ABS-2 Worksheet

ABS-2 Worksheet

Attachment B

Welcome to the 2017 Annual Business Survey
This worksheet is intended to assist you with gathering information and preparing your data prior to
reporting online. Businesses that reported business activity for all or any part of 2017 are eligible to be
selected to respond to this survey. Businesses with more than 10 employees should use the ABS-2
Worksheet for assistance. Businesses reporting for ABS-2 will be asked questions on the following
topics:
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Company Information
Owner Characteristics
Innovation
Technology and Intellectual Property
Financing and Other Business Characteristics
Contact Information

Please view the online report for specific instructions.
Return to https://portal.census.gov when you are ready to report online.

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COMPANY INFORMATION
This section collects information on the operations and structure of the business. This section should
take approximately 5 minutes to complete.
CEASED OPERATIONS
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 OPERATIONS CEASED
Enter the month and year this business ceased operations.
MM/YYYY
If response is between 1/2018 and 12/2018, you are still required to complete the survey
covering the business activity for 2017, even though this business is not currently operating.
If response is between 1/2017 and 12/2017, you are still required to complete the survey
covering the portion of the year this business was active for 2017, even though this business is
not currently operating.
If response is prior to 1/2017, this business is not required to complete this survey. Skip to
‘Contact Information’.
BUSINESS OWNERSHIP – FOREIGN ENTITY
In 2017, was this business a majority-owned subsidiary of a foreign company?
 Yes – If ‘Yes’ note the reporting unit for the survey is the U.S. located business
 No
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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 10% OR MORE OWNERSHIP
 No
BUSINESS OWNERSHIP – GOVERNMENT OR TRIBAL ENTITY
In 2017, was this business owned by a government or tribal entity?
 Yes
 No
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
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1 person
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2 people
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3 people
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4 people
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5-10 people
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11 or more people
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Don’t know
NUMBER OF PAID OWNERS
Of the reported as owner(s), 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.
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Non-Owners
A. Employees who received a W-2 issued by this business for salary or
wages
B. Individuals who received payment in other ways (for example,
contractors/consultants/ temporary workers who received a 1099 or
payment from another business), including those who received stock
or other forms of compensation.
C. Unpaid individuals who worked for the business (for example,
interns, friends, family members)

Number of
People

TOTAL SALES AND REVENUES
What was the amount of this business’s sales and revenues, including grants, during 2017? Round to
the nearest one thousand dollars. If none report zero.

2017 sales, revenues, and
grants

$ Billions

Millions

Thousands

SOURCES OF SALES AND REVENUE
Approximately what share of this business’s 2017 sales and revenues, including grants, came
from the following?

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 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 Sates it reports 100% of its sales in this question.

Domestic Operations

$ Billions

Millions

Thousands

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PRIMARY BUSINESS ACTIVITY
Describe this business’s primary business activity during 2017.

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OWNER CHARACTERISTICS
This 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. This section takes approximately 4 - 8 minutes to complete.
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%.
Name of Owner

Percentage Owned

SEX
What is the sex of Owner X?
☐ Male
☐ Female
ETHNICITY
Is Owner X 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 below. For example,
Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.
RACE
What is Owner X’s race? NOTE: For this survey, Hispanic origins are not races. Select all that apply.
☐ White
☐ Black or African American
☐ American Indian or Alaska Native –Enter name of enrolled or principal tribe
__________________________________________
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☐ 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 X ever served in any branch of the U.S. Armed Forces, including the Coast Guard, the
National Guard, or Reserve component of any service branch?
☐ Yes
☐ No – SKIP to INITIAL ACQUISITION
MILITARY SERVICE DISABILITY
Is Owner X 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 X’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

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INITIAL ACQUISITION
How did Owner X 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 X acquire ownership of this business?
YEAR ______
 Don’t Know
JOB FUNCTION(S)
In 2017, which of the following were Owner X’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
AVERAGE NUMBER OF HOURS WORKED
In 2017, what was the average number of hours per week that Owner X spent managing or working
in this business?
 None
 Less than 20 hours
 20-39 hours
 40 hours
 41-59 hours
 60 hours or more
PRIMARY INCOME SOURCE
In 2017, did this business provide Owner X’s primary source of income?
 Yes
 No

