Various Economic Area Pretesting Activities

Generic Clearence for Questionnaire Pretesting Research

omb1133SBOenc1

Various Economic Area Pretesting Activities

OMB: 0607-0725

Document [pdf]
Download: pdf | pdf
10012011
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

SBO-1

2012 SURVEY OF BUSINESS OWNERS AND
SELF-EMPLOYED PERSONS
OMB No. 0607-0943: Approval Expires xx/xx/xxxx

(08-26-2011) Draft 1

DUE DATE
30 days after receipt of form

Mail your completed form to:
U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47132-0001
- OR -

Report online at:
www.census.gov/econhelp/sbo
Need help or have questions
about completing this form?
Visit www.census.gov/econhelp
Call 1-888-824-9954, between
8 a.m. and 6 p.m., Eastern time,
Monday through Friday.
- OR -

Write to the address above.
Include your 11-digit Census
File Number (CFN) printed in
the mailing address.
(Please correct any errors in this mailing address.)

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other
organizations that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau.
By the same law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold
the confidentiality of Census Bureau information and may be used only for statistical purposes. Further, copies
retained in respondents’ files are immune from legal process.

➜

Start Here

Please PRINT the first and last name of the person who
is filling out this form.
Name

The Census Bureau is responsible for
collecting information on the U.S. economy.
• The data that you provide will be combined with
the responses from other businesses and
business owners.

Include today’s date and a telephone number so we can
contact you if there is a question.

• Survey results will contain information on the
demographic and economic composition of
businesses in the United States.

MM

DD

YYYY

• Your response is important, and we keep your
answers confidential.
Area code

This form asks for two types of information:
• specific information about the business

Number

–

–

• information about the principal business owners
Extension

INSTRUCTIONS
Please read the enclosed insert before
answering the questions.
• Use blue or black ink.
• Place an "✘" inside the box.

✘

• Center numbers in boxes.
• Do not put slashes through 0 or 7.

7 0

➜

Please turn to the next page to continue.

§+"5,¤

10012029

2

Please answer the following questions for the self-employment or business activity of the person(s) or
business named in the mailing label even if the business has since been sold, reorganized, or discontinued.
You may use estimates if this form requests information that is not available in your business records.
An enclosure with answers to the most frequently asked questions regarding this survey has been provided.
1 In 2012, did another company or organization own more
than 50% of this business?
Yes - Go to 65 on Page 7

No

C. As of December 31, 2012, how many owners were
there in this business?
• Do not combine two or more owners to create
one owner.
• Count spouses and partners as separate owners.

2 In 2012, did employees under an Employee Stock
Ownership Plan (ESOP) own more than 50% of this
business?
Yes - Go to 65 on Page 7

No

3 In 2012, did members in a cooperative or club own more
than 50% of this business?
Yes - Go to 65 on Page 7

No

4 In 2012, did an estate or trust own more than 50% of this
business?
Yes - Go to 65 on Page 7

No

5 In 2012, did an Alaska Native Regional or Village
Corporation or an American Indian tribal entity own
more than 50% of this business?
Yes - Go to 65 on Page 7

1

5–9

2

10 – 49

3

50 or more

4

Unknown

D. For the person(s) owning the largest percentage(s)
in this business in 2012, please list the percentage
owned by each person and his or her position title.
• Do not report percentages owned by parent
companies, estates, trusts, etc.
• If more than 4 persons owned this business equally,
select any 4.
• Round percentages to whole numbers. For example,
report 1/3 ownership (33.3%) as:

3 3. 0 %

No

6 In 2012, was this business a nonprofit organization?
Position Title

Yes - Go to 65 on Page 7

No

Percentage Owned
(Estimates are
acceptable)

7 In 2012, was this business a publicly held corporation?
Yes

No

Owner 1:

. 0 %

Owner 2:

. 0 %

Owner 3:

. 0 %

Owner 4:

. 0 %

(Example: sole owner,
co-owner, shareholder,
president,
vice president, etc.)

