SBPS Questionnaire SBPS Questionnaire (Phase 6 testing)

Small Business Pulse Survey Phase 6 draft 04.27.21 v4

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 19 question survey; it will take approximately 5 minutes.

For the completion of this survey, please provide data for: XXXX [Name of company]

Q.1 Is XX-XXXXXXX the Employer Identification Number (EIN) used on this business’s latest

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

Select only one:

• Yes

• No

If no, please provide EIN:

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

Select only one:

• 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 have difficulties hiring paid employees?

Select only one:

• Yes

• No

• Not applicable

Q9. 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

Q10. The White House declared a national emergency because of the Coronavirus pandemic on March 13, 2020.

Compared to what was normal before March 13, 2020, how has the number of paid employees at this business changed?

Select only one:

• Large increase in paid employees

• Moderate increase in paid employees

• Little or no change in paid employees

• Moderate decrease in paid employees

• Large decrease in paid employees

Alt 10. Compared to what was normal before March 13, 2020, has the number of paid employees at this business changed?

Select only one:

• Yes, increased

• Yes, decreased

• No change

Q11. Compared to what was normal before March 13, 2020, how has the percent of this business’s paid employees working onsite changed?

Select only one:

• Large increase in percent of employees working onsite

• Moderate increase in percent of employees working onsite

• Little or no change in percent of employees working onsite

• Moderate decrease in percent of employees working onsite

• Large decrease in percent of employees working onsite

Alt 11. Compared to what was normal before March 13, 2020, has the percent of this business’s paid employees working onsite changed?

Select only one:

• Yes, increased

• Yes, decreased

• No change

Q12. Compared to what was normal before March 13, 2020, how has this business’s customer base changed?

Select only one:

• Large increase in customer base

• Moderate increase in customer base

• Little or no change in customer base

• Moderate decrease in customer base

• Large decrease in customer base

Alt 12. Compared to what was normal before March 13, 2020, how has the demand for this business’s goods or services changed?

Select only one:

• Large increase in demand

• Moderate increase in demand

• Little or no change in demand

• Moderate decrease in demand

• Large decrease in demand

Q13. Compared to what was normal before March 13, 2020, how have the prices this business pays for goods from suppliers changed?

Select only one:

• Large increase in prices

• Moderate increase in prices

• Little or no change in prices

• Moderate decrease in prices

• Large decrease in prices

Alt 13. Compared to what was normal before March 13, 2020, how have the prices this business pays for goods or services changed?

Select only one:

• Large increase in prices

• Moderate increase in prices

• Little or no change in prices

• Moderate decrease in prices

• Large decrease in prices

Q14. Since March 13, 2020, has this business permanently increased its use of technology in order to reduce its number of paid employees?

Select only one:

• Yes

• No

Alt 14. Since March 13, 2020, has this business permanently increased its use of technology resulting in a reduction in its number of paid employees?

Select only one:

• Yes

• No

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

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)

• Restaurant Revitalization Fund

• Shuttered Venue Operators Grants
• This business has not received financial assistance from the above sources since December 27, 2020.

Q16. 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

Q17. 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

• Identify and hire new employees

• Permanently close this business

• None of the above

Q18. In your opinion, how much time do you think will pass before this business returns to its normal 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 normal level of operations.
• This business has permanently closed.
• There has been little or no effect on this business's normal level of operations.
• This business has returned to its normal level of operations

Q19. Please describe any permanent changes this business has made to its operations due to the Coronavirus pandemic.

(1000 characters)

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)

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.

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