Form 1 2017 ABS Questionnaire

Welcome to the 2017 Annual Business Survey
DO NOT use this worksheet to respond to the survey, it is intended to assist you with gathering and preparing your data
prior to reporting online. Please view the online report for specific instructions.
Return to https://portal.census.gov when you are ready to report online.

SECTION A: COMPANY INFORMATION
The following section collects information on the operations and structure of the business. All businesses that receive
this questionnaire should answer questions in the upcoming section.
CEASED OPERATION
Has this business ceased operations?
Yes
No – Skip to BUSINESS OWNERSHIP - FOREIGN ENTITY
REASON OPERATIONS CEASED
Why did this business cease operations? Select all that apply.
Owner’s military deployment
Owner’s illness or injury
Owner(s) retired
Owner(s) deceased
Operated for a specific or one-time event
Inadequate cash flow or low sales
Lack of business loans/credit
Lack of personal loans/credit
Started another business
Sold this business
Other
DATE CEASED OPERATIONS
Enter the month and year this business ceased operations.
Month
Year
_____
____
If ceased date is before January 2017, skip to SECTION G: CONTACT INFORMATION.
BUSINESS OWNERSHIP – FOREIGN ENTITY
In 2017, was this business a majority-owned subsidiary of a foreign company?
Yes
No
If “Yes”, note the reporting unit for the survey is the U.S. located business.
BUSINESS OWNERSHIP – U.S. ENTITY
In 2017, did another U.S. company or other entity own more than 50 percent of this business? Examples of other
entities include estates, trusts, employee stock ownership plans (ESOPs), associations, membership clubs, and
cooperatives.
Yes – Skip to BUSINESS - 10% or MORE OWNERSHIP
No
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BUSINESS OWNERSHIP – GOVERNMENT OR TRIBAL ENTITY
In 2017, was this business owned by a government or tribal entity?
Yes
No
BUSINESS - 10% or MORE OWNERSHIP
In 2017, did at least one person own 10% or more of this business? (Do not count parent companies, estates, trusts
or other entities.)
Yes
No - Select “No” ONLY if no person owned 10% or more of this business.
NUMBER OF OWNERS
In 2017, how many people owned this business?
• Do not combine two or more owners to create one owner.
• Count spouses and partners as separate owners.
1 person
2 people
3 people
4 people
5-10 people
11 or more people
Don’t know
NUMBER OF PAID OWNERS
Of the owners reported in the ‘NUMBER OF OWNERS’ question, how many received a W-2 issued by this
business for salary or wages? If none, report zero.
_________
NUMBER OF EMPLOYEES
For the pay period including March 12, 2017, how many people worked for this business, including those paid through
grants? Include both full-time and part-time workers as well as yourself. Count each person only once. If none, report zero.
Non-Owners
a. Employees who received a W-2 issued by this business for salary or wages

Number of People
_________

b. Individuals who received payment in other ways
(for example, contractors/ consultants/temporary workers
who received a 1099 or payment from another business)

_________

c. Unpaid individuals who worked for the business
(for example, interns, friends, family members)

_________

TOTAL SALES AND REVENUES
What was the amount of this business’s sales and revenues, including grants, during 2017? Report dollar amount in
thousands. If none, report zero.
2017 sales, revenues, and grants

$Bil. Mil. Thou.
__________,000

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SOURCES OF SALES AND REVENUE
Approximately what share of this business’s 2017 sales and revenues, including grants, came from the
following? If none, report zero.
____%
a. Selling goods to customers, including other businesses
b. Selling services to customers, including other businesses

____%

c. Licensing

____%

d. Grants

____%

e. Other (specify):

____%

______________________________________
DOMESTIC SALES AND REVENUES
How much of the ‘TOTAL SALES AND REVENUES’ in 2017 sales, revenue, and grants was attributable to or originated from
domestic operations? Include sales and operating revenues to foreign customers, including foreign subsidiaries. For
example, a U.S. manufacturing corporation sells parts to customers around the world, however, because all of its
operations are located inside the United States it reports 100% of its sales in this question. Report dollar amount in
thousands. If none, report zero.
$Bil. Mil. Thou.
__________,000
PRIMARY BUSINESS ACTIVITY
Describe this business’s primary business activity during 2017.

SECTION B: OWNER CHARACTERISTICS
The following section collects information on the owners of the business. Based on the number of owners you reported
in the Company Information section, you may be asked to complete this section for up to four owners of the business.
Unless otherwise indicated, the reporting period for this section is calendar year 2017.
PERCENT OWNERSHIP
For the person(s) owning the largest percentage(s) in this business in 2017, please list each person’s name and
percentage owned.
 Do not report percentages owned by parent companies, estates, trusts, or other entities.
 If more than 4 people owned this business equally, select any 4 people.
 Round percentages to whole numbers. For example, report 1/3 ownership as 33%.
Percentage Owned
Name of Owner

(Estimates are acceptable)

Name:
Name:
Name:
Name:

______________________________________________
______________________________________________
______________________________________________
______________________________________________

Owner 1:
Owner 2:
Owner 3:
Owner 4:

____%
____%
____%
____%

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OWNER 1 - If applicable, if not skip to page 16
SEX
What is the sex of Owner 1?
Male
Female
ETHNICITY
Is Owner 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin—
Enter origin, for example, Argentinean, Colombian,
Dominican, Nicaraguan, Salvadoran, Spaniard, and
so on.
_________________________________________
RACE
What is Owner 1’s race? Select all that apply. (For this
survey, Hispanic origins are not races.)
White
Black or African American
American Indian or Alaska Native—Enter name of
enrolled or principal tribe.

