Small Business Pul Small Business Pulse Survey

Small Business Pulse Survey

SBPS Phase 5 Questionnaire Version 1 3.17.2021 (1)

OMB: 0607-1014

Document [docx]
Download: docx | pdf

Small Business Pulse Survey Phase 5 2021-03-17





Welcome to the Small Business Pulse Survey


The U.S. Census Bureau is requesting your assistance in understanding the effect of changing business conditions due to the Coronavirus pandemic on your business. Your response is especially important right now as it helps policy makers, government officials, and businesses like yours understand these effects. Please complete this short 18 question survey; it will take approximately 5 minutes.


Q1. For the completion of this survey, please provide data for: XXXX

Is XX-XXXXXXX the Employer Identification Number (EIN) used on this businesses latest

Internal Revenue Service Form 941, Employer's Federal Quarterly Tax Return?


o Yes

o No


If no, please provide EIN:


------------------------------------------------------------------------------------------------------------------------------------------

Q2. Overall, how has this business been affected by the Coronavirus pandemic?


• Large negative effect
• Moderate negative effect
• Little or no effect
• Moderate positive effect
• Large positive effect



Q3. In the last month, what were the total operating revenues/sales/receipts for this business, not including any financial assistance or loans?


Select only one:
• $0 - $500
• $501 - $2,500
• $2,501 - $5,000
• $5,001 - $15,000
• $15,001 - $50,000
• $50,001 - $125,000
• $125,001 - $200,000
• $200,001 - $500,000
• $500,001 or more
• Don’t know




Q4. In the last week, did this business have a change in operating revenues/sales/receipts, not including any financial assistance or loans?


Select only one:
• Yes, increased
• Yes, decreased
• No change



Q5. In the last week, did this business do any of the following?


Select only one:
• Open a previously closed location
• Temporarily close a location
• Permanently close a location
• None of the above



Q6. In the last week, did this business have a change in the number of paid employees?


Select only one:
• Yes, increased
• Yes, decreased
• No change



Q7. In the last week, did this business have a change in the total number of hours worked by paid employees?


Select only one:

• Yes, increased

• Yes, decreased

• No change



Q8. In the last week, did this business require employees to test negative for COVID-19 before physically coming to work?


Select only one:

• Yes

• No

• Not applicable, this business did not have employees physically coming to work in the last week.




Q9. In the last week, did this business require employees to have proof of COVID-19 vaccination before physically coming to work?


Select only one:

• Yes

• No

• Not applicable, this business did not have employees physically coming to work in the last week.



Q10. In the last week, did this business have any of the following?


Select all that apply:
Domestic supplier delays
Foreign supplier delays
• Difficulty locating alternative domestic suppliers
• Difficulty locating alternative foreign suppliers
• Production delays at this business
• Delays in delivery/shipping to customers
• None of the above



Q11. In the last week, was this business’s operating capacity affected by any of the following?

Note: Operating capacity is the maximum amount of activity this business could conduct under realistic operating conditions.


Select all that apply:

• Availability of employees to work

• Ability of employees to work from home

• Availability of COVID-19 tests for employees

• Availability of COVID-19 vaccine for employees

• Physical distancing of employees

• Physical distancing of customers or clients and/or limits on the number of

concurrent customers or clients

• Availability of Personal Protective Equipment (PPE) and/or related equipment or

supplies

• Availability of other supplies or inputs used to provide good or services

• None of the above








Q12. How would you describe this business’s current operating capacity relative to its operating capacity prior to the Coronavirus pandemic?

Note: Operating capacity is the maximum amount of activity this business could conduct under realistic operating conditions.


Select only one:

• Operating capacity has increased 50% or more
• Operating capacity has increased less than 50%
• No change in operating capacity
• Operating capacity has decreased less than 50%
• Operating capacity has decreased 50% or more



Q13. The White House declared a national emergency because of the Coronavirus pandemic on March 13, 2020.


Since March 13, 2020, did this business change the amount of square footage leased/rented for operations?