8 In 2012, did any individual own 10% or more of the
rights, claims, interests, or stock in this business?
Yes

No - Go to 65 on Page 7

9 A. In 2012, was this business jointly owned by a
husband and wife?
Yes, equally operated by husband and wife
Yes, but primarily operated by husband
Yes, but primarily operated by wife
No
B. In 2012, did two or more members of the same family
own the majority of this business? (Family refers to
spouses, parents/guardians, children, siblings, or
close relatives.)
Yes

FORM SBO-1 (08/26/2011)

No

§+"5>¤

10012037

19 Was Owner 1 born in the United States?

Owner 1

Yes

Please answer the following questions about Owner 1
listed in 9 D on Page 2.
10 How did Owner 1 initially acquire ownership of this business?
Founded

Inherited

Purchased

Received transfer of
ownership/gift

11 When did Owner 1 acquire ownership of this business?

No

Please answer BOTH Question 20 about
☞ NOTE:
Hispanic origin and Question 21 about race. For
this survey, Hispanic origins are not races.
20 Is Owner 1 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano

Before 1984

2010

Yes, Puerto Rican

1985 – 1994

2011

Yes, Cuban

1995 – 2004

2012

2005 – 2009

Don’t know

12 In 2012, which of the following best represents Owner 1’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods

Financial control with
the authority to sign
loans, leases, and
contracts

Managing day-to-day
operations

None of the above

13 In 2012, what was the average number of hours per week that

Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C

21 What is Owner 1’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Owner 1 spent managing or working in this business?
None

40 hours

Less than 20 hours

41 – 59 hours

20 – 39 hours

60 hours or more

14 In 2012, did this business provide Owner 1’s primary source
of personal income?
Yes

Asian Indian

Japanese

Chinese

Korean

Filipino

Vietnamese

Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C

No

15 Prior to establishing, purchasing, or acquiring this business,
had Owner 1 ever owned a business or been self-employed?
Yes

No

Native Hawaiian
Guamanian or Chamorro

16 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 1
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate

Associate Degree

High school graduate Diploma or GED

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Some other race - Print race C

service including the Coast Guard?
Yes

Female

18 What was the age of Owner 1 as of December 31, 2012?
Under 25

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

FORM SBO-1 (08/26/2011)

Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C

22 A. Is Owner 1 a veteran of any branch of the U.S. military

17 What is the sex of Owner 1?
Male

Samoan

No - Go to 23

B. (If Yes) Was Owner 1 disabled as the result of injury
incurred or aggravated during active military service?
Yes

No

23 Was more than 1 owner listed in 9 D on Page 2?
Yes

No - Go to 65 on Page 7

§+"5F¤

3

10012045

4

33 Was Owner 2 born in the United States?

Owner 2

Yes

Please answer the following questions about Owner 2
listed in 9 D on Page 2.
24 How did Owner 2 initially acquire ownership of this business?
Founded

Inherited

Purchased

Received transfer of
ownership/gift

25 When did Owner 2 acquire ownership of this business?

No

Please answer BOTH Question 34 about
☞ NOTE:
Hispanic origin and Question 35 about race. For
this survey, Hispanic origins are not races.
34 Is Owner 2 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano

Before 1984

2010

Yes, Puerto Rican

1985 – 1994

2011

Yes, Cuban

1995 – 2004

2012

2005 – 2009

Don’t know

26 In 2012, which of the following best represents Owner 2’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods

Financial control with
the authority to sign
loans, leases, and
contracts

Managing day-to-day
operations

None of the above

27 In 2012, what was the average number of hours per week that

Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C

35 What is Owner 2’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Owner 2 spent managing or working in this business?
None

40 hours

Less than 20 hours

41 – 59 hours

20 – 39 hours

60 hours or more

28 In 2012, did this business provide Owner 2’s primary source
of personal income?
Yes

Asian Indian

Japanese

Chinese

Korean

Filipino

Vietnamese

Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C

No

29 Prior to establishing, purchasing, or acquiring this business,
had Owner 2 ever owned a business or been self-employed?
Yes