MILITARY SERVICE
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
No – Skip to INITIAL ACQUISTION
MILITARY SERVICE DISABILITY
Is Owner 1 disabled as the result of illness or injury
incurred or aggravated during military service?
Yes
No
OTHER MILITARY SERVICE
Do any of the following characteristics describe Owner 1’s
military service? Select all that apply.
Served on active duty military service, not including
training for the Reserves or National Guard
Served on active duty military service after
September 11, 2001
Served on active duty military service in 2017
Served in the National Guard or as a reservist of any
branch of the U.S. Armed Forces in 2017
None of the above

_________________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian—Enter race, for example, Hmong,
Laotian, Thai, Pakistani, Cambodian, and so on.
_________________________________________
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander—Enter race, for example,
Fijian, Tongan, and so on.
_________________________________________

INITIAL ACQUISITION
How did Owner 1 initially acquire ownership of this
business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 1 initially acquire ownership of
this business?
Year
Don’t know
_____
JOB FUNCTION(S)
In 2017, which of the following were Owner 1’s
function(s) in this business? Select all that apply.
Managing day-to-day operations
Providing services and/or producing goods
Financial control with the authority to sign loans,
leases, and contracts
None of these functions
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AVERAGE NUMBER OF HOURS WORKED
In 2017, what was the average number of hours per
week that 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
PRIMARY INCOME SOURCE
In 2017, did this business provide Owner 1’s primary
source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this
business, how many previous businesses has Owner 1
owned? (Include self-employed businesses.)
0 – Skip to EDUCATION PRIOR TO OWNING THE
BUSINESS
1
2
3
4
5 or more
PRIOR BUSINESS OWNERSHIP - CONTINUED
Not including this business, what is the status of the
previous business Owner 1 started most recently?
Business is still operating and Owner 1 still owns it
Business is no longer in operation
Business was purchased by another company
Business was purchased by another individual
Other (specify):
__________________________________________
EDUCATION PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the highest degree or level of school
Owner 1 completed?
Less than high school / secondary school graduate –
Skip to AGE
High school / secondary school graduate Diploma or GED – Skip to AGE
Technical, trade, or vocational school – Skip to AGE
Some college, but no degree – Skip to AGE
Associate Degree (for example, AA, AS) –
Skip to AGE
Bachelor’s Degree (for example, BA, BS)

Masters Degree (for example, MA, MEng, Med,
MSW, MBA)
Doctorate Degree (for example, PhD, EdD)
Professional Degree, beyond a Bachelor’s Degree
(for example, MD, DDS, DVM, LLB, JD)
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE
BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the field of the highest degree
completed for Owner 1? Select all that apply.
Biological, agricultural and environmental life
sciences
Chemistry, except biochemistry
Computer and mathematical sciences and other
technology and technical fields
Earth, atmospheric and ocean sciences
Economics, political, psychology, sociology and
other social sciences
Engineering
Health
Physics and astronomy
Science and mathematics teacher education
Other science and engineering related fields, not
listed above
Art and humanities fields
Education, except science and math teacher
education
Management and administration fields
Sales and marketing fields
Social service and related fields
Other non-science and non-engineering related
fields, not listed above
AGE
What was the age of Owner 1 as of December 31, 2017?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Is Owner 1 a citizen of the United States?
Yes
No
PLACE OF BIRTH
Was Owner 1 born in the United States?
Yes
No
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REASONS FOR OWNING THE BUSINESS
How important to Owner 1 are each of the following reasons for owning this business? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income
Best avenue for my ideas/goods/services
Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a role model
Wanted to carry on the family business
Wanted to help and/or become more involved in my community
Other (specify)
_______________________________________________________________________________________

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OWNER 2 - If applicable, if not skip to page 16
SEX
What is the sex of Owner 2?
Male
Female
ETHNICITY
Is Owner 2 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin Yes,
Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin—
Enter origin, for example, Argentinean, Colombian,
Dominican, Nicaraguan, Salvadoran, Spaniard, and
so on.
_______________________________________
RACE
What is Owner 2’s race? Select all that apply. (For this
survey, Hispanic origins are not races.)
White
Black or African American
American Indian or Alaska Native—Enter name of
enrolled or principal tribe.
_______________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian—Enter race, for example, Hmong,
Laotian, Thai, Pakistani, Cambodian, and so on.
_________________________________________
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander—Enter race, for example,
Fijian, Tongan, and so on.
__________________________________________

MILITARY SERVICE
Has Owner 2 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
No – Skip to INITIAL ACQUISTION
MILITARY SERVICE DISABILITY
Is Owner 2 disabled as the result of illness or injury
incurred or aggravated during military service?
Yes
No
OTHER MILITARY SERVICE
Do any of the following characteristics describe Owner 2’s
military service? Select all that apply.
Served on active duty military service, not including
training for the Reserves or National Guard
Served on active duty military service after
September 11, 2001
Served on active duty military service in 2017
Served in the National Guard or as a reservist of any
branch of the U.S. Armed Forces in 2017
None of the above
INITIAL ACQUISITION
How did Owner 2 initially acquire ownership of this
business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 2 initially acquire ownership of
this business?
Year
Don’t know
_____
JOB FUNCTION(S)
In 2017, which of the following were Owner 2’s
function(s) in this business? Select all that apply.
Managing day-to-day operations
Providing services and/or producing goods
Financial control with the authority to sign loans,
leases, and contracts
None of these functions
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AVERAGE NUMBER OF HOURS WORKED
In 2017, what was the average number of hours per
week that 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
PRIMARY INCOME SOURCE
In 2017, did this business provide Owner 2’s primary
source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this
business, how many previous businesses has Owner 2
owned? (Include self-employed businesses.)
0 – Skip to EDUCATION PRIOR TO OWNING THE
BUSINESS
1
2
3
4
5 or more
PRIOR BUSINESS OWNERSHIP - CONTINUED
Not including this business, what is the status of the
previous business Owner 2 started most recently?
Business is still operating and Owner 2 still owns it
Business is no longer in operation
Business was purchased by another company
Business was purchased by another individual
Other (specify):
__________________________________________
EDUCATION PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the highest degree or level of school
Owner 2 completed?
Less than high school / secondary school graduate –
Skip to AGE
High school / secondary school graduate Diploma or GED – Skip to AGE
Technical, trade, or vocational school – Skip to AGE
Some college, but no degree – Skip to AGE
Associate Degree (for example, AA, AS) –
Skip to AGE
Bachelor’s Degree (for example, BA, BS)
Masters Degree (for example, MA, MEng, Med,
MSW, MBA)

