2016 ASE Worksheet 2016 ASE Worksheet

Attachment B - 2016 ASE Worksheet

Welcome to the 2016 Annual Survey of Entrepreneurs
DO NOT use this worksheet to respond to the survey, it is intended to assist you with gathering and preparing your data
prior to reporting online. Please view the online report for specific instructions.
Return to https://portal.census.gov when you are ready to report online.
CONTACT INFORMATION
Please enter the first and last name of the person who is filling out this survey. We request a telephone number so we
can contact you if there is a question.
Contact Name:
Phone:
NUMBER OF OWNERS
In 2016, how many people owned this business?
 Do not combine two or more owners to create one
 Count spouses and partners as separate owners
 1 person – Skip to 10 percent or more ownership
 2 people – Skip to 10 percent or more ownership
 3 people - Skip to 10 percent or more ownership
 4 people – Skip to 10 percent or more ownership
 5-10 people – Skip to 10 percent or more ownership
 11 or more people
 Business is owned by a parent company, estate, trust, or other entity
 Don’t know
GOVERNMENT OR TRIBAL ENTITY OWNERSHIP
In 2016, was this business owned by a government or tribal entity?
Yes
No
10 PERCENT or MORE OWNERSHIP
In 2016, did at least one person own 10% or more of this business? (Do not count parent companies, estates, trusts or
other entities.)
Yes
No
PERCENT OWNERSHIP
For the person(s) owning the largest percentage(s) in this business in 2016, please list the percentage owned by each
person and his or her name.
 Do not report percentages owned by parent companies, estates, trusts, or other entities
 If more than 4 people owned this business equally, select any 4 people
 Round percentages to whole numbers. For example, report 1/3 ownership as 33%.
Percentage Owned (Estimates are acceptable)

Name

Owner 1:
Owner 2:
Owner 3:
Owner 4:
1

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OWNER 1 – If applicable, if not skip to page 18
INITIAL ACQUISITION
How did Owner 1 initially acquire ownership of this business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 1 acquire ownership of this business?
Year
Don’t Know
JOB FUNCTION(S)
In 2016, which of the following were Owner 1’s function(s) in this business? Select all that apply.
Managing day-to-day operations Providing
services and/or producing goods
Financial control with the authority to sign loans, leases, and contracts
None of these functions
AVERAGE NUMBER OF HOURS WORKED
In 2016, what was the average number of hours per week that 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
PRIMARY INCOME SOURCE
In 2016, did this business provide Owner 1’s primary source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this business, how many previous businesses has Owner 1 owned?
0
1
2
3
4
 5 or more

2

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EDUCATION PRIOR TO OWNING THE BUSINESS
What was the highest degree or level of school Owner 1 completed prior to establishing, purchasing, or