No

Native Hawaiian
Guamanian or Chamorro

30 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 2
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate

Associate Degree

High school graduate Diploma or GED

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Some other race - Print race C

service including the Coast Guard?
Yes

Female

32 What was the age of Owner 2 as of December 31, 2012?
Under 25

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

FORM SBO-1 (08/26/2011)

Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C

36 A. Is Owner 2 a veteran of any branch of the U.S. military

31 What is the sex of Owner 2?
Male

Samoan

No - Go to 37

B. (If Yes) Was Owner 2 disabled as the result of injury
incurred or aggravated during active military service?
Yes

No

37 Was more than 2 owner listed in 9 D on Page 2?
Yes

No - Go to 65 on Page 7

§+"5N¤

10012052

47 Was Owner 3 born in the United States?

Owner 3

Yes

Please answer the following questions about Owner 3
listed in 9 D on Page 2.
38 How did Owner 3 initially acquire ownership of this business?
Founded

Inherited

Purchased

Received transfer of
ownership/gift

39 When did Owner 3 acquire ownership of this business?

No

Please answer BOTH Question 48 about
☞ NOTE:
Hispanic origin and Question 49 about race. For
this survey, Hispanic origins are not races.
48 Is Owner 3 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano

Before 1984

2010

Yes, Puerto Rican

1985 – 1994

2011

Yes, Cuban

1995 – 2004

2012

2005 – 2009

Don’t know

40 In 2012, which of the following best represents Owner 3’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods

Financial control with
the authority to sign
loans, leases, and
contracts

Managing day-to-day
operations

None of the above

41 In 2012, what was the average number of hours per week that

Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C

49 What is Owner 3’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Owner 3 spent managing or working in this business?
None

40 hours

Less than 20 hours

41 – 59 hours

20 – 39 hours

60 hours or more

42 In 2012, did this business provide Owner 3’s primary source
of personal income?
Yes

Asian Indian

Japanese

Chinese

Korean

Filipino

Vietnamese

Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C

No

43 Prior to establishing, purchasing, or acquiring this business,
had Owner 3 ever owned a business or been self-employed?
Yes

No

Native Hawaiian
Guamanian or Chamorro

44 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 3
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate

Associate Degree

High school graduate Diploma or GED

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Some other race - Print race C

service including the Coast Guard?
Yes

Female

46 What was the age of Owner 3 as of December 31, 2012?
Under 25

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

FORM SBO-1 (08/26/2011)

Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C

50 A. Is Owner 3 a veteran of any branch of the U.S. military

45 What is the sex of Owner 3?
Male

Samoan

No - Go to 51

B. (If Yes) Was Owner 3 disabled as the result of injury
incurred or aggravated during active military service?
Yes

No

51 Was more than 3 owner listed in 9 D on Page 2?
Yes

No - Go to 65 on Page 7

§+"5U¤

5

10012060

6

61 Was Owner 4 born in the United States?

Owner 4

Yes

Please answer the following questions about Owner 4
listed in 9 D on Page 2.
52 How did Owner 4 initially acquire ownership of this business?
Founded

Inherited

Purchased

Received transfer of
ownership/gift

53 When did Owner 4 acquire ownership of this business?

No

Please answer BOTH Question 62 about
☞ NOTE:
Hispanic origin and Question 63 about race. For
this survey, Hispanic origins are not races.
62 Is Owner 4 Spanish/Hispanic/Latino?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano

Before 1984

2010

Yes, Puerto Rican

1985 – 1994

2011

Yes, Cuban

1995 – 2004

2012

2005 – 2009

Don’t know

54 In 2012, which of the following best represents Owner 4’s
function(s) in this business? Mark ✘ all that apply.
Providing services
and/or producing
goods

