Form ITA-4143P-3 Annual Baseline Survey Example 2024

OMB Control Number: 0625-0225 / Expiration Date: XX/XX/20XX

SABIT Program Survey - Long Term

Hello from the SABIT Program.
We are reaching out to you to ask for your help by answering some questions about
how information you received while on the SABIT Program has assisted you in your
job and as you promote more business friendly practices in your industry and
country.

* 1. Please provide the following information.
Пожалуйста, укажите следующие данные.
First Name/Имя
Last Name/Фамилия
City/Город
Position, Company/
Должность, компания

2. Country of citizenship
Страна гражданской принадлежности
Armenia/Армения
Azerbaijan/Азербайджан
Belarus/Беларусь
Bhutan
Georgia/Грузия
India
Kazakhstan/Казахстан
Kyrgyz Republic/Киргизия
Moldova/Молдова
Pakistan
Russia/Россия
Sri Lanka
Tajikistan/Таджикистан
Turkmenistan/Туркмения
Ukraine/Украина
Uzbekistan/Узбекистан
My country is not listed.
Моей страны нет в этом списке.

Other country/Другая страна

* 3. Which year did you participate in the SABIT Program?

* 4. DOES NOT SHOW UP FOR SHORT TERM Which type of Program did you participate in?
Individual Internship is defined as spending 1-6 months in one U.S. company. Generally, these
programs took place from 1992 through 2004.
Group program is defined as participating in a delegation of 10-25 people who came to the
United States and visited multiple U.S. organizations as a group. These programs began in
1995 and are ongoing.
Individual Internship
Group Program
I don't know

* 5. DOES NOT SHOW UP IN SHORT TERM If you answered Individual Internship, which
company did you intern with?

* 6. If you answered Group Program, which Industry Sector?

7. Does your company trade with the United States? (L1)
Yes

We plan to in the next year.

No

We plan to in the next 2 years.

We want to, but have a problem.

We plan to in the next 5 years.

We did, but no longer.
Other (please specify)

8. If you answered yes, above, what percentage of your trade is regional? (L2)
< 10%

50% - 75%

11%-25%

> 75%

< 50%
Other (please specify)

9. Has this increased since your SABIT Program participation? (L2)
Yes
No
Not sure
Comment:

10. Are you participating in trade with companies outside your home country, but within your
region? If yes, please select all that apply. (L2)
Central Asia (Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, Uzbekistan)
South Asia (Afghanistan, Bangladesh, India, Pakistan, Sri Lanka)
Eurasia (Armenia, Azerbaijan, Georgia, Russia, Ukraine)
Europe (Countries of the EU, Moldova, United Kingdom, Nordic and Baltic Countries)
Other (please specify)

11. Please list any questions you still want to be answered or any information you would like
us to try to obtain for you.
Пожалуйста, укажите любые вопросы, которые остались без ответа, или какую
информацию Вам бы хотелось, чтобы мы попробовали для Вас получить.

12. Please share any additional comments about any aspects of the program you think
relevant. Thank you!
Пожалуйста, поделитесь дополнительными комментариями относительно любых,
важных на Ваш взгляд, аспектов программы. Спасибо!

13. Please provide up-to-date contact information.
Пожалуйста, укажите Ваши текущие контактные данные.
Email/Адрес
электронной почты
Work telephone/
Номер рабочего
телефона
Mobile telephone/
Номер мобильного
телефона

14. Which method of communication do you prefer? Check all that apply.
Какой способ связи Вы предпочитаете? Отметьте все подходящие варианты.
Email/Электронная почта
Work telephone/Рабочий телефон
Mobile telephone/Мобильный телефон

Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently
valid OMB Control Number. The approved OMB Control Number for this information collection is 0625-0225. Without this approval, we could not
conduct this information collection. Public reporting for this information collection is estimated to be approximately 1 hour per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of
this information collection, including suggestions for reducing this burden to the International Trade Administration Paperwork Reduction Act
Program: [email protected] or to Katelynn Byers, ITA PRA Process Administrator: [email protected].