SBIR Baseline Monitoring Survey

SBIR Baseline Monitoring Survey
Pursuant to 5 CFR 1320.5(b), an agency may not conduct or sponsor, and a person is not required to respond to an
information collection unless it displays a valid OMB control number. The OMB control number for this collection is
3145-0238. Public reporting burden for this collection of information is estimated to average 80 to 120 minutes per
response, including the time for reviewing instructions (average of 60 minutes for section 2 and 20 minutes per
founder for section 3). Send comments regarding this burden estimate and any other aspect of this collection of
information, including suggestions for reducing this burden, to: Suzanne Plimpton, Reports Clearance Officer, Office
of the General Counsel, National Science Foundation, 2415 Eisenhower Ave., Alexandria, VA 22314.

Survey Overview
This survey collects information on the founder(s), lineages, business structures, R&D activities,
and demographics of your company during the FY 20XX. The survey is divided into 3 sections.
Each section asks questions about different aspects of your company. Due to the specialized
nature of each section, it might require collaboration with other persons in your company.

Section 1. Contact Information
1-1. Who is the survey coordinator?
The survey coordinator is the person at your company responsible for gathering all requested information, ensuring
instructions are followed, and submitting the completed survey. This is also the person we should contact if there
are any queries regarding the form.

Name (Last, First):
Title (at the company):
Telephone:
Email Address:

Section 2. Company Information
The questions in this section apply to the entire business, and only require one response from
the respondent regardless of how many founders were entered.
2-1. Please select the NSF SBIR Award number from the (drop-down) list:

General information
2-2. Please provide the company information below.
Company Name:
Company Location (city, state):
Company URL:
DUNS Number:
Employer ID Number (EIN, 9 digit):

Business Structure
2-3. What is the business structure of your company? (Mark only one)
o
o
o
o
o

C-corporation
S-corporation
Limited Liability Corporation (LLC)
Sole Proprietorship
Other – specify

Technology Sector
2-4. Which 5-digit NAICS (North American Industry Classification System) code(s) best describe
both business and R&D activities of your company? (Use the search feature at
www.census.gov/naics as a guide; type in a keyword that describes your business. For example,
if you are developing a new kind of DNA recombinant technologies, type in the keyword DNA
in the "2017 NAICS Search" box on the left side of the page and the search will prompt a list of
NAICS codes containing that keyword)
NAICS code(s):
2-5. Give your best estimate of the current Technology Readiness Level (TRL) of the technology
being developed under your current NSF SBIR/STTR award? (Mark only one)
The Technology Readiness Level (TRL) scale is used to describe the stage of maturity in the development process
from observation of basic principles through final product operation. TRL is originally developed by NASA and have
been adopted by the U.S. Department of Defense. TRL has served as the basis for conducting technology readiness
assessment and enabled a common understanding pertaining to the translation and transition of technology.

o

o

o

o

o

TRL 1 – Basic Principles Observed and Reported. This is where scientific research begins to be
translated into applied research and development. Examples might include paper studies of a
technology’s basic properties
TRL 2—Technology Concept and/or Application Formulated. This is where invention begins.
Once basic principles are observed, practical applications are identified but speculative, no
experimental proof or detailed analysis is available to support the assumption or conjecture.
TRL 3—Analytical and Experimental Critical Function and/or Characteristics Proof of Concept.
This is where active R&D is initiated, where the technology is placed in an appropriate context
with laboratory demonstrations, modeling and simulation to validate the analytical prediction.
TRL 4—Component and/or Breadboard Validation in Laboratory Environment. This is where
active basic technological components are integrated to establish that they will work together.
This is relatively “low fidelity” compared with the eventual system. Examples include integration
of “ad hoc” hardware in the laboratory.
TRL 5—Component and/or Breadboard Validation in Relevant Environment. This is where
fidelity of the technology increases significantly. The basic technological components are
integrated with reasonably realistic supporting elements so they can be tested in a simulated
environment. Performance predictions are made for subsequent development phases.

