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8
U.S. DEPARTMENT OF COMMERCE
70 In 2012, in which language(s) did this business conduct
transactions with its customers? Mark ✘ all that apply.
English
German
Portuguese
African
language(s)
Hindi/Urdu
Russian
Arabic
Italian
Spanish
Chinese
Japanese
Tagalog
French
Korean
Vietnamese
French
Creole
Polish
Other
75 In 2012, did this business operate primarily from somebody’s
home?
FORM
Yes
SBO-1
No
OMB No. 0607-xxxx: Approval Expires xx/xx/xxxx
(08/21/2012)
76 In 2012, did this business own one or more of the following?
Copyright
Patent (granted)
Trademark
Patent (pending)
None
77 In 2012, did any of the following characteristics describe
the activity of this business? Mark ✘ all that apply.
Operated less than 12 months
Full-time paid employees
Seasonal business (for example, fireworks sales
or tax preparer)
Part-time paid employees
Operated occasionally (for example, event organizer
or guest speaker)
Paid day laborers
None of the above
Temporary staffing obtained from a temporary help
service
Leased employees from a leasing service or a
professional employer organization
Contractors, subcontractors, independent contractors, or
outside consultants
None of the above
72 In 2012, which of the following employee benefits were paid
78 A. Is this business currently operating?
Yes
No
B. (If No) Did the operations cease for any of the following
reasons? Mark ✘ all that apply.
Owner’s military
deployment
Owner’s illness or
injury
Lack of business
loans/credit
Lack of personal
loans/credit
Owner(s) retired
Started another business
Owner(s) deceased
Operated for
a specific or
one-time event
Inadequate cash
flow or low sales
Sold this business
totally or partly by this business? Mark ✘ all that apply.
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.
COMPLETE THIS SURVEY ONLINE
Health insurance
Contributions to retirement plans, including 401(k),
Keogh, etc.
Profit sharing and/or stock options
Paid holidays, vacation, and/or sick leave
Tuition assistance and/or reimbursement
None of the above
73 In 2012, did this business have a website?
No
74 A. In 2012, did this business have any e-commerce sales?
(E-commerce sales 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, extranet, EDI network, electronic mail,
or other online system. Payment may or may not be made online.)
No ➜ Go to 75 .
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
Remarks
• Go to: econhelp.census.gov/sbo
• Log in using the ID and password listed above.
Or mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
Why did I receive this survey?
We are surveying small and large companies,
self-employed people, and people working for
others as nonemployees or independent
contractors. Your responses will help us produce
reliable information about the U.S. economy.
Am I self-employed?
INSTRUCTIONS
Please read the enclosed insert before
answering the questions.
• Use blue or black ink.
• Place an "✘" inside the box. ✘
• Center numbers in boxes.
7 0
• Do not put slashes through 0 or 7.
1 Please PRINT the first and last name of the person
who is filling out this form.
Contact Name
Include today’s date and a telephone number so we
can contact you if there is a question.
MM
DD
YYYY
Yes, if you earned income working for yourself or
for someone else as a nonemployee during 2012.
Need help or have questions?
Less than 1%
20% – 49%
• Visit econhelp.census.gov/sbo
• Call 1-888-824-9954, between 8 a.m. and 6 p.m.,
Eastern time, Monday through Friday.
1% – 4%
50% – 99%
¿Necesita ayuda?
5% – 9%
100%
10% – 19%
Don’t know
B. In 2012, what percent of this business’s total sales of
goods and/or services were e-commerce sales?
FORM SBO-1
2012 SURVEY OF BUSINESS OWNERS AND
SELF-EMPLOYED PERSONS
Operated less than 40 hours per week on average
this business? Mark ✘ all that apply.
Yes
U.S. CENSUS BUREAU
Mark ✘ all that apply.
71 In 2012, which of the following types of workers were used by
Yes
Economics and Statistics Administration
Si usted habla espanol y necesita ayuda para
completar su cuestionario, Ilame sin cargo alguno
al 1-888-824-9954, entre las 8 a.m. y 6 p.m., hora
del este, de lunes y viernes.