Doctorate Degree (for example, PhD, EdD)
Professional Degree, beyond a Bachelor’s Degree
(for example, MD, DDS, DVM, LLB, JD)
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE
BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the field of the highest degree
completed for Owner 2? Select all that apply.
Biological, agricultural and environmental life
sciences
Chemistry, except biochemistry
Computer and mathematical sciences and other
technology and technical fields
Earth, atmospheric and ocean sciences
Economics, political, psychology, sociology and
other social sciences
Engineering
Health
Physics and astronomy
Science and mathematics teacher education
Other science and engineering related fields, not
listed above
Art and humanities fields
Education, except science and math teacher
education
Management and administration fields
Sales and marketing fields
Social service and related fields
Other non-science and non-engineering related
fields, not listed above
AGE
What was the age of Owner 2 as of December 31, 2017?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Is Owner 2 a citizen of the United States?
Yes
No
PLACE OF BIRTH
Was Owner 2 born in the United States?
Yes
No

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REASONS FOR OWNING THE BUSINESS
How important to Owner 2 are each of the following reasons for owning this business? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income
Best avenue for my ideas/goods/services
Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a role model
Wanted to carry on the family business
Wanted to help and/or become more involved in my community
Other (specify)
_______________________________________________________________________________________

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OWNER 3 - If applicable, if not skip to page 16
SEX
What is the sex of Owner 3?
Male
Female
ETHNICITY
Is Owner 3 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin—
Enter origin, for example, Argentinean, Colombian,
Dominican, Nicaraguan, Salvadoran, Spaniard, and
so on.
__________________________________________
RACE
What is Owner 3’s race? Select all that apply. (For this
survey, Hispanic origins are not races.)
White
Black or African American
American Indian or Alaska Native—Enter name of
enrolled or principal tribe.
__________________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian—Enter race, for example, Hmong,
Laotian, Thai, Pakistani, Cambodian, and so on.
_________________________________________
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander—Enter race, for example,
Fijian, Tongan, and so on.
________________________________________

MILITARY SERVICE
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
No – Skip to INITIAL ACQUISTION
MILITARY SERVICE DISABILITY
Is Owner 3 disabled as the result of illness or injury
incurred or aggravated during military service?
Yes
No
OTHER MILITARY SERVICE
Do any of the following characteristics describe Owner 3’s
military service? Select all that apply.
Served on active duty military service, not including
training for the Reserves or National Guard
Served on active duty military service after
September 11, 2001
Served on active duty military service in 2017
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2017
None of the above
INITIAL ACQUISITION
How did Owner 3 initially acquire ownership of this
business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 3 initially acquire ownership of
this business?
Year
Don’t know
_____
JOB FUNCTION(S)
In 2017, which of the following were Owner 3’s
function(s) in this business? Select all that apply.
Managing day-to-day operations
Providing services and/or producing goods
Financial control with the authority to sign loans,
leases, and contracts
None of these functions
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AVERAGE NUMBER OF HOURS WORKED
In 2017, what was the average number of hours per
week that 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
PRIMARY INCOME SOURCE
In 2017, did this business provide Owner 3’s primary
source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this
business, how many previous businesses has Owner 3
owned? (Include self-employed businesses.)
0 – Skip to EDUCATION PRIOR TO OWNING THE
BUSINESS
1
2
3
4
5 or more
PRIOR BUSINESS OWNERSHIP - CONTINUED
Not including this business, what is the status of the
previous business Owner 3 started most recently?
Business is still operating and Owner 3 still owns it
Business is no longer in operation
Business was purchased by another company
Business was purchased by another individual
Other (specify):
__________________________________________
EDUCATION PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the highest degree or level of school
Owner 3 completed?
Less than high school / secondary school graduate –
Skip to AGE
High school / secondary school graduate Diploma or GED – Skip to AGE
Technical, trade, or vocational school – Skip to AGE
Some college, but no degree – Skip to AGE
Associate Degree (for example, AA, AS) –
Skip to AGE
Bachelor’s Degree (for example, BA, BS)

Masters Degree (for example, MA, MEng, Med,
MSW, MBA)
Doctorate Degree (for example, PhD, EdD)
Professional Degree, beyond a Bachelor’s Degree
(for example, MD, DDS, DVM, LLB, JD)
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE
BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the field of the highest degree
completed for Owner 3? Select all that apply.
Biological, agricultural and environmental life
sciences
Chemistry, except biochemistry
Computer and mathematical sciences and other
technology and technical fields
Earth, atmospheric and ocean sciences
Economics, political, psychology, sociology and
other social sciences
Engineering
Health
Physics and astronomy
Science and mathematics teacher education
Other science and engineering related fields, not
listed above
Art and humanities fields
Education, except science and math teacher
education
Management and administration fields
Sales and marketing fields
Social service and related fields
Other non-science and non-engineering related
fields, not listed above
AGE
What was the age of Owner 3 as of December 31, 2017?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Is Owner 3 a citizen of the United States?
Yes
No
PLACE OF BIRTH
Was Owner 3 born in the United States?
Yes
No
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REASONS FOR OWNING THE BUSINESS
How important to Owner 3 are each of the following reasons for owning this business? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income
Best avenue for my ideas/goods/services
Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a role model
Wanted to carry on the family business
Wanted to help and/or become more involved in my community
Other (specify)
______________________________________________________________________________________

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OWNER 4 - If applicable, if not skip to page 16
SEX
What is the sex of Owner 4?
Male
Female
ETHNICITY
Is Owner 4 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin—
Enter origin, for example, Argentinean, Colombian,
Dominican, Nicaraguan, Salvadoran, Spaniard, and
so on.
_________________________________________
RACE
What is Owner 4’s race? Select all that apply. (For this
survey, Hispanic origins are not races.)
White
Black or African American
American Indian or Alaska Native—Enter name of
enrolled or principal tribe.
_________________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian—Enter race, for example, Hmong,
Laotian, Thai, Pakistani, Cambodian, and so on.
_________________________________________
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander—Enter race, for example,
Fijian, Tongan, and so on.
_________________________________________