o

o

o

o

TRL 6—System/Subsystem Model or Prototype Demonstration in a Relevant Environment. This
is where a representative model or prototype system—well beyond that of TRL 5—is tested in a
relevant environment. This represents a major step up in a technology’s demonstrated readiness.
Examples include testing a prototype in a high-fidelity laboratory environment or in a simulated
operational environment.
TRL 7—System Prototype Demonstration in an Operational Environment. This is where the
prototype is near or at planned operational system. This level represents a major step up from
TRL 6 by requiring demonstration of an actual system prototype in an operational environment.
TRL 8—Actual System Completed and “Flight Qualified” through Test and Demonstration. This
is where the technology has been proven to work in its final form under expected conditions. In
almost all cases, this TRL represents the end of true system development.
TRL 9—Actual System Proven through Successful Mission Operations. This is the actual
application of the technology in its final form, under mission conditions (such as those
encountered in operational test and evaluation).

R&D efforts
2-6. Is the company focused solely on the business opportunity for which it received an
SBIR/STTR award from the National Science Foundation, or does it also have other ongoing
R&D or business efforts unrelated to the award? (Mark only one)
o
o

The company is focused solely on the R&D efforts for which this company received in SBIR/STTR
award from the National Science Foundation
The company also has other ongoing R&D efforts unrelated to the SBIR/STTR award from the
National Science Foundation

For-profit affiliations
2-7. Is your company a spin-out or corporate spin-off of another domestic company?
▪
▪

Yes
No

2-8. Is your company a majority-owned subsidiary of another domestic company?
▪
▪

Yes
No

2-9. Does another domestic company have the power to control the management and policies
of your company?
▪
▪

Yes
No

University affiliations
The next few questions pertain to the company’s previous and current affiliations/relationships to universities
and/or research institutions.

2-10. Were the key inventions underlying the company’s products or services made at an
university or research institution?
▪
▪

Yes
No

2-11. Has the company’s intellectual property been licensed or obtained from an university or
research institution?
▪
▪

Yes
No

2-12. Does the company use the facilities of an university or research institution as a significant
part of its operations?
▪
▪

Yes
No

2-13. Does an university or research institution own equity in the company?
▪
▪

Yes
No

2-14. Is an university or research institution entitled to any royalties based on the company’s
revenues?
▪
▪

Yes
No

2-15. Was at least one of the company founders affiliated with an university or research
institution at the time the company was established?
▪
▪

Yes
No

Payroll and Revenue
2-16. When did your company’s most recent fiscal year end? (MM/YYYY)
o
o

Most recent fiscal year ends on: MM
YYYY
Company has not yet completed one fiscal year

2-17. In [year selected in prior question], what were the company’s total payroll expenses?
This includes salaries and wages paid to employees, fringe benefits, payroll taxes (W2, 1099,
and other tax forms) but excludes “sweat equity.”
$

,000.00

2-18. In [year selected in prior question], how much revenue or funding did the company
receive from each of the following sources? Estimates are acceptable.
Equity Financing (including convertible debt):

$

,000.00

Founder contributions (excluding sweat equity and in-kind contributions):

$

,000.00

Product and service revenue:

$

,000.00

Debt financing:

$

,000.00

Licensing or joint development project revenue:

$

,000.00

SBIR/STTR grants or contracts:

$

,000.00

Other government grants or contracts (non-SBIR):

$

,000.00

Other revenues:

$

,000.00

Total:

$

,000.00

Participation in NSF programs
2-19. Which of the following National Science Foundation (NSF) programs has this company
participated in? (Mark all that apply)
o
o
o
o
o
o

I-Corps (National)
I-Corps (Regional)
Partnerships for Innovation (PFI)
Industry/University Cooperative Research Centers (I/UCRC)
NSF Basic Research (Engineering)
NSF Basic Research (Non-engineering)

2-20. If applicable, did participation in NSF’s I-Corps (National) program lead to the formation
of this company?
▪
▪
▪