Area code
Number
Extension
§+"5,¤
10012029
2
Please answer the following questions for the person(s)
or business named in the mailing label. Answer even
if the business has been sold, reorganized, or ceased
operation.
5 For the person(s) owning the largest percentage(s)
in this business as of December 31, 2012, please list
the percentage owned by each person and his or her
position title.
• Do not report percentages owned by parent
You may use estimates if this form requests information
that is not available in your business records.
62 In what year was this business originally established or self-
Personal/family assets other than savings of owner(s)
Don’t know
Personal/family home equity loan
select any 4 people.
• Round percentages to whole numbers. For example,
63 In 2012, did all or part of this business operate as a franchise?
report 1/3 ownership as 33.0%.
worked as a consultant or an independent
contractor.
Yes
Percentage Owned
Position Title
(Estimates are
acceptable)
(Example: sole owner, co-owner,
shareholder, president,
vice president, etc.)
• Do not combine two or more owners to create one
owner.
Owner 2:
.0 %
Owner 3:
.0 %
5 – 10 people
11 or more people
Business is owned by a
parent company, estate,
trust, or other entity.
Go to 3 .
NOTE: Do not list more than 4 owners.
Don’t know
3 On December 31, 2012, was this business owned by
a government or tribal entity?
Yes
.0 %
Owner 4:
No
6
A. In 2012, did two or more members of one
family own the majority of this business?
(Family refers to spouses, parents/guardians,
children, siblings, or close relatives.)
Yes
4 On December 31, 2012, did any one person own
10% or more of this business?
Yes
No – Go to 62 on page 7 ONLY if no person
owned 10% or more of this business.
No ➜ Go to 7 .
C. (If Yes) Was this business operated equally by both
spouses?
No, primarily operated by Owner 1
Government-guaranteed business loan from a bank
or financial institution, including SBA-guaranteed loans
Business loan from a bank or financial institution
Personal/family savings of owner(s)
Business loan from federal, state, or local government
Personal/family assets other than savings of owner(s)
Business loan/investment from family/friend(s)
Personal/family home equity loan
Investment by venture capitalist(s)
Personal credit card(s) carrying balances
Business profits and/or assets
Business credit card(s) carrying balances
Grants
Government-guaranteed business loan from a bank
or financial institution, including SBA-guaranteed
loans
Other source(s) of capital
Business loan from a bank or financial institution
Don’t know
Business loan from federal, state, or local
government
Wanted to expand or make capital improvement(s),
but could not obtain funding
Business loan/investment from family/friend(s)
Did not expand or make capital improvement(s)
66 In 2012, which of the following types of customers accounted
for 10% or more of this business’s total sales of goods and/or
services? Mark ✘ all that apply.
Grants
No ➜ Go to 7 .
Yes, equally operated by spouses
Business credit card(s) carrying balances
Investment by venture capitalist(s)
B. (If Yes) Did spouses jointly own this business?
Yes
No
5 , what was the source(s) of
capital used to start or initially acquire this business?
(If you did not list owners in 5 , go to 65 .) Mark ✘ all
that apply.
.0 %
Owner 1:
Personal credit card(s) carrying balances
64 A. For the owners listed in
1 person
Go to 5 .
Personal/family savings of owner(s)
employment activity begun?
• If more than 4 people owned this business equally,
• Include yourself if you were a sole proprietor or
2 – 4 people
to finance expansion or capital improvement(s) for this
business? Mark ✘ all that apply.
companies, estates, trusts, or other entities.
2 On December 31, 2012, how many people owned this
business?
• Count spouses and partners as separate owners.
65 In 2012, were any of the following sources of capital used
Business
Other source(s) of capital
Federal government
Don’t know
State and local government, including school districts,
transportation authorities, etc.
None needed ➜ Go to 65 .
Other businesses and/or organizations, including
distributors of your product(s)
B. For the owners listed in 5 , what was the total amount
of capital used to start or initially acquire this business?
(Capital includes savings, other assets, and borrowed
funds of owner(s).)