MILITARY SERVICE
Has Owner 4 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
No – Skip to INITIAL ACQUISTION
MILITARY SERVICE DISABILITY
Is Owner 4 disabled as the result of illness or injury
incurred or aggravated during military service?
Yes
No
OTHER MILITARY SERVICE
Do any of the following characteristics describe Owner 4’s
military service? Select all that apply.
Served on active duty military service, not including
training for the Reserves or National Guard
Served on active duty military service after
September 11, 2001
Served on active duty military service in 2017
Served in the National Guard or as a reservist of any
branch of the U.S. Armed Forces in 2017
None of the above
INITIAL ACQUISITION
How did Owner 4 initially acquire ownership of this
business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 4 initially acquire ownership of
this business?
Year
Don’t know
_____
JOB FUNCTION(S)
In 2017, which of the following were Owner 4’s
function(s) in this business? Select all that apply.
Managing day-to-day operations
Providing services and/or producing goods
Financial control with the authority to sign loans,
leases, and contracts
None of these functions
13

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AVERAGE NUMBER OF HOURS WORKED
In 2017, what was the average number of hours per
week that 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
PRIMARY INCOME SOURCE
In 2017, did this business provide Owner 4’s primary
source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this
business, how many previous businesses has Owner 4
owned? (Include self-employed businesses.)
0 – Skip to EDUCATION PRIOR TO OWNING THE
BUSINESS
1
2
3
4
5 or more
PRIOR BUSINESS OWNERSHIP - CONTINUED
Not including this business, what is the status of the
previous business Owner 4 started most recently?
Business is still operating and Owner 4 still owns it
Business is no longer in operation
Business was purchased by another company
Business was purchased by another individual
Other (specify):
___________________________________________
EDUCATION PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the highest degree or level of school
Owner 4 completed?
Less than high school / secondary school graduate –
Skip to AGE
High school / secondary school graduate Diploma or GED – Skip to AGE
Technical, trade, or vocational school – Skip to AGE
Some college, but no degree – Skip to AGE
Associate Degree (for example, AA, AS) –
Skip to AGE
Bachelor’s Degree (for example, BA, BS)

Masters Degree (for example, MA, MEng, Med,
MSW, MBA)
Doctorate Degree (for example, PhD, EdD)
Professional Degree, beyond a Bachelor’s Degree
(for example, MD, DDS, DVM, LLB, JD)
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE
BUSINESS
Prior to establishing, purchasing, or acquiring this
business, what was the field of the highest degree
completed for Owner 4? Select all that apply.
Biological, agricultural and environmental life
sciences
Chemistry, except biochemistry
Computer and mathematical sciences and other
technology and technical fields
Earth, atmospheric and ocean sciences
Economics, political, psychology, sociology and
other social sciences
Engineering
Health
Physics and astronomy
Science and mathematics teacher education
Other science and engineering related fields, not
listed above
Art and humanities fields
Education, except science and math teacher
education
Management and administration fields
Sales and marketing fields
Social service and related fields
Other non-science and non-engineering related
fields, not listed above
AGE
What was the age of Owner 4 as of December 31, 2017?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Is Owner 4 a citizen of the United States?
Yes
No
PLACE OF BIRTH
Was Owner 4 born in the United States?
Yes
No
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REASONS FOR OWNING THE BUSINESS
How important to Owner 4 are each of the following reasons for owning this business? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income
Best avenue for my ideas/goods/services
Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a role model
Wanted to carry on the family business
Wanted to help and/or become more involved in my community
Other (specify)
_______________________________________________________________________________________

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SECTION C: INNOVATION
The following section collects information on the business’s innovations and innovation activities. An innovation is the
introduction of a new or significantly improved product, process, organizational method, or marketing method by this
business.
An innovation must have characteristics or intended uses that are new or which provide a significant improvement over
what was previously used or sold by the business. However, an innovation can fail or take time to prove itself.
An innovation need only be new or significantly improved for the business. It could have been originally developed or
used by other businesses or organizations.
The following section asks about the three previous years including the calendar year 2017 instead of one year as in
other sections of this questionnaire.
INNOVATION BUSINESS STRATEGIES
During the three years 2015 to 2017, how important were each of the following strategies to this business?
Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
a. Focus on improving existing goods or services
b. Focus on introducing new goods or services
c. Focus on reaching new customer groups
d. Focus on customer-specific solutions
e. Focus on low price
f.

Focus on reducing costs

g. Focus on satisfying key customers
h. Focus on developing niche or specialized markets
i.

Focus on opening up new domestic markets

j.

Focus on opening up new export markets

k. Focus on internal processes/improve internal processes
l.

Focus on improving delivery of existing products or services

m. Focus on employee skills/improve work force
n. Focus on understanding and/or meeting customer needs
GOODS OR SERVICES OFFERED
During the three years 2015 to 2017, did this business sell any goods or offer any services?
Yes
No– Skip to ORGANIZATIONAL AND MARKETING INNOVATION
PRODUCT INNOVATION
During the three years 2015 to 2017, did this business introduce new or significantly improved: Select one for each row.
Yes
No
Not Applicable
a. Goods. (exclude the simple resale of new goods and changes
of a solely aesthetic nature). A good is usually a tangible
object such as a smartphone, furniture, or packaged
software, but downloadable software, music and film
are also goods.
b. Services. A service is usually intangible, such as retailing,
insurance, educational courses, air travel, consulting, etc.
If “No” is selected for a. and b., skip to PROCESS INNOVATION.
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BUSINESS PRODUCT INNOVATION
During the three years 2015 to 2017, were any of this business’s product innovations (goods or services):
Select one for each row.
Yes
No
New to the market? This business introduced a new or
significantly improved product (good or service) into your
market before its competitors (it may have already been
available in other markets)
Only new to this business? This business introduced a new
or significantly improved product (good or service) that was
already available from its competitors in the market
PERCENT OF SALES FROM PRODUCT INNOVATION
Include your total sales only for the year 2017. Give the percent of total sales in 2017 only from:
a. New or significantly improved products (goods or services) introduced during the
three years 2015 to 2017, that were new to the market
b. New or significantly improved products (goods or services) introduced during the
three years 2015 to 2017, that were only new to this business

____%
____%

c. Products (goods or services) that were unchanged or only marginally modified
during the three years 2015 to 2017, (include the resale of new products purchased
____%
from other companies)
Total sales from 2017 100%
PROCESS INNOVATION
During the three years 2015 to 2017, did this business introduce new or significantly improved:
Yes
No
a. Methods of manufacturing for producing goods or services

Not Applicable

b. Logistics, delivery or distribution methods for inputs, goods
or services
c. Supporting activities for processes, such as maintenance
systems or operations for purchasing, accounting, or
computing
If “No” is selected for a. and b. from the PRODUCT INNOVATION question AND “No” is selected for a. – c.
from the PROCESS INNOVATION question, skip to ORGANIZATIONAL AND MARKETING INNOVATION.

