Persinal interview worksheet for supplier and support bu

DRAFT

2014

Southwest Alaska Fisheries Data Collection Project

CONFIDENTIAL

Personal Interview Worksheet for

Supplier and Support Businesses

Conducted by

NOAA Fisheries

Alaska Fisheries Science Center

OMB Approval No. XXXX-XXXX

Expiration Date YYYY

Instructions

This worksheet contains the information we will be asking you about in the interview. Please examine the worksheet and have it available during the interview. The interviewer will answer any questions and help fill out the worksheet during the interview. You do not need to fill out or return a completed worksheet prior to the interview. your responses ARE VOLUNTARY AND will be strictly confidential and used only to estimate the economic contributions of sw alaska fisheries to southwest alaska and other u.s. regions.

Confidentiality

Per Section 402(b) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.), all individual survey responses are confidential and will be held by only a limited number of researchers at Alaska Fisheries Science Center and contractors who are authorized to work with the data. After the data have been entered in an electronic format, only those researchers will have (password-protected) access to the data. Individual survey forms and electronic responses will be destroyed upon completion of the study. Your name, business name, and address will be used only for mailing and survey administration purposes. Only summary results of this survey will be reported to the public. NOAA Fisheries and other agencies will see only aggregate results in summary form, not individual responses.

YOUR RESPONSES AND THE DATA COLLECTED FROM THIS SURVEY WILL NOT BE SEEN OR USED FOR ANY OTHER PURPOSE BY NOAA FISHERIES, OTHER FEDERAL GOVERNMENT AGENCIES, THE STATE OF ALASKA OR OTHER PARTIES.

Paperwork Reduction Act Statement

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the form. Please send comments regarding this burden estimate or any other suggestions for reducing this burden to Chang Seung, Alaska Fisheries Science Center (Address: 7600 Sand Point Way NE Seattle WA 98115-6349), Phone: 206-526-4250 Email: [email protected]

Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid U.S. Office of Management and Budget Approval Number. This collection of information has been approved by the U.S. Office of Management and Budget (Approval Number XXXX-XXXX expiration date yyyy).

Content

This worksheet is designed to ask pertinent questions needed to characterize the role of commercial fishing and related businesses in the Southwest Alaska (SW Alaska) economy and elsewhere. For purposes of this survey, the SW Alaska economy includes the following boroughs and census areas (BCAs): Aleutians West Census Area (AW), Aleutians East Borough (AE), Bristol Bay Borough (BB), Dillingham Census Area (DH), Lake and Peninsula Borough (LP), and Kodiak Island Borough (KI).

The worksheet contains three sections. Section A contains business contact information, which we have pre-filled. Section B asks for information about your customer base and where you sell products and services. Section C asks where your primary business operating expenditures are made.

Please record your responses to the following questions so as to reflect your business operations.

Section A: Contact Information (Please make any corrections.)

	Information on Record	Corrections, if any
Supplier Name:	New Nets Co.
Address:
	Kodiak AK 99615
Contact Pson:	Perchis Erman
Phone:	555-555-1234
Email:	[email protected]
Interview Date:	Jan. aa, 20XX

Section B: Customer base and products and services sold

1. Who are your customers? (e.g., vessels, processors, other commercial fishing industry businesses, recreational fishing businesses, repair yards, other)

1. Primary: ____________________________________________________

2. Secondary: _________________________________________________

3. Other: _____________________________________________________

2. What products and services do you offer?

   1. ________________________________

   2. ________________________________

   3. ________________________________

   4. ________________________________

   5. ________________________________

   6. ________________________________

3. What proportion of those products and services are sold to buyers in the following regions?

Item	Approximate Percentage of Item Sales to Buyers in:
	Southwest Alaska BCAs*						Other Alaska	West Coast	Other US	Outside the US	Total
	AW	AE	BB	DH	LP	KI
a.											100%
b.											100%
c.											100%
d.											100%
e.											100%
f.											100%
											100%
*Southwest Alaska BCAs: AW=Aleutians West Census Area, AE=Aleutians East Borough, BB=Bristol Bay Borough, DH=Dillingham Census Area, LP=Lake and Peninsula Borough, and KI=Kodiak Island Borough (see map).

Section C: Regional distribution of business operating expenditures?

4. Where were your purchases and primary business operating expenditures made? (Including where do your employees reside?). (“I” = inventory item).

Item	Approximate Percentage of Item Purchases Made in:
	Southwest Alaska BCAs*						Other Alaska	West Coast	Other US	Outside the US	Total
	AW	AE	BB	DH	LP	KI
Labor											100%
Utilities											100%
Accounting											100%
Other											100%
I1:											100%
I2:											100%
I3:											100%
I4:											100%
*Southwest Alaska BCAs: AW=Aleutians West Census Area, AE=Aleutians East Borough, BB=Bristol Bay Borough, DH=Dillingham Census Area, LP=Lake and Peninsula Borough, and KI=Kodiak Island Borough (see map).

Map of Southwest Alaska BCAs and Associated Communities

SW Alaska Boroughs & Census Areas	Associated Communities
Aleutian West Census Area (AW)	Atak, Adak, Nikolski, St. Paul, St. George, Unalaska (Dutch Harbor)
Aleutian East Borough (AE)	Akutan, Belkofski Village,  Cold Bay, False Pass, King Cove, Nelson Lagoon, Pauloff Harbor, Sand Point, Unga
Bristol Bay Borough (BB)	King Salmon, Naknek, South Naknek
Dillingham Census Area (DH)	Aleknagik, Clarks Point, Dillingham, Ekwok, Ekuk, Koliganek, Manokotak, New Stuyahok, Portage Creek, Twin Hills, Togiak
Lake and Peninsula Borough (LP)	Chignik Lake, Chignik Lagoon, Chignik, Egegik, Ivanoff Bay, Iliamna, Igiugig, Kokhanok, Levelock, Nondalton, Newhalen, Port Heiden, Port Alsworth, Pilot Point, Perrysville, Pedro Bay, Ugashik
Kodiak Island Borough (KI)	Akhiok, Afognak, Kodiak, Karluk, Larsen Bay, Ouzinkie, Old Harbor, Port Lions

Comments:

Customer Base Comments

Products and Services Sold Comments

Regional Distribution of Expenditures Comments

Comments on Interview Questions and Other Comments

THANK YOU FOR YOUR PARTICIPATION!