Yes
No
Not Applicable

2-21. If applicable, did participation in NSF’s I-Corps (Regional) program lead to the formation
of this company?
▪
▪
▪

Yes – list relevant award number(s)
No
Not Applicable

2-22. If applicable, did participation in NSF’s PFI program lead to the formation of this
company?
▪
▪
▪

Yes– list relevant award number(s)
No
Not Applicable

2-23. If applicable, did participation in NSF’s I/UCRC program lead to the formation of this
company?
▪
▪
▪

Yes– list relevant award number(s)
No
Not Applicable

2-24. If applicable, did participation in NSF’s NSF Basic Research (Engineering) program lead to
the formation of this company?
▪
▪
▪

Yes– list relevant award number(s)
No
Not Applicable

2-25. If applicable, did participation in NSF’s Basic Research (Non-engineering) program lead to
the formation of this company?
▪
▪
▪

Yes– list relevant award number(s)
No
Not Applicable

External funding
2-26. Prior to receiving NSF SBIR/STTR funding, what was the total amount of external funding
received by the company since its inception by source? DO include founder cash investments,
but do not include “sweat equity”. Estimates are acceptable.
Equity Financing (including convertible debt):

$

,000.00

Founder contribution (excluding sweat equity and in-kind contributions):

$

,000.00

Product and service revenue:

$

,000.00

Debt financing:

$

,000.00

Licensing or joint development project revenue:

$

,000.00

SBIR/STTR grants or contracts:

$

,000.00

Other government grants or contracts (non-SBIR):

$

,000.00

Other revenues:

$

,000.00

Total:

$

,000.00

Other SBIR/STTR awards
2-27. Prior to the company’s most recent SBIR/STTR award from the National Science
Foundation (NSF), what was the total number of Phase I and Phase II SBIR/STTR awards
received by the company from any agency of the U.S. Federal Government?
o
o

Number of Phase I awards:
Number of Phase II awards:

2-28. Of the awards reported above, how many came from NSF? Do not include the company’s
most recent NSF SBIR award.
o
o

Number of Phase I awards from NSF:
Number of Phase II awards from NSF:

Reporting Information
2-29. How did you hear about the National Science Foundation’s SBIR Program? (Mark all that
apply)
o
o
o
o
o
o
o
o
o
o
o
o
o

Conference or trade shows
Professional or personal network
Consultant or service provider
Angel investor(s)
Venture capitalist(s)
University business incubator or accelerator
State economic development office
Small Business Administration
United States Patent and Trademark Office
Grants.gov
NSF.gov
Social Media – Twitter, Facebook, LinkedIn
Others – please specify

2-30. Approximately how long did it take you to complete this section?
Time (hours: minutes):

Section 3. Founder(s) Information
3-1. How many people founded this company?
A person is considered to be a founder if he/she: is deeply involved in the company operations and day-to-day
decision-making process AND either was involved in the founding of the company OR owns at least 10 % equity of
this company.

o
o
o
o

1
2
3
4 or more

3-2. Please list up to 3 person(s) who founded the company. If there were more than 3 persons
founded the company, select the three who are most involved in the day-to-day management
and operations of the company.
Name of Founder 1 (Last, First):
Name of Founder 2 (Last, First):
Name of Founder 3 (Last, First):

3-3. In what year was the company founded?
Year (YYYY):

3a. Founder 1
3-4. What is your name?
3-5. What is your title in the company?
3-6. What is your email address?
3-7. Do you own at least 10 % equity of the company?
▪
▪

Yes
No

3-8. Were you involved in the founding of the company?
▪
▪

Yes
No

3-9. Have you been at this company since it was founded?
▪
▪

Yes
No

3-10. Are you currently involved in company operations and decision-making on a day-to-day
basis?
▪
▪

Yes
No

3-11. How did you initially acquire ownership of the company? (Mark only one)
o
o
o
o

Founded or started
Purchased
Inherited
Received transfer of ownership (i.e. as stock options) or gift