No, primarily operated by Owner 2
Less than $5,000
$100,000 – $249,999
$5,000 – $9,999
$250,000 – $999,999
$10,000 – $24,999
$1,000,000 – $2,999,999
$25,000 – $49,999
$3,000,000 or more
$50,000 – $99,999
Don’t know
Individuals
67 In 2012, what percent of this business’s total sales of goods
and/or services consisted of exports outside the United
States?
.0 %
None
Don’t know
68 In 2012, did this business have operations outside the
United States?
Yes
No
69 In 2012, did this business outsource or transfer any business
function and/or service to another company outside the
United States?
Yes
➜
FORM SBO-1
FORM SBO-1
No
Please turn to the next page to continue.
§+"5>¤
7
10012037
6
Please answer BOTH Question
about
☞ NOTE:
Hispanic origin and Question
about race. For
59
Owner 4
60
this survey, Hispanic origins are not races.
Please answer the following questions about Owner 4
listed in 5 on Page 2.
49 How did Owner 4 initially acquire ownership of this business?
Mark ✘ all that apply.
59 Is Owner 4 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Inherited
Purchased
Received transfer of
ownership or gift
business?
7 How did Owner 1 initially acquire ownership of this business?
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
in this business? Mark ✘ all that apply.
Financial control with
Managing day-to-day
the authority to sign
operations
loans, leases, and
contracts
Providing services
and/or producing
None of these functions
goods
52 In 2012, what was the average number of hours per week that
No, not of Hispanic, Latino, or Spanish origin
Inherited
Purchased
Received transfer of
ownership or gift
Yes, Puerto Rican
8 In what year did Owner 1 initially acquire ownership of this
business?
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
Don’t know
60 What is Owner 4’s race? Mark ✘ all that apply.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Asian Indian
Native Hawaiian
Japanese
Owner 4 spent managing or working in this business?
9 In 2012, which of the following were Owner 1’s function(s)
in this business? Mark ✘ all that apply.
Financial control with
Managing day-to-day
the authority to sign
operations
loans, leases, and
contracts
Providing services
and/or producing
None of these functions
goods
10 In 2012, what was the average number of hours per week that
18 What is Owner 1’s race? Mark ✘ all that apply.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Asian Indian
Japanese
Native Hawaiian
Owner 1 spent managing or working in this business?
None
20 – 39 hours
41 – 59 hours
Chinese
Korean
Guamanian or
Chamorro
None
20 – 39 hours
41 – 59 hours
Chinese
Korean
Guamanian or
Chamorro
Less than
20 hours
40 hours
60 hours
or more
Filipino
Vietnamese
Samoan
Less than
20 hours
40 hours
60 hours
or more
Filipino
Vietnamese
Samoan
53 In 2012, did this business provide Owner 4’s primary source
of personal income?
Yes
No
Other Pacific
Islander - Print
Other Asian - Print
race, for example,
Hmong, Laotian, Thai,
Pakistani, Cambodian,
and so on. C
race, for example,
Fijian, Tongan,
and so on. C
54 Prior to establishing, purchasing, or acquiring this business,
Yes
No
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Some college,
but no degree
Male
Female
Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
No ➜ Go to 62 .
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
58 Was Owner 4 born a citizen of the United States?
Yes
Yes
No
completed prior to establishing, purchasing, or acquiring
this business? Mark ✘ ONE box only.
Less than high
Associate Degree
school graduate
B. (If Yes) Do any of the following characteristics describe
Owner 4’s military service? Mark ✘ all that apply.
Served on active duty military service, not including
training for the Reserves or National Guard
Some other race - Print race C
19 A. Has Owner 1 ever served in any branch of the U.S.
Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
Yes
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Served on active duty military service, not including
training for the Reserves or National Guard
Disabled as the result of illness or injury incurred
or aggravated during military service
14 What is the sex of Owner 1?
Male
No ➜ Go to 20 .
B. (If Yes) Do any of the following characteristics describe
Owner 1’s military service? Mark ✘ all that apply.