Financial control with
the authority to sign
loans, leases, and
contracts

Managing day-to-day
operations

None of the above

55 In 2012, what was the average number of hours per week that

Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on. C

63 What is Owner 4’s race? Mark ✘ one or more races.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of
enrolled or principal tribe. C

Owner 4 spent managing or working in this business?
None

40 hours

Less than 20 hours

41 – 59 hours

20 – 39 hours

60 hours or more

56 In 2012, did this business provide Owner 4’s primary source
of personal income?
Yes

Asian Indian

Japanese

Chinese

Korean

Filipino

Vietnamese

Other Asian - Print race, for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on. C

No

57 Prior to establishing, purchasing, or acquiring this business,
had Owner 4 ever owned a business or been self-employed?
Yes

No

Native Hawaiian
Guamanian or Chamorro

58 Prior to establishing, purchasing, or acquiring this business,
what was the highest degree or level of school Owner 4
completed? Mark ✘ ONE box only for the highest level
completed or degree received.
Less than high
school graduate

Associate Degree

High school graduate Diploma or GED

Bachelor’s Degree

Technical, trade, or
vocational school

Master’s, Doctorate,
or Professional Degree

Some college,
but no degree

Some other race - Print race C

service including the Coast Guard?
Female

60 What was the age of Owner 4 as of December 31, 2012?
Under 25

45 – 54

25 – 34

55 – 64

35 – 44

65 or over

FORM SBO-1 (08/26/2011)

Other Pacific Islander - Print race, for example, Fijian,
Tongan, and so on. C

64 A. Is Owner 4 a veteran of any branch of the U.S. military

59 What is the sex of Owner 4?
Male

Samoan

Yes

No - Go to 65

B. (If Yes) Was Owner 4 disabled as the result of injury
incurred or aggravated during active military service?
Yes

No

§+"5]¤

10012078

70 In 2012, were any of the following sources used to finance

Business

expansion or capital improvement(s) for this business?
Mark ✘ all that apply.

65 In what year was this business originally established?

Personal/family savings of owner(s)

Before 1984

2008

2012

Personal/family assets other than savings of owner(s)

1985 – 1994

2009

Don’t know

Personal/family home equity loan

1995 – 2004

2010

Personal/business credit card(s)

2005 – 2007

2011

Business loan from federal, state, or local government

66 A. For the owner(s) as of December 31, 2012, what was the

Government-guaranteed business loan from a bank
or financial institution

source(s) of capital used to start or acquire this business?
Mark ✘ all that apply.

Business loan from a bank or financial institution

Personal/family savings of owner(s)

Business loan/investment from family/friend(s)

Personal/family assets other than savings of owner(s)
Personal/family home equity loan

Investment by venture capitalist(s) (An early-stage
investment in exchange for ownership equity by an
individual, outside group, or business not directly involved
in the overall operation and management of the business.)

Personal/business credit card(s)

Business profits and/or assets

Business loan from federal, state, or local
government

Grants

Government-guaranteed business loan from a bank
or financial institution

Other source(s) of capital

Business loan from a bank or financial institution

Don’t know

Business loan/investment from family/friend(s)

Did not have access to capital

Investment by venture capitalist(s) (An early-stage
investment in exchange for ownership equity by an
individual, outside group, or business not directly involved
in the overall operation and management of the business.)

Did not expand or make capital improvement(s)

71 In 2012, which of the following types of customers accounted

Grants

for 10% or more of this business’s total sales of goods and/or
services? Mark ✘ all that apply.

Other source(s) of capital

Federal
government

Don’t know

State and local government, including school districts,
transportation authorities, etc.

None needed – Go to

67

Other businesses and/or organizations, including
distributors of your product(s)

B. For the owner(s) as of December 31, 2012, what was the
total amount of capital used to start or acquire this
business? (Capital includes savings, other assets, and borrowed

Individuals

funds of owner(s)).

