Various Economic Area Pretesting Activities

10012011

8
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
Yes

FORM

No

Copyright

Patent (granted)

OMB No. 0607-0943: Approval Expires 11/30/2015

(11/13/2012)

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

OPY
C
N
O
I
T
A
INFORM SE TO REPORT
U
DO NOT

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

SBO-1

2012 SURVEY OF BUSINESS OWNERS AND
SELF-EMPLOYED PERSONS

76 In 2012, did this business own one or more of the following?

Operated less than 40 hours per week on average

this business? Mark ✘ all that apply.

Yes

Economics and Statistics Administration

U.S. CENSUS BUREAU

home?

Mark ✘ all that apply.

71 In 2012, which of the following types of workers were used by

Yes

U.S. DEPARTMENT OF COMMERCE

Si usted habla español y necesita ayuda para
completar su cuestionario, Ilame sin cargo alguno
al 1-888-824-9954, entre las 8 a.m. y las 6 p.m., hora
del Este, de lunes a 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

5

Investment by venture capitalist(s)

B. (If Yes) Did spouses jointly own this business?
Yes

Business credit card(s) carrying balances

, 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

No

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 or African Am.

American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Asian Indian

Native Hawaiian

Japanese

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 or African Am.

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?

Owner 4 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

No

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Male

Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
No ➜ Go to 62 .

Female

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

58 Was Owner 4 born a citizen of the United States?
Yes

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

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

Female

Served on active duty military service after
September 11, 2001

15 What was the age of Owner 1 as of December 31, 2012?

57 What was the age of Owner 4 as of December 31, 2012?
Under 25

Yes

B. (If Yes) Do any of the following characteristics describe
Owner 4’s military service? Mark ✘ all that apply.

Disabled as the result of illness or injury incurred
or aggravated during military service

56 What is the sex of Owner 4?

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.

Yes

High school graduate Diploma or GED

Yes

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

of personal income?

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?

had Owner 4 ever owned a business or been self-employed?
Yes

11 In 2012, did this business provide Owner 1’s primary source

12 Prior to establishing, purchasing, or acquiring this business,

54 Prior to establishing, purchasing, or acquiring this business,

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

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?
Yes

No

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 or African Am.

American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Asian Indian

Native Hawaiian

Japanese

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 or African Am.

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?

Owner 2 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

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 .

Disabled as the result of illness or injury incurred
or aggravated during military service
Female

25 – 34

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

Female

Served on active duty military service after
September 11, 2001

43 What was the age of Owner 3 as of December 31, 2012?

29 What was the age of Owner 2 as of December 31, 2012?
45 – 54

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

28 What is the sex of Owner 2?

Under 25

Yes

B. (If Yes) Do any of the following characteristics describe
Owner 2’s military service? Mark ✘ all that apply.

Some college,
but no degree

Male

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.

Yes

High school graduate Diploma or GED

Yes

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

of personal income?

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?

had Owner 2 ever owned a business or been self-employed?
Yes

39 In 2012, did this business provide Owner 3’s primary source

40 Prior to establishing, purchasing, or acquiring this business,

26 Prior to establishing, purchasing, or acquiring this business,

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

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

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 or African Am.

American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Asian Indian

Native Hawaiian

Japanese

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 or African Am.

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?

Owner 2 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

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 .

Disabled as the result of illness or injury incurred
or aggravated during military service
Female

25 – 34

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

Female

Served on active duty military service after
September 11, 2001

43 What was the age of Owner 3 as of December 31, 2012?

29 What was the age of Owner 2 as of December 31, 2012?
45 – 54

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

28 What is the sex of Owner 2?

Under 25

Yes

B. (If Yes) Do any of the following characteristics describe
Owner 2’s military service? Mark ✘ all that apply.

Some college,
but no degree

Male

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.

Yes

High school graduate Diploma or GED

Yes

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

of personal income?

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?

had Owner 2 ever owned a business or been self-employed?
Yes

39 In 2012, did this business provide Owner 3’s primary source

40 Prior to establishing, purchasing, or acquiring this business,

26 Prior to establishing, purchasing, or acquiring this business,

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

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

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 or African Am.

American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Asian Indian

Native Hawaiian

Japanese

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 or African Am.

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?

Owner 4 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

No

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Male

Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
No ➜ Go to 62 .

Female

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

58 Was Owner 4 born a citizen of the United States?
Yes

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

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

Female

Served on active duty military service after
September 11, 2001

15 What was the age of Owner 1 as of December 31, 2012?

57 What was the age of Owner 4 as of December 31, 2012?
Under 25

Yes

B. (If Yes) Do any of the following characteristics describe
Owner 4’s military service? Mark ✘ all that apply.

Disabled as the result of illness or injury incurred
or aggravated during military service

56 What is the sex of Owner 4?

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.

Yes

High school graduate Diploma or GED

Yes

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

of personal income?

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?

had Owner 4 ever owned a business or been self-employed?
Yes

11 In 2012, did this business provide Owner 1’s primary source

12 Prior to establishing, purchasing, or acquiring this business,

54 Prior to establishing, purchasing, or acquiring this business,

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

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?
Yes

No

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

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

5

Investment by venture capitalist(s)

B. (If Yes) Did spouses jointly own this business?
Yes

Business credit card(s) carrying balances

, 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

No

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

10012011

8
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
Yes

FORM

No

OMB No. 0607-0943: Approval Expires 11/30/2015

(11/13/2012)

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

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

Economics and Statistics Administration

U.S. CENSUS BUREAU

home?

Mark ✘ all that apply.

71 In 2012, which of the following types of workers were used by

Yes

U.S. DEPARTMENT OF COMMERCE

Si usted habla español y necesita ayuda para
completar su cuestionario, Ilame sin cargo alguno
al 1-888-824-9954, entre las 8 a.m. y las 6 p.m., hora
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§+"5,¤