FMS/EFTPS 1040-ES Quarterly Payers Survey

SCREENER DOCUMENT

DEPARTMENT OF TREASURY IN-DEPTH INTERVIEWS

SOLE PROPRIETORS

Name: _________________________________________________________

Address: _________________________________________________________

City, State, Zip: _________________________________________________________

Phone: _________________________________________________________

Recruiter: _________________________________________________________

DATES TO BE DETERMINED PRIOR TO BEGINNING RECRUITMENT

Hello. My name is __________ and I’m a representative of Harte-Hanks Analytics, an independent research firm. We will be conducting telephone interviews during the next few weeks on behalf of the U.S. Department of the Treasury to better understand the attitudes of selected individuals about the process of making income tax payments. I want to assure you that Treasury is not interested in your name or any specific details about you as an individual or your business. In fact, your name will be held confidential by the research firm. According to the Paperwork Reduction Act of 1995, you are not required to respond to a survey like this one unless you are given a valid OMB control number. The valid OMB control number for this survey is 1510-0074.

I am calling today to pre-screen participants for a follow-up phone interview. May I ask you a few questions to see if you meet the qualifications of individuals we plan to include in the study? This will only take a few minutes.

IF TERMINATE DURING SCREENING PROCESS READ: I’m sorry, we already have enough participants in that category. Thank you very much for your time.

INTERVIEWER INSTRUCTION: IF RESPONDENT EXPRESSES CONCERN AT ANY POINT DURING THE INTERVIEW, REASSURE HIM OR HER THAT YOU DO NOT WORK FOR THE GOVERNMENT. YOU ARE WORKING FOR AN INDEPENDENT RESEARCH COMPANY. THE PERSON’S ANSWERS AND PARTICIPATION WILL BE COMPLETELY CONFIDENTIAL, AND INDIVIDUAL RESPONSES WILL NOT BE SHARED WITH ANYONE. IF NECESSARY, REASSURE RESPONDENTS WE WON’T BE ASKING FOR PERSONAL INFORMATION SUCH AS AN EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER.

IF RESPONDENT WANTS A PHONE NUMBER TO CALL TO VERIFY THIS IS A LEGITIMATE SURVEY, PLEASE ASK HIM OR HER TO CONTACT:
Melanie Rigney, Financial Management Service, a bureau of the U.S. Department of the Treasury, 202-874-6763.

RECORD GENDER:

	Male	□
	Female	□
	IDEALLY, RECRUIT A 50/50 RATIO OF MALES TO FEMALES.

Do you or does anyone in your immediate family work for any of the following?
(READ LIST.)

		YES	NO
	In the banking industry?	□	□
	In marketing or opinion research?	□	□
	In journalism or for the news media?	□	□
	For the Federal government?	□	□
	As a tax preparation professional?	□	□
	TERMINATE IF YES TO ANY OF ABOVE.

3. Which of the following best describes the way that you earn the majority of your income?

	Self-employed	□
	Employed full-time or part-time by a company that you do not own	□
	Do not earn income by working for self or an employer	□
	MUST CHOOSE ONLY ONE RESPONSE. TERMINATE IF NOT SELF EMPLOYED.

4. As a self-employed worker, how is your business legally organized? Is it a…

Sole proprietor	□
Corporation or LLC	□
Other	□
TERMINATE IF CORPORATION, LLC OR OTHER .

5. Just to clarify…

Sole proprietors report income and/or losses and expenses by filing a tax form called a Schedule C or Schedule C-EZ, along with their 1040. Does this describe how you filed in 2011?	YES	NO
TERMINATE IF NO

6.

Do you expect to file as a sole proprietor in 2012?	YES	NO
TERMINATE IF NO

7. How do you make your Federal and self-employment tax payments?

Quarterly estimated payments	□
Pay one time per year by April deadline	□
Other or do not know	□
CONTINUE ONLY IF QUARTERLY PAYMENTS

8. How do you make your quarterly estimated payments? READ LIST IF NEEDED.

Mail 1040-ES paper voucher with a check	□
Electronically	□
Other	□
CONTINUE ONLY IF MAIL PAPER COUPON AND CHECK

9. To make sure we are talking to a variety of people:

Please briefly explain the nature of your business so that I may classify it.

IF NEEDED PROVIDE AN EXAMPLE SUCH AS, “I AM A LANDSCAPER.”

OBTAIN A MIX OF INDUSTRIES. NO MORE THAN 2 PER INDUSTRY.

NAICS CATEGORY	DESCRIPTION
Consultant	Business services	□
Internet/Technology	Web/app designer, computer programmer	□
Pest control	Exterminating and pest control	□
Security	Investigation and security services	□
Cleaning	Janitorial or cleaning services – domestic and commercial	□
Landscaping	Landscaping services	□
Office	Office administrative services	□
Travel	Travel arrangement & reservation services	□
Agriculture, Forestry, Hunting & Fishing	Animal breeding including cats and dogs; fishing, hunting & trapping	□
Performing Arts	Agent or manager for artists, athletes, entertainers or other public figures or independent artist, writer or performer	□
Special Trade Contractor	Drywall, electrical, finish carpentry, flooring, framing, glass, masonry, painting, plumbing, roofing, tile	□
Health care	Home health care services, child day care services, individual and family services	□
Other services	Beautician/barber, coin-operated laundry, pet care, automotive mechanic, electronic and precision equipment repair & maintenance	□
Specialized design services	Interior, graphic or fashion designer	□
Other technical services	Photographic services, translation and interpretation services	□
Real estate	Real estate agent	□
Transportation	General freight trucking long-distance, taxi service	□
Couriers	Courier or messenger	□
Other	Specify________________

10. Please stop me when I reach the category that includes your age. (READ LIST.)

	Under 18	
	18-24	
	25-34	
	35-44	
	45-54	
	55-64	
	65 or over	
	TERMINATE UNDER 18. ATTEMPT TO OBTAIN A MIX OF AGES

11. Would you describe yourself as…

Hispanic or Latino…………………………….1

Not Hispanic or Latino………………………..2

Prefer not to answer…………………………...3

OBTAIN AT LEAST 2 RECRUITS THAT IDENTIFY AS HISPANIC OR LATINO

12. Would you describe yourself as… (ACCEPT MULTIPLE ANSWERS)

American Indian or Alaska Native……………1

Asian…………………………………………..2

Black or African American……………………3

Native Hawaiian or Other Pacific Islander……4

White…………………………………………..5

Prefer not to answer…………………………...6

INVITATION:

We would like to invite you to participate in a marketing research phone interview. The discussion will take approximately 25-30 minutes of your time, and would assist the federal government in understanding sole proprietors’ preferences for tax payment options.

Will you be available on _________________ from _______ to _______ am/p.m.?

	Yes	ٱ	CONTINUE
	No	ٱ	TERMINATE

IF YES: CONFIRM DATE, TIME AND PREFERRED TELEPHONE NUMBER. ADVISE PARTICIPANT THEY WILL BE CONTACTED BY A RESEARCHER AT THE STATED DATE AND TIME WHO WILL IDENTIFY AS REPRESENTING HARTE-HANKS. IT IS IMPORTANT TO BE AVAILABLE FOR THE CALL. NO PREPARATION FOR THE CALL IS NEEDED.

IF NO, THANK, TERMINATE AND RECORD FOR REPORTING PURPOSES.

EFTPS 1040-ES Quarterly Payers Survey

Screener

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