business?
No
Please answer BOTH Question 48 about
☞ NOTE:
Hispanic origin and Question 49 about race. For
this survey, Hispanic origins are not races.
48 Is Owner 3 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Before 1984
2010
Yes, Puerto Rican
1985 – 1994
2011
Yes, Cuban
1995 – 2004
2012
2005 – 2009
Don’t know
40 In 2012, which of the following best represents Owner 3’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods
Financial control with
the authority to sign
loans, leases, and
contracts
Managing day-to-day
operations
None of the above
41 In 2012, what was the average number of hours per week that
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
49 What is Owner 3’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Owner 3 spent managing or working in this business?
None
40 hours
Less than 20 hours
41 – 59 hours
20 – 39 hours
60 hours or more
42 In 2012, did this business provide Owner 3’s primary source
of personal income?
Yes
Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C
No
43 Prior to establishing, purchasing, or acquiring this business,
had Owner 3 ever owned a business or been self-employed?
Yes
No
Native Hawaiian
Guamanian or Chamorro
44 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 3
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate
Associate Degree
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Some college,
but no degree
Some other race - Print race C
service including the Coast Guard?
Yes
Female
46 What was the age of Owner 3 as of December 31, 2012?
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
FORM SBO-1 (08/26/2011)
Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C
50 A. Is Owner 3 a veteran of any branch of the U.S. military
45 What is the sex of Owner 3?
Male
Samoan
No - Go to 51
B. (If Yes) Was Owner 3 disabled as the result of injury
incurred or aggravated during active military service?
Yes
No
51 Was more than 3 owner listed in 9 D on Page 2?
Yes
No - Go to 65 on Page 7
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5
10012060
6
61 Was Owner 4 born in the United States?
Owner 4
Yes
Please answer the following questions about Owner 4
listed in 9 D on Page 2.
52 How did Owner 4 initially acquire ownership of this business?
Founded
Inherited
Purchased
Received transfer of
ownership/gift
53 When did Owner 4 acquire ownership of this business?
No
Please answer BOTH Question 62 about
☞ NOTE:
Hispanic origin and Question 63 about race. For
this survey, Hispanic origins are not races.
62 Is Owner 4 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Before 1984
2010
Yes, Puerto Rican
1985 – 1994
2011
Yes, Cuban
1995 – 2004
2012
2005 – 2009
Don’t know
54 In 2012, which of the following best represents Owner 4’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods
Financial control with
the authority to sign
loans, leases, and
contracts
Managing day-to-day
operations
None of the above
55 In 2012, what was the average number of hours per week that
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
63 What is Owner 4’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Owner 4 spent managing or working in this business?
None
40 hours
Less than 20 hours
41 – 59 hours
20 – 39 hours
60 hours or more
56 In 2012, did this business provide Owner 4’s primary source
of personal income?
Yes
Asian Indian
Japanese
Chinese
Korean
Filipino
Vietnamese
Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C
No
57 Prior to establishing, purchasing, or acquiring this business,
had Owner 4 ever owned a business or been self-employed?
Yes
No
Native Hawaiian
Guamanian or Chamorro
58 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 4
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate
Associate Degree
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Some college,
but no degree
Some other race - Print race C
service including the Coast Guard?
Female
60 What was the age of Owner 4 as of December 31, 2012?
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
FORM SBO-1 (08/26/2011)
Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C
64 A. Is Owner 4 a veteran of any branch of the U.S. military
59 What is the sex of Owner 4?
Male
Samoan
Yes
No - Go to 65
B. (If Yes) Was Owner 4 disabled as the result of injury
incurred or aggravated during active military service?
Yes
No
§+"5]¤
10012078
70 In 2012, were any of the following sources used to finance
Business
expansion or capital improvement(s) for this business?
Mark ✘ all that apply.
65 In what year was this business originally established?
Personal/family savings of owner(s)
Before 1984
2008
2012
Personal/family assets other than savings of owner(s)
1985 – 1994
2009
Don’t know
Personal/family home equity loan
1995 – 2004
2010
Personal/business credit card(s)
2005 – 2007
2011
Business loan from federal, state, or local government
66 A. For the owner(s) as of December 31, 2012, what was the
Government-guaranteed business loan from a bank
or financial institution
source(s) of capital used to start or acquire this business?
Mark ✘ all that apply.
Business loan from a bank or financial institution
Personal/family savings of owner(s)
Business loan/investment from family/friend(s)
Personal/family assets other than savings of owner(s)
Personal/family home equity loan
Investment by venture capitalist(s) (An early-stage
investment in exchange for ownership equity by an
individual, outside group, or business not directly involved
in the overall operation and management of the business.)