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PRODUCT OR PROCESS INNOVATION ACTIVITIES
Innovation activities include the acquisition of machinery, equipment, buildings, software, and licenses; engineering and
development work, feasibility studies, design, training, R&D and marketing when they are specifically undertaken to
develop and/or implement a product or process innovation. This includes also all types of research and development
activities to create new knowledge or solve scientific or technical problems.
During the three years 2015 to 2017, did this business engage in the following product or process innovation activities?
Select one for each row.
Product or process innovation activities only
Yes
No
a. In-house R&D Research and development activities undertaken by this business
to create new knowledge, solve scientific or technical problems, or devise new
applications of available knowledge (include software development that meets this
requirement)
If yes, did this business perform R&D during the three years 2015 to 2017:
Continuously (business had permanent R&D staff in-house)
Occasionally (as needed only)
b. External R&D This business contracted-out R&D to other companies or to public or
private research organizations
c. Acquisition of machinery, equipment, software & buildings New machinery,
equipment software and buildings that were acquired for the purpose of developing
new or significantly improved goods, services, manufacturing or logistics
d. Acquisition of existing knowledge from other companies or organizations Acquisition
of existing know-how, copyrighted works, patented and non-patented inventions, etc.
from other companies or organizations for the development of new
or significantly improved products and processes
e. Training for innovative activities In-house or contracted out training for your personnel
specifically for the development and/or introduction of new or significantly improved
products and processes
f.

Market introduction of innovations In-house or contracted out activities for the market
introduction of your new or significantly improved goods or services, including market
research, launch advertising, and social media announcements

g. Brand Building In-house or contracted out activities such as advertising or promotion to
build this business’s brand identity or brand name
h. Design In-house or contracted out activities to alter the shape, appearance or usability
of goods or services
i.

Other Other in-house or contracted out activities to develop or implement new or
significantly improved products or processes such as feasibility studies, testing,
industrial engineering, etc.

RESULTS OF INNOVATION ACTIVITIES
During the three years 2015 to 2017, did this business have any innovation activities that did not result in a product or
process innovation because the activities were: Select one for each row.
Yes
No
a. Abandoned or suspended before completion
b. Still ongoing at the end of 2017

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PUBLIC FINANCIAL SUPPORT FOR INNOVATION ACTIVITIES
During the three years 2015 to 2017, did this business receive any public financial support for innovation activities from
the following levels of U.S. government? Include financial support via tax credits, grants, subsidized loans, and loan
guarantees. Exclude R&D and other innovation activities conducted entirely for the public sector under contract.
Select one for each row.
Yes
No
a. Local or State Government
b. U.S. Federal Government
INNOVATION ACTIVITIES BY TYPE AND LOCATION OF COOPERATION PARTNER
During the three years 2015 to 2017, with which of the following companies or organizations and indicating their
location, did this business cooperate with on any of its innovation activities? Innovation cooperation is active
participation with other companies or organizations on innovation activities. Both partners do not need to commercially
benefit. Exclude work that is contracted out. Select all that apply.
Type and Location of Cooperation Partner
a. Other affiliated companies
(legal entities under common ownership)

United States

All other countries

Not applicable

b. Suppliers of equipment, materials, components,
or software
c. Clients or customers from the private sector
d. Clients or customers from the public sector
e. Competitors or other companies in your sector
f.

Companies not in your sector

g. Consultants or commercial labs
h. Universities or other higher education institutes
i.

Government or public research institutes

j.

Private research institutes

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ORGANIZATIONAL AND MARKETING INNOVATION
During the three years 2015 to 2017, did this business introduce new: Select one for each row.
Yes

No

a. Business practices for organizing procedures (for example, first time use of supply
chain management, business re-engineering, knowledge management,
lean production, quality management, etc.)
b. Methods of organizing work responsibilities and decision making
(for example, first time use of a new system of employee responsibilities, team work,
decentralization, integration or de-integration of departments,
education/training systems, etc.)
c. Methods of organizing external relations with other companies or public
organizations (for example, first time use of alliances, partnerships, outsourcing
or sub-contracting, etc.)
d. Aesthetic design or packaging of a good or service (exclude changes that alter the
product’s functional or user characteristics – these are product innovations)
e. Media or techniques for product promotion (for example, first time use of a new
advertising media, a new brand image, introduction of loyalty cards, etc.)
f.

Methods for product placement or sales channels (for example, first time use of
franchising or distribution licenses, direct selling, exclusive retailing, new concepts
for product presentation, etc.)

g. Methods of pricing goods or services (for example, first time use of variable pricing
by demand, discount systems, etc.)
If “No” is selected for a. and b. from the PRODUCT INNOVATION question AND “No” is selected for a. – c. from the
PROCESS INNOVATION question AND “No” is selected for a. – g. from the ORGANIZATIONAL AND MARKETING
INNOVATION question, skip to BUSINESS REASONS FOR NOT INNOVATING.
FACTORS INTERFERING WITH BUSINESS INNOVATION
During the three years 2015 to 2017, how important were the following factors in interfering with this business’s ability
to innovate? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
a. Lack of internal finance
b.

Lack of credit or private equity

c.

Innovation costs too high

d.

Lack of skilled employees within the business

e.