72 In 2012, what percent of this business’s total sales of goods

Less than $5,000

$100,000 – $249,999

$5,000 – $9,999

$250,000 – $999,999

None

5% - 9%

50% - 99%

$10,000 – $24,999

$1,000,000 or more

Less than 1%

10% - 19%

100%

$25,000 – $49,999

Don’t know

1% - 4%

20% - 49%

Don’t know

$50,000 – $99,999

and/or services consisted of exports outside the United States?

73 In 2012, did this business establish operations outside the
United States?

67 In 2012, did this business operate primarily from somebody’s
home?
Yes

Yes

No

No

74 In 2012, did this business outsource or transfer any business
function and/or service to a company outside the
United States?

68 In 2012, did this business operate as a franchise?
Yes

No

Yes

No

69 In 2012, did a franchiser own more than 50% of this business?
Yes
FORM SBO-1 (08/26/2011)

No

➜

Please turn to the next page to continue.

§+"5o¤

7

10012086

8
75 In 2012, in which language(s) did this business conduct

80 In 2012, did this business make purchases online?

transactions with its customers? Mark ✘ all that apply.

Yes

No

English

Hindi/Urdu

Russian

Arabic

Italian

Spanish

Chinese

Japanese

Tagalog

Operated less than 40 hours per week on average

French

Korean

Vietnamese

Operated less than 12 months

German

Polish

Other

Greek

Portuguese

Seasonal business (for example, fireworks sales
or tax preparer)
Operated occasionally (for example, event organizer
or guest speaker)

81 In 2012, did any of the following characteristics describe
the activity of this business? Mark ✘ all that apply.

76 In 2012, were any of the following types of workers used by
this business?

Yes

None of the above

No

A. Full-time paid employees. . . . . . . . . . . . . .

82 A. Is this business currently operating?
Yes

B. Part-time paid employees. . . . . . . . . . . . . .
C. Paid day laborers. . . . . . . . . . . . . . . . . . . .

B. (If No) Did the operations cease for any of the reasons
listed below? Mark ✘ all that apply.

D. Temporary staffing obtained from a
temporary help service . . . . . . . . . . . . . . . .
E. Leased employees from a leasing
service or a professional employer
organization . . . . . . . . . . . . . . . . . . . . . . . .
F. Contractors, subcontractors,
independent contractors, or
outside consultants. . . . . . . . . . . . . . . . . . .

Profit sharing and/or stock options
Paid holidays, vacation, and/or sick leave

Owner(s) deceased

Started another business

Operated for
a specific or
one-time event

Sold this business
Other

Thank you for participating in the Survey of Business
Owners and Self-Employed Persons.
Please return the completed original questionnaire in the
postage-paid envelope. Make sure the barcode above your
address shows in the window of the envelope. Please make
a photocopy of this form for your records.
If the envelope has been misplaced, please mail the form to:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

None of the above

78 In 2012, did this business have a Web site?
Yes

Lack of personal
loans/credit

Lack of business
loans/credit

totally or partly by this business? Mark ✘ all that apply.

Contributions to retirement plans, including 401(k),
Keogh, etc.

Owner(s) retired

Inadequate cash
flow or low sales

77 In 2012, which of the following employee benefits were paid
Health insurance

No

Remarks

No

79 A. In 2012, did this business have any e-commerce sales?
(E-commerce sales and other operating receipts are sales of goods
and/or services where an order is placed by the buyer or price and
terms of the sale are negotiated over the Internet. Payment may or
may not be made online.)

Less than 1%

No - Go to 80

B. In 2012, what percent of this business’s total sales of
goods and/or services were e-commerce sales?
Less than 1%

20% – 49%

1% – 4%

50% – 99%

5% – 9%

100%

10% – 19%

Don’t know

FORM SBO-1 (08/26/2011)

§+"5w¤


File Typeapplication/pdf
File Titlesbo1_p01_12.g
File Modified2011-10-06
File Created2011-08-31

© 2024 OMB.report | Privacy Policy