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PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this business, how many previous businesses has
Owner X 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 X started most
recently?
 Business is still operating and Owner X 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 X 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)
 Master’s, 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 X? 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
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Attachment B

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 X as of December 31, 2017?
 Under 25
 25-34
 35-44
 45-54
 55-64
 65 or over
U.S. CITIZENSHIP
Is Owner X a citizen of the United States?
 Yes
 No
PLACE OF BIRTH
Was Owner X born in the United States?
 Yes
 No
REASONS FOR OWNING THE BUSINESS
How important to Owner X are each of the following reasons for owning this business? Select one for
each row.
Very
Somewhat
Not at all
Important
Important
Important
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A. Wanted to be my own boss
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B. Flexible hours
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C. Balance work and family
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D. Opportunity for greater income
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E. Best avenue for my
ideas/goods/services
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F. Unable to find employment
G. Working for someone else didn’t
appeal to me
H. Always wanted to start my own
business
I. An entrepreneurial friend or
family member was my role
model
J. Wanted to carry on the family
business
K. Wanted to help and/or become
more involved in my community
L. Other (specify)

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INNOVATION
This 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.
This section asks about the three previous years including the calendar year 2017 instead of one year
as in other sections of this questionnaire.
This section should take approximately 20 minutes to complete.
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

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e. Focus on low price

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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

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n. Focus on understanding and/or
meeting customer needs

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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
 
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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.

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If response to A. (Goods) OR B. (Services) from the ‘Product Innovation’ question is Yes, then we
consider this to be a product innovation.
If response to A. (Goods) AND B. (Services) from the ‘Product Innovation’ question is No, then
skip to ‘Process Improvement’
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

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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:
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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

1

0

0

%

PROCESS 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. Methods of manufacturing for producing goods or services

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B. Logistics, delivery or distribution methods for inputs, goods or
services

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C. Supporting activities for processes, such as maintenance
systems or operations for purchasing, accounting, or computing

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If response to A. (Methods of Manufacturing), B. (Logistics, delivery, or distribution methods) or C.
(Supporting activities) ‘Process Innovation’ question is Yes, then we consider this to be a process
innovation.
If response to A. (Goods) AND B. (Services) from the ‘Product Innovation’ question is No, AND
response to A. (Methods of Manufacturing), B. (Logistics, delivery, or distribution methods) AND
C. (Supporting activities) from the ‘Process Innovation’ question is No, then skip to ‘Organizational
and Marketing Innovation’.
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 R&D consisting of research and development
activities to create new knowledge or solve scientific or technical problems.

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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

A. In-house R&D

Research and development activities undertaken by this
business to create new knowledge or solve scientific or
technical problems (include software development that meets
this requirement)

Yes

No

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If yes, did this business perform R&D during the three years
2015 to 2017:
 Continuously (business had permanent R&D staff inhouse)
 Occasionally (as needed only)
B. External R&D

This business contracted-out R&D to other companies (include
affiliated companies) or to public or private research
organizations

C. Acquisition of
machinery,
equipment,
software & buildings

New machinery, equipment software and building that were
acquired for the purpose of developing 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

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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

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G. Brand Building

In-house or contracted out activities such as advertising or
promotion to build this business’s brand identity or brand name

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H. Design

In-house or contracted out activities to alter the shape,
appearance or usability of goods or services

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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.

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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

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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 from
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.
Innovation
activities only
Yes

No

A. Local or State government

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B. U.S. Federal government

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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

United
States

All other
Not
countries Applicable
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A. Other affiliated companies (legal entities under
common ownership)
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

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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.)

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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)

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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.)

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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.)

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G. Methods of pricing goods or services (for example, first time use of
variable pricing by demand, discount systems, etc.)

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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.)