Lack of collaboration partners

f.

Difficulties in obtaining government grants or subsidies

g.

Uncertain market demand for your ideas

h.

Too much competition in your market

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REGULATIONS AND INNOVATION
What is the effect of the following types of legislation or regulations on this business’s innovation activities during the
three years 2015 to 2017? Select all that apply.
Generated
Created no
an
Stimulated
major
Created
excessive
Not
Legislation or regulation
Innovation
problems
uncertainty
burden
applicable
Product safety /consumer protection
Operational and worker safety
Environmental
Intellectual property
Tax
Employment or social affairs
Other, specify
___________________________________________________________________________
Skip to SECTION D: RESEARCH AND DEVELOPMENT
BUSINESS REASONS FOR NOT INNOVATING
Which of the following best describes why this business had no innovation activities during the three years 2015 to 2017:
No compelling reason to innovate – Skip to REASONS FOR NOT INNOVATING
Considered innovating, but too many issues prevented it
FACTORS PREVENTING INNOVATION
During the three years 2015 to 2017, how important were the following factors in preventing this business from
innovating? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
a. Lack of internal finance
b. Lack of credit or private equity
c. Innovation costs too high
d. Lack of skilled employees within the business
e. Lack of collaboration partners
f.

Difficulties in obtaining government grants or subsidies

g. Uncertain market demand for your ideas
h. Too much competition in your market
i.

Legislation/regulation that generated excessive burden

j.

Legislation/regulation that created uncertainty

k. Legislation/regulation that lacked consistency across the
United States
Skip to SECTION D: RESEARCH AND DEVELOPMENT

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REASONS FOR NOT INNOVATING
How important were the following reasons for this business not to conduct innovation activities during the three years
2015 to 2017? Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
a. Low demand for innovations in your market
b. No need to innovate due to previous innovations
c. No need to innovate due to very little competition in the
business’s market
d. Lack of good ideas for innovations

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SECTION D: RESEARCH AND DEVELOPMENT
The following section collects information on research and development activity from businesses.
What is Research and Development (R&D)?
Research and development (R&D) comprise creative and systematic work undertaken in order to increase the stock of
knowledge and to devise new applications of available knowledge.
R&D activity in software INCLUDES:
• Software development or improvement activities that expand scientific or technological knowledge
• Construction of new theories and algorithms in the field of computer science
R&D activity in software EXCLUDES:
• Software development that does not depend on a scientific or technological advance, such as
o supporting or adapting existing systems
o adding functionality to existing application programs, and
o routine debugging of existing systems and software
• Creation of new software based on known methods and applications
• Conversion or translation of existing software and software languages
• Adaptation of a product to a specific client, unless knowledge that significantly improved the base program was added
in that process
Reporting unit
The reporting unit is this business, including all subsidiaries and divisions. Include subsidiary companies where there is
more than 50 percent ownership.
Reporting period
Report data for the calendar year 2017, if possible, or for this business’s fiscal year ending between April 2017 and
March 2018.
Estimates are acceptable:
Report all items to the best of your ability.
R&D ACTIVITIES
During 2017, did this business do any of the following R&D activities? Include activities that:
• This business performed
• Others paid this business to do
• This business paid others to do
Yes

No

a. Conducted activities aimed at acquiring new knowledge or understanding
without specific immediate commercial applications or uses
b. Conducted activities aimed at acquiring new knowledge for solving a specific
problem or meeting a specific commercial objective
c. Conducted systematic work, drawing on research and practical experience and
resulting in additional knowledge, which is directed to producing new products
or processes or to improving existing products or processes
d. Developed and tested goods, services, or processes that were derived from scientific
research or technical findings
e. Developed software that advanced scientific or technological knowledge
f. Produced findings that could be published in academic journals or presented at
scientific conferences
g. Applied scientific or technical knowledge in a way that has never been done before
h. Created new scientific or technical solutions that can be generalized to other situations
i. Conducted work to discover previously unknown technological facts, structures,
or relationships
j. Conducted work to extend the understanding of scientific facts, relationships, or
principles in ways that could be useful to others
If “No” is selected for a. – j., skip to SECTION E: TECHNOLOGY AND INTELLECTUAL PROPERTY.

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R&D COSTS
What was the total cost (both direct and indirect) in 2017 for all the R&D activities reported as “Yes” in the ‘R&D
ACTIVITIES’ question? Your best estimate is acceptable. Report dollar amount in thousands. If none, report zero.
Include the following costs:
• Salaries, wages, fringe benefits
• Plant, machinery, and equipment, except that which was capitalized because it had an alternative future use
 Materials, supplies, software
• Rent, utilities
• Consultants, contractors
 Depreciation expense from plant, machinery, and equipment that was capitalized because it had an alternative future
use
Do not include:
• Costs for routine product testing, quality control, and technical services unless they are an integral part of an R&D
project
• Market research
• Efficiency surveys or management studies
• Literary, artistic, or historical projects, such as films, music, or books and other publications
• Prospecting or exploration for natural resources
Total costs for ‘R&D activities’ reported in the R&D Activities question for 2017
$Bil. Mil. Thou.
__________,000
TYPES OF R&D COSTS
Of the total R&D amount reported in the ‘R&D COSTS‘ question, what percent was for each of the following types of
costs?
a. Salaries, wages, and fringe benefits
____%
b. Expensed machinery and equipment (not capitalized)

____%

c. Materials and supplies

____%

d. Payments to business partners for collaborative R&D

____%

e. Purchased R&D services

____%

f.

____%

Depreciation on R&D property and equipment

g. All other costs (for example, consultants, contractors, travel, rent)

____%
Total = 100%

FUNDING SOURCES FOR R&D ACTIVITIES
Of the total R&D amount reported in the ‘R&D COSTS‘ question, how much was paid for by the following sources?
a. This U.S. business
____%
b. Your foreign owner (if the business is foreign owned)

____%

c. Another U.S. business

____%

d. Other businesses located outside the U.S.

____%

e. U.S. university or college

____%

f.

____%

U.S. non-profit organization

g. U.S. Federal government (including R&D grants)

____%

h.