Select only one:

• Yes, increased

• Yes, decreased

• No change

• Not applicable, this business does not lease/rent space.



Q14. Since March 13, 2020, what changes did this business make to its planned capital expenditures for 2020?


Select all that apply:
• Canceled planned capital expenditures

• Postponed planned capital expenditures

• Decreased planned capital expenditures

• Increased planned capital expenditures

• Introduced new unplanned capital expenditures

• This business had no changes to planned capital expenditures for 2020.

• This business had no planned capital expenditures for 2020.









Q15. On December 27, 2020, the Consolidated Appropriations Act 2021 was enacted providing a second round of Coronavirus pandemic relief.


Since December 27, 2020, has this business requested financial assistance from any of the following sources?


Select all that apply:

• Paycheck Protection Program (PPP), first time applicant
• Paycheck Protection Program (PPP), second time applicant

• Paycheck Protection Program (PPP) loan forgiveness

• Economic Injury Disaster Loans (EIDL)
• Paid Sick Leave and Paid Family Leave Credit
• Employee Retention and Rehiring Credit

• Restaurant Revitalization Fund

• Shuttered Venue Operators Grants
• Other Federal programs
• State or local government programs
• Banks or other financial institutions
• Owners
• Family or friends
• Other sources
• This business has not requested financial assistance from any source since December 27, 2020.



Q16. Since December 27, 2020, has this business received financial assistance from any of the following sources?


Select all that apply:
• Paycheck Protection Program (PPP)
• Paycheck Protection Program (PPP) loan forgiveness

• Economic Injury Disaster Loans (EIDL)
• Paid Sick Leave and Paid Family Leave Credit
• Employee Retention and Rehiring Credit

• Restaurant Revitalization Fund

• Shuttered Venue Operators Grants
• Other Federal programs
• State or local government programs
• Banks or other financial institutions
• Owners
• Family or friends
• Other sources
• This business has not received financial assistance from any source since December 27, 2020.







Q17. In the next 6 months, do you think this business will have business travel expenditures for air, rail, car rental, or lodging?


Select only one:

• Yes

• No

• Not applicable, this business does not usually have business travel expenditures.



Q18. In the next 6 months, do you think this business will need to do any of the following?


Select all that apply:

• Obtain financial assistance or additional capital

• Identify new supply chain options

• Develop online sales or websites

• Increase marketing or sales

• Learn how to better provide for the safety of customers and employees

• Identify and hire new employees

• Make a capital expenditure

• Cancel or postpone a planned capital expenditure

• Permanently close this business

• None of the above



Q19. In your opinion, how much time do you think will pass before this business returns to its usual level of operations?


Select only one:
• 1 month or less
• 2-3 months
• 4-6 months
• More than 6 months
• I do not believe this business will return to its usual level of operations.
• This business has permanently closed.
• There has been little or no effect on this business's usual level of operations.
• This business has returned to its usual level of operations.



Would you like to provide any information about your responses to these questions or this business's experiences during the Coronavirus pandemic?


Remarks (500 characters)

Shape1








OMB Number


This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number is 0607-1014 and appears in the top right corner of each reporting screen. Without this approval, we could not conduct this survey.


Authority and Confidentiality


Title 13, United States Code, Sections 131 and 182, authorizes the U.S. Census Bureau to conduct this collection and to request your voluntary assistance. The Census Bureau is required by Section 9 of the same law to keep your information confidential and use your responses only to produce statistics. The Census Bureau is not permitted to publicly release your responses in a way that could identify your business, organization, or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.


Burden Estimate Statement


We estimate the Small Business Pulse Survey will take an average of 5 minutes to complete. Factors such as company size, complexity and activity will affect your actual time to complete the survey. This estimate includes the time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the survey.


Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:


EID Survey Comments 0607-1014

U.S. Census Bureau

4600 Silver Hill Road

Room EID-6K081

Washington, DC 20233


You may email comments to [email protected]. Be sure to use “EID Survey Comments 0607-1014” as the subject.



11




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2021-07-04

© 2024 OMB.report | Privacy Policy