Some college,
but no degree
Served on active duty military service after
September 11, 2001
57 What was the age of Owner 4 as of December 31, 2012?
Under 25
No
race, for example,
Fijian, Tongan,
and so on. C
13 What was the highest degree or level of school Owner 1
61 A. Has Owner 4 ever served in any branch of the U.S.
Disabled as the result of illness or injury incurred
or aggravated during military service
56 What is the sex of Owner 4?
Yes
Other Pacific
Islander - Print
Other Asian - Print
race, for example,
Hmong, Laotian, Thai,
Pakistani, Cambodian,
and so on. C
had Owner 1 ever owned a business or been self-employed?
Yes
High school graduate Diploma or GED
of personal income?
Some other race - Print race C
55 What was the highest degree or level of school Owner 4
completed prior to establishing, purchasing, or acquiring
this business? Mark ✘ ONE box only.
Less than high
Associate Degree
school graduate
11 In 2012, did this business provide Owner 1’s primary source
12 Prior to establishing, purchasing, or acquiring this business,
had Owner 4 ever owned a business or been self-employed?
FORM SBO-1
17 Is Owner 1 of Hispanic, Latino, or Spanish origin?
Yes, Mexican, Mexican Am., Chicano
Founded or started
Don’t know
51 In 2012, which of the following were Owner 4’s function(s)
this survey, Hispanic origins are not races.
Please answer the following questions about Owner 1
listed in 5 on Page 2.
Yes, Puerto Rican
50 In what year did Owner 4 initially acquire ownership of this
17
18
Mark ✘ all that apply.
Yes, Mexican, Mexican Am., Chicano
Founded or started
Please answer BOTH Question
about
☞ NOTE:
Hispanic origin and Question
about race. For
Owner 1
Female
Served on active duty military service after
September 11, 2001
15 What was the age of Owner 1 as of December 31, 2012?
Served on active duty military service in 2012
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2012
None of the above
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
16 Was Owner 1 born a citizen of the United States?
No
Yes
FORM SBO-1
No
Served on active duty military service in 2012
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2012
None of the above
20 Was more than 1 owner listed in 5 on Page 2?
Yes
No ➜ Go to 62 on Page 7.
§+"5F¤
3
10012045
4
Please answer BOTH Question
about
☞ NOTE:
Hispanic origin and Question
about race. For
31
Owner 2
32
this survey, Hispanic origins are not races.
Please answer the following questions about Owner 2
listed in 5 on Page 2.
21 How did Owner 2 initially acquire ownership of this business?
Mark ✘ all that apply.
31 Is Owner 2 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Inherited
Purchased
Received transfer of
ownership or gift
business?
35 How did Owner 3 initially acquire ownership of this business?
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
in this business? Mark ✘ all that apply.
Financial control with
Managing day-to-day
the authority to sign
operations
loans, leases, and
contracts
Providing services
and/or producing
None of these functions
goods
24 In 2012, what was the average number of hours per week that
No, not of Hispanic, Latino, or Spanish origin
Inherited
Purchased
Received transfer of
ownership or gift
Yes, Puerto Rican
36 In what year did Owner 3 initially acquire ownership of this
business?
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C
Don’t know
32 What is Owner 2’s race? Mark ✘ all that apply.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Asian Indian
Native Hawaiian
Japanese
Owner 2 spent managing or working in this business?
37 In 2012, which of the following were Owner 3’s function(s)
in this business? Mark ✘ all that apply.
Financial control with
Managing day-to-day
the authority to sign
operations
loans, leases, and
contracts
Providing services
and/or producing
None of these functions
goods
38 In 2012, what was the average number of hours per week that
46 What is Owner 3’s race? Mark ✘ all that apply.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C
Asian Indian
Japanese
Native Hawaiian
Owner 3 spent managing or working in this business?
None
20 – 39 hours
41 – 59 hours
Chinese
Korean
Guamanian or
Chamorro
None
20 – 39 hours
41 – 59 hours
Chinese
Korean
Guamanian or
Chamorro
Less than
20 hours
40 hours
60 hours
or more
Filipino
Vietnamese
Samoan
Less than
20 hours
40 hours
60 hours
or more
Filipino
Vietnamese
Samoan
25 In 2012, did this business provide Owner 2’s primary source
of personal income?