3-12. Do you have signing authority for the company?
▪
▪

Yes
No

Company involvement
3-13. Are you an employee of this company?
▪
▪

Yes
No

3-14. In what year did you become an employee of this company?
Year (YYYY):

3-15. Approximately what percentage of your working time is dedicated to the company?
%

3-16. Approximately what percentage of your working time was dedicated to the company
before Phase I began?
%

3-17. What percentage of equity stake in this company do you own?
%

Pre-company situation
3-18. Which of the following best describes your employment situation prior to your
involvement in this company? (Mark all that apply)
o
o
o
o
o
o
o
o

I was self-employed
I was an undergraduate or graduate student
I was employed by the government (federal, state, or local)
I was employed at a not-for-profit research institution
I was employed by another business with 10 or fewer employees
I was employed by another business that has between 11 and 499 employees
I was employed by another business with 500 or more employees
Other (please specify):

Number of companies founded
3-19. Other than this company, how many other companies have you founded? Include
companies you founded on your own, or with other individuals.
o
o
o
o
o

0 – no other companies founded
1
2
3
4 or more – specify

Number of years at tech start-ups
A tech start-up is a newly-established company or a company that has been established for less than 5
years whose purpose is to bring technology products or services to market.

3-20. Other than this company, have you worked at any other technology start-up companies?
▪
▪

Yes
No

3-21. If Yes, other than this company, how many years have you worked at any techstart-up
companies? (Round partial years to the nearest whole year)
o
o
o
o
o
o

Less than 1 year
1 year
2 years
3 years
4 years
5 or more years – specify

University affiliation
3-22. Are you currently enrolled or employed by an university or other institution of higher
learning?
▪
▪

Yes
No

3-23. If yes, which of the following best describes your enrollment or employment status with
an university or other institution of higher learning?
o
o
o
o
o
o

Undergraduate student
Graduate student
Postdoctoral scholar
Faculty member
Staff member
Other – specify

Highest degree
3-24. What was the highest degree or level of school you have completed? (Mark one answer.
If currently enrolled, mark the highest degree received)
o
o
o
o
o
o
o

Some college credit, no degree
Associate’s degree (for example: AA, AS)
Bachelor’s degree (for example: BA, BS)
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)
Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)
Other – specify

3-25. If applicable, what type of professional degree(s) do you have? (Mark all that apply)
o
o
o
o
o
o
o
o
o
o
o
o

Master of Arts (MA)
Master of Science (MS, MSc)
Master of Business Administration (MBA)
Master of Public Health (MPH), Master of Social Work (MSW), Master of Fine Arts (MFA), Master
of Music (MM/MMus), Master of Engineering (MEng), Master of Architecture (MArch)
Master of Education (Med, MSEd, MIT, MAEd, MAT)
Doctor of Philosophy (PhD)
Doctor of Engineering (DEng, DESc, DES)
Doctor of Education (EdD)
Doctor of Fine Arts (DFA), Doctor of Music (DM), Doctor of Public Health (DPH), Doctor of Social
Work (DSW)
Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), Doctor of Veterinary Medicine (DVM)
Juris Doctor (JD), Legum Baccalaureus (LLB)
Other(s) – specify

Year degree earned
3-26. If a degree (associate’s, bachelor’s, master’s, professional, or doctorate) was attained,
in what year was the highest degree awarded?
Year (YYYY):

Ethnicity, race, and gender
3-27. Are you of Hispanic, Latino, or Spanish origin? (Mark one answer)
o
o
o
o
o
o

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, or Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin
Prefer not to answer

3-28. What is your race? (Mark one answer)
o
o
o
o
o
o

American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Asian
Black or African American
White
Prefer not to answer

3-29. What is your sex? (Mark one answer)
o
o
o

Male
Female
Prefer not to answer

Reporting Information
3-30. Approximately how long did it take you to complete this section?
Time (hours: minutes):

3b. Founder 2 (if applicable)
Questions will be the same as section 3a, from question 3-4 to 3-30

3c. Founder 3 (if applicable)
Questions will be the same as section 3a, from question 3-4 to 3-30