U.S. State or Local government (not including state universities)

____%

i.

All other organizations outside the U.S.

____%
Total = 100%
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R&D PAID FOR BY THIS BUSINESS
Of the total R&D amount reported in the ‘R&D COSTS‘ question, how much did this business pay others to perform? Report
dollar amount in thousands. If none, report zero.
$Bil. Mil. Thou.
__________,000
PERCENT PAID FOR R&D CONDUCTED BY OTHERS
Of the R&D amount this business paid others to perform, what percentage went to another U.S. business, a U.S.
university or college, or another source?
____%
a. Another U.S. business
b. U.S. university or college

____%

c. Other (specify):

____%

_________________________

Total = 100%

R&D CATEGORIES
Of the total R&D amount reported in the ‘R&D COSTS‘ question, how much was for the following categories?
a. Basic Research – activities aimed at acquiring new knowledge
____%
or understanding without specific immediate commercial applications or uses
b. Applied Research – activities aimed at solving a specific problem or meeting a
specific commercial objective

____%

c. Development – systematic work, drawing on research and practical experience
and resulting in additional knowledge, which is directed to producing new products
or processes or to improving existing products or processes

____%
Total = 100%

R&D EMPLOYEES
For the pay period including March 12, 2017, how many employees from this business’s foreign and domestic
operations, were R&D employees and how many were all other employees?
R&D employees include all employees who work on R&D or who provide direct support to R&D, such as researchers,
R&D managers, technicians, clerical staff, and others assigned to R&D groups. Exclude employees who provide only
indirect support to R&D, such as corporate personnel, security guards, and cafeteria workers.
(1) Domestic
(2) Foreign
(3) Total
Operations
Operations
Employees
___________ ___________
___________
a. Female R&D employees
___________
___________ ___________
b. Male R&D employees
___________ ___________
___________
Total R&D employees
___________ ___________
___________
c. All other employees
___________ ___________
___________
d. Total employees

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R&D EMPLOYEE OCCUPATIONS
For the pay period including March 12, 2017, how many of the total R&D Employees reported in the ‘R&D EMPLOYEES’
question worked in the occupations listed below?
(1) Domestic
(2) Foreign
(3) Total
Operations
Employees
Operations
a. Researchers (including R&D scientists, engineers,
___________ ___________
___________
and their managers)
___________ ___________
___________
Number of Researchers with PhD (excluding MD,
JD, and EdD)
___________ ___________
___________
b. R&D technicians and equivalent staff
c. R&D support staff (clerical and other)

___________

___________

___________

d. Total R&D employees

___________

___________

___________

DOMESTIC R&D EMPLOYEES FULL TIME EQUIVALENT
Of the domestic R&D employees reported in the ‘R&D Employees’ question, what was the number of full-time
equivalents (FTEs) for R&D activity? For full-time R&D employees use the number of employees for the FTEs. For other
full-time employees not working solely on R&D or part-time employees working on R&D use the share of full-time work
week they work on R&D.
Total FTEs _________
DOMESTIC RESEARCHERS FULL TIME EQUIVALENT
Of the domestic researchers reported in the ‘R&D Employee Occupations’ question, what was the number of full-time
equivalents (FTEs) for R&D activity?
Total FTEs _________
TAX CREDIT FOR RESEARCH ACTIVITIES
Did this business file for the tax credit for increasing research activities (IRS Form 6765) in 2017?
Yes
No

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SECTION E: TECHNOLOGY AND INTELLECTURAL PROPERTY
The following section collects information on intellectual property and technology use for the business.
PATENTS PENDING
How many U.S. patent applications, if any, did this business have pending as of the end of 2017? If none, report zero.
Number of U.S. patent applications currently pending _____
PATENTS OWNED
How many U.S. patents did this business own as of the end of 2017? If none, enter zero.
Number of U.S. patents owned _____
INTELLECTUAL PROPERTY ACTIVITIES
Indicate whether this business did any of the following during 2017. Select one for each row.
Yes
a. Transferred intellectual property (IP) to others not owned by this business
through participation in technical assistance or "know - how" agreements

No

b. Received IP from others not owned by this business through participation in
technical assistance or "know how" agreements
c. Participated in cross-licensing agreements in which two or more parties grant
a license to each other for the use of the subject matter claimed in one or more
of the patents owned by each party
d. Allowed free use of patents or other IP owned by this business (for example,
allowing free use of software patents by the open source community)
e. Made use of open source patents or other freely available IP not owned by
this business
IMPORTANCE OF INTELLECTUAL PROPERTY
During 2017, how important to this business were the following types of intellectual property protection?
Select one for each row.
Very
Somewhat
Not at all
Important
Important
Important
a. Utility patents (patents for inventions)
b. Design patents (patents for appearance)
c. Trademarks
d. Copyrights
e. Trade secrets
f.

Nondisclosure agreements

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DIGITAL SHARE OF BUSINESS ACTIVITY
In 2017, how much of each type of information was kept in digital format at this business? Select one for each row.
This type of
information
not collected
Up to
More than
Don’t
by this
None
50%
50%
All know
business
a. Personnel
b. Financial
c. Customer Feedback
d. Marketing
e. Supply Chain
f.

Production

g. Other (specify)
__________________________________________________________________
CLOUD SERVICE PURCHASES
Considering the amount spent on each of these IT functions, how much was spent on cloud services? (Cloud services are
services provided by a third party that this business accesses on-demand via the internet.) Select one for each row.
Up to
More than
Don’t
Don’t use
None
50%
50%
All
know
IT function
a. All IT functions
b. Security or firewall
c. Servers
d. Data storage and management
(Examples: Amazon Web Services,
IBM Bluemix, Microsoft Azure)
e. Collaboration and file synchronization
(Examples: Dropbox, OneDrive,
Google Drive)
f.

Data Analysis

g. Billing and account management
h. Customer relationship management
i.