Yes
No
Other Pacific
Islander - Print
Other Asian - Print
race, for example,
Hmong, Laotian, Thai,
Pakistani, Cambodian,
and so on. C
race, for example,
Fijian, Tongan,
and so on. C
26 Prior to establishing, purchasing, or acquiring this business,
Yes
No
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
No ➜ Go to 34 .
Female
55 – 64
35 – 44
65 or over
30 Was Owner 2 born a citizen of the United States?
Yes
No
Some other race - Print race C
47 A. Has Owner 3 ever served in any branch of the U.S.
Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
Yes
High school graduate Diploma or GED
Bachelor’s Degree
Technical, trade, or
vocational school
Master’s, Doctorate,
or Professional Degree
Served on active duty military service, not including
training for the Reserves or National Guard
Disabled as the result of illness or injury incurred
or aggravated during military service
42 What is the sex of Owner 3?
Male
No ➜ Go to 48 .
B. (If Yes) Do any of the following characteristics describe
Owner 3’s military service? Mark ✘ all that apply.
Some college,
but no degree
Served on active duty military service after
September 11, 2001
29 What was the age of Owner 2 as of December 31, 2012?
25 – 34
No
completed prior to establishing, purchasing, or acquiring
this business? Mark ✘ ONE box only.
Less than high
Associate Degree
school graduate
Served on active duty military service, not including
training for the Reserves or National Guard
Disabled as the result of illness or injury incurred
or aggravated during military service
45 – 54
Yes
B. (If Yes) Do any of the following characteristics describe
Owner 2’s military service? Mark ✘ all that apply.
28 What is the sex of Owner 2?
Under 25
No
race, for example,
Fijian, Tongan,
and so on. C
41 What was the highest degree or level of school Owner 3
33 A. Has Owner 2 ever served in any branch of the U.S.
Some college,
but no degree
Male
Yes
Other Pacific
Islander - Print
Other Asian - Print
race, for example,
Hmong, Laotian, Thai,
Pakistani, Cambodian,
and so on. C
had Owner 3 ever owned a business or been self-employed?
Yes
High school graduate Diploma or GED
of personal income?
Some other race - Print race C
27 What was the highest degree or level of school Owner 2
completed prior to establishing, purchasing, or acquiring
this business? Mark ✘ ONE box only.
Less than high
Associate Degree
school graduate
39 In 2012, did this business provide Owner 3’s primary source
40 Prior to establishing, purchasing, or acquiring this business,
had Owner 2 ever owned a business or been self-employed?
FORM SBO-1
45 Is Owner 3 of Hispanic, Latino, or Spanish origin?
Yes, Mexican, Mexican Am., Chicano
Founded or started
Don’t know
23 In 2012, which of the following were Owner 2’s function(s)
this survey, Hispanic origins are not races.
Please answer the following questions about Owner 3
listed in 5 on Page 2.
Yes, Puerto Rican
22 In what year did Owner 2 initially acquire ownership of this
45
46
Mark ✘ all that apply.
Yes, Mexican, Mexican Am., Chicano
Founded or started
Please answer BOTH Question
about
☞ NOTE:
Hispanic origin and Question
about race. For
Owner 3
Female
Served on active duty military service after
September 11, 2001
43 What was the age of Owner 3 as of December 31, 2012?
Served on active duty military service in 2012
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2012
None of the above
34 Were more than 2 owners listed in 5 on Page 2?
Yes
Under 25
45 – 54
25 – 34
55 – 64
35 – 44
65 or over
44 Was Owner 3 born a citizen of the United States?
No ➜ Go to 62 on Page 7.
Yes
FORM SBO-1
No
Served on active duty military service in 2012
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2012
None of the above
48 Were more than 3 owners listed in 5 on Page 2?
Yes
No ➜ Go to 62 on Page 7.
§+"5N¤
5
| File Type | application/pdf |
| File Title | sbo1_12_p01_08.g |
| File Modified | 2012-08-21 |
| File Created | 2012-08-21 |