Personal/business credit card(s)
Business profits and/or assets
Business loan from federal, state, or local
government
Grants
Government-guaranteed business loan from a bank
or financial institution
Other source(s) of capital
Business loan from a bank or financial institution
Don’t know
Business loan/investment from family/friend(s)
Did not have access to capital
Investment by venture capitalist(s) (An early-stage
investment in exchange for ownership equity by an
individual, outside group, or business not directly involved
in the overall operation and management of the business.)
Did not expand or make capital improvement(s)
71 In 2012, which of the following types of customers accounted
Grants
for 10% or more of this business’s total sales of goods and/or
services? Mark ✘ all that apply.
Other source(s) of capital
Federal
government
Don’t know
State and local government, including school districts,
transportation authorities, etc.
None needed – Go to
67
Other businesses and/or organizations, including
distributors of your product(s)
B. For the owner(s) as of December 31, 2012, what was the
total amount of capital used to start or acquire this
business? (Capital includes savings, other assets, and borrowed
Individuals
funds of owner(s)).
72 In 2012, what percent of this business’s total sales of goods
Less than $5,000
$100,000 – $249,999
$5,000 – $9,999
$250,000 – $999,999
None
5% - 9%
50% - 99%
$10,000 – $24,999
$1,000,000 or more
Less than 1%
10% - 19%
100%
$25,000 – $49,999
Don’t know
1% - 4%
20% - 49%
Don’t know
$50,000 – $99,999
and/or services consisted of exports outside the United States?
73 In 2012, did this business establish operations outside the
United States?
67 In 2012, did this business operate primarily from somebody’s
home?
Yes
Yes
No
No
74 In 2012, did this business outsource or transfer any business
function and/or service to a company outside the
United States?
68 In 2012, did this business operate as a franchise?
Yes
No
Yes
No
69 In 2012, did a franchiser own more than 50% of this business?
Yes
FORM SBO-1 (08/26/2011)
No
➜
Please turn to the next page to continue.
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10012086
8
75 In 2012, in which language(s) did this business conduct
80 In 2012, did this business make purchases online?
transactions with its customers? Mark ✘ all that apply.
Yes
No
English
Hindi/Urdu
Russian
Arabic
Italian
Spanish
Chinese
Japanese
Tagalog
Operated less than 40 hours per week on average
French
Korean
Vietnamese
Operated less than 12 months
German
Polish
Other
Greek
Portuguese
Seasonal business (for example, fireworks sales
or tax preparer)
Operated occasionally (for example, event organizer
or guest speaker)
81 In 2012, did any of the following characteristics describe
the activity of this business? Mark ✘ all that apply.
76 In 2012, were any of the following types of workers used by
this business?
Yes
None of the above
No
A. Full-time paid employees. . . . . . . . . . . . . .
82 A. Is this business currently operating?
Yes
B. Part-time paid employees. . . . . . . . . . . . . .
C. Paid day laborers. . . . . . . . . . . . . . . . . . . .
B. (If No) Did the operations cease for any of the reasons
listed below? Mark ✘ all that apply.
D. Temporary staffing obtained from a
temporary help service . . . . . . . . . . . . . . . .
E. Leased employees from a leasing
service or a professional employer
organization . . . . . . . . . . . . . . . . . . . . . . . .
F. Contractors, subcontractors,
independent contractors, or
outside consultants. . . . . . . . . . . . . . . . . . .
Profit sharing and/or stock options
Paid holidays, vacation, and/or sick leave
Owner(s) deceased
Started another business
Operated for
a specific or
one-time event
Sold this business
Other
Thank you for participating in the Survey of Business
Owners and Self-Employed Persons.
Please return the completed original questionnaire in the
postage-paid envelope. Make sure the barcode above your
address shows in the window of the envelope. Please make
a photocopy of this form for your records.
If the envelope has been misplaced, please mail the form to:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
None of the above
78 In 2012, did this business have a Web site?
Yes
Lack of personal
loans/credit
Lack of business
loans/credit
totally or partly by this business? Mark ✘ all that apply.
Contributions to retirement plans, including 401(k),
Keogh, etc.
Owner(s) retired
Inadequate cash
flow or low sales
77 In 2012, which of the following employee benefits were paid
Health insurance
No
Remarks
No
79 A. In 2012, did this business have any e-commerce sales?
(E-commerce sales and other operating receipts are sales of goods
and/or services where an order is placed by the buyer or price and
terms of the sale are negotiated over the Internet. Payment may or
may not be made online.)
Less than 1%
No - Go to 80
B. In 2012, what percent of this business’s total sales of
goods and/or services were e-commerce sales?
Less than 1%
20% – 49%
1% – 4%
50% – 99%
5% – 9%
100%
10% – 19%
Don’t know
FORM SBO-1 (08/26/2011)
§+"5w¤
| File Type | application/pdf |
| File Title | sbo1_p01_12.g |
| File Modified | 2011-10-06 |
| File Created | 2011-08-31 |