Other (specify)
__________________________________________________________________

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BUSINESS TECHNOLOGIES
In 2017, to what extent did this business use the following technologies in producing goods or services?
Select one for each row.
In use for
In use for
In use for
Testing but less than
between
more than
not using in 5% of
5% - 25% of
25% of
production production production
production
Don’t
No use or service
or service
or service
or service
know
a. Augmented reality
b. Automated guided
vehicles (AGV) or AGV
systems
c. Automated storage
and retrieval systems
d. Machine learning
e. Machine vision software
f.

Natural language
processing

g. Radio-frequency
identification (RFID)
inventory system
h. Robotics
i. Touchscreens/ kiosks
for customer interface
(Examples: self-checkout,
self-check-in, touchscreen
ordering)
j. Voice recognition
software

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SECTION F: FINANCING AND OTHER BUSINESS CHARACTERISTICS
The following section collects information on various characteristics of the business. Unless otherwise indicated, the
reporting period is calendar year 2017.
ONE FAMILY MAJORITY OWNERSHIP
In 2017, did two or more members of one family own the majority of this business? (Family refers to
spouses/unmarried partners, parents/guardians, children, siblings, or close relatives.)
Yes
No
JOINT OWNERSHIP
In 2017, did spouses/unmarried partners jointly own this business?
Yes
No – Skip to CAPITAL FUNDING
EQUAL OPERATION
In 2017, was this business operated equally by both spouses/unmarried partners?
Yes, equally operated by spouses/unmarried partners
No, primarily operated by Owner 1
No, primarily operated by Owner 2
CAPITAL FUNDING
For the owner(s) reported, what was the source(s) of capital used to start or initially acquire this business?
Select all that apply.
Personal/family savings of owner(s)
Personal/family assets other than savings of owner(s)
Personal/family home equity loan
Personal credit card(s) carrying balances
Business credit card(s) carrying balances
Government-guaranteed business loan from a bank or financial institutions, including SBA-guaranteed loans
Business loan from a bank or financial institution
Business loan from a federal, state, or local government
Business loan/investment from family/friend(s)
Investment by venture capitalist(s)
Grants
Other source(s) of capital
Don’t know
None needed – Skip to FUNDING FROM OWNERS
AMOUNT OF CAPITAL NEEDED TO START OR INITIALLY ACQUIRE THE BUSINESS
For the owner(s) you reported, 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).)
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

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FUNDING FROM OWNER(S)
For 2017, what was the total amount of money that the owner(s) personally put into the business? Your best estimate is
fine.
Include:
 Investments from personal savings
 Personal retirement accounts
 Home equity loans
 Personally borrowed funds
Business does not have owners
$0
$1 - $4,999
$5,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
Don’t know
FUNDING FROM INSIDERS
For 2017, what was the total amount of investment funds this business received from family, friends, and employees?
$0
$1 - $4,999
$5,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
Don’t know
FUNDING FROM BANKS OR OTHER FINANCIAL INSTITUTIONS
For 2017, what was the total amount of money this business borrowed from a bank or other financial institutions,
including business loans, a business credit card carrying a balance, or a business line of credit? Include all draws on a
business line of credit, even if paid off during the year.
$0
$1 - $4,999
$5,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
Don’t know

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FUNDING FROM OUTSIDE INVESTORS
For 2017, what was the total amount of money this business received from angel investors, venture capitalists, or other
businesses in return for a share of ownership in this business? (An “angel investor” is an affluent individual who
provides capital for a business start-up, usually in exchange for convertible debt or ownership equity.)
$0
$1 - $4,999
$5,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
Don’t know
FUNDING FROM GOVERNMENT GRANTS
For 2017, what was the total amount of money this business received from government grants (such as the Small
Business Innovation Research (SBIR) and/or Small Business Technology Transfer (STTR) programs)?
$0
$1 - $4,999
$5,000 - $9,999
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 or more
Don’t know
AVOIDANCE OF ADDITIONAL FINANCING
At any time during 2017, did this business need additional financing?
Yes, business needed additional financing and the owner(s) chose not to apply
Yes, business needed additional financing and the owner(s) did apply – Skip to PROFITABILITY
No, business did not need additional financing – Skip to PROFITABILITY
REASON FOR AVOIDANCE OF ADDITIONAL FINANCING NEEDED
Why did this business choose not to apply for additional financing? Select all that apply.
Did not think business would be approved by lender
Did not want to accrue debt
Decided the financing costs would be too high
Preferred to reinvest the business profits instead
Felt the loan search/application process would be too time consuming
Decided to wait until funding conditions improved
Decided to wait until business hit milestones to be in stronger position to raise funds
None of the above

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PROFITABILITY
For 2017, did this business have profits, losses, or break even?
Profits
Losses
Break even
NEGATIVE IMPACT ON PROFITABILITY
For 2017, which of the following negatively impacted the profitability of this business? Only include responses
that impacted profitability. Select all that apply.
Access to financial capital
Cost of financial capital
Finding qualified labor
Taxes
Government regulations (for example, U.S. Federal, state and/or local)
Slow business or lost sales
Customers or clients not making payments or paying late
The unpredictability of business conditions
Changes or updates in technology
None of the above
TYPES OF CUSTOMERS
In 2017, which of the following types of customers accounted for 10% or more of this business’s total sales of goods
and/or services? Select all that apply.
U.S. Federal government
State and local government, including school districts, transportation authorities, etc.
Other businesses, including distributors of your product(s)
Other organizations (foreign governments, nonprofits, etc.)
Individuals
TYPES OF WORKERS
In 2017, which of the following types of workers were used by this business? Select all that apply.
Full-time paid employees (workers who received a W-2)
Part-time paid employees (workers who received a W-2)
Paid day laborers
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 (workers who received a 1099 or
payment from another company)
None of the above
EMPLOYEE BENEFITS
In 2017, which of the following employee benefits were paid totally or partly by this business?
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
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SECTION G: CONTACT INFORMATION
CONTACT INFORMATION
Enter the first and last name of the person who is filling out this survey. We request a telephone number so we can
contact you if there is a question.
Contact Name:
Title:
Phone:
Ext:
Email address:
REMARKS
Additional Remarks: Please use this space for any explanations that may be essential in understanding your reported
data.

THANK YOU
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