If response to A. (Goods) AND B. (Services) from the ‘Product Innovation’ question is No, AND
response to A. (Methods of Manufacturing), B. (Logistics, delivery, or distribution methods) AND
C. (Supporting activities) from the ‘Process Innovation’ question is No, AND response to A.
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(Business Practices), B. (Organizing work responsibilities and decision making), C. (Organizing
external relations), D. (Design or packaging), E. (Product promotion), F. (Product placement), AND
G. (Pricing) from the ‘Organization and Marketing Innovation’ question is NO, then skip to
‘Business Reason 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
Important
Important
A. Lack of internal finance
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B. Lack of credit or private equity
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C. Innovation costs too high
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D. Lack of skilled employees within the business
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E. Lack of collaboration partners
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F. Difficulties in obtaining government grants or subsidies
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G. Uncertain market demand for your ideas
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H. Too much competition in your market
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Not at all
Important
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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
Not
Created no
an
applicable
major
excessive
Stimulated
Created
Legislation or regulation
innovation
problems
uncertainty
burden
Product safety / consumer
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protection
Operational and worker safety
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Environmental
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Intellectual property
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Tax
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Employment or social affairs
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Other, Specify______
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Skip to ‘R&D Activities’
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:
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No compelling reason to innovate - Skip to ‘REASONS FOR NOT INNOVATING’
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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
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

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Not at all
Important

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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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TECHNOLOGY AND INTELLECTUAL PROPERTY
This section collects information on intellectual property and technology use for the business.
This section should take approximately 7 minutes to complete.
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.
___________________
PATENTS OWNED
How many U.S. patents did this business own as of the end of 2017? If none, report zero.
___________________
INTELLECTUAL PROPERTY ACTIVITIES
Indicate whether this business did any of the following during 2017. Select one for each row.
Yes

No

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a. Transferred intellectual property (IP) to others not
owned by this business through participation in
technical assistance or "know how" agreements
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
Important

Somewhat
Important

Not at all
Important
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A. Utility patents (patents for inventions)

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B. Design patents (patents for appearance)

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C. Trademarks

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D. Copyrights

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E. Trade secrets

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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.

A.
B.
C.
D.
E.
F.
G.

Personnel
Financial
Customer Feedback
Marketing
Supply Chain
Production
Other: (specify)
____________________

None

Up
to
50%

More
than
50%

All

Don’t
know

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This type of
information
not
collected by
this business
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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.

A.
B.
C.
D.

All IT functions
Security or firewall
Servers
Data storage and
management (Examples:

None

Up
to
50%

More
than
50%

All

Don’t
Know

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Don’t
use this
IT
function
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E.

F.
G.
H.
I.

Amazon Web Services, IBM
Bluemix, Microsoft Azure)
Collaboration and file
synchronization (Examples:
Dropbox, OneDrive, Google
Drive)
Data Analysis
Billing and account
management
Customer relationship
management
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.

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-

No
use

Testing, but not
using in
production or
service

In use for
less than
5% of
production
or service

In use for
more than
25% of
production
or service

Don’t know

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In use for
between
5% – 25%
of
production
or service
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Attachment B

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check-in,
touchscreen
ordering)
J. Voice recognition
software

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Attachment B

FINANCING AND OTHER BUSINESS CHARACTERISTICS
This section collects information on various characteristics of the business. This section should
take approximately 3 minutes to complete.
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 FUNDING FROM OWNER(S)
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 SBAguaranteed 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
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Attachment B

☐ Don’t know
☐ None needed – Skip to FUNDING FROM OWNER(S)
AMOUNT OF CAPITAL NEEDED TO START OR INITIALLY ACQUIRE THE BUSINESS
For the owner(s) reported, what was the total amount of capital used to start or initially acquire
this business?
☐ Less than $5,000
☐ $5,000 - $9,999
☐ $10,000 - $24,999
☐ $25,000 - $49,999
☐ $50,000 - $99,999
☐ $100,000 - $249,999
☐ $250,000 - $999,999
☐ $1,000,000 - $2,999,999
☐ $3,000,000 or more
☐ Don’t know
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

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Attachment B

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
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
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Attachment B

☐ $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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Attachment B

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
☐ 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

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Attachment B

☐ 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?
Select all that apply.
☐ 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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Attachment B

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:

_____________________________________________________________________

Email address: _________________________________________________________________________

Additional Remarks: Please use this space for any explanations that may be essential in understanding
your reported data.

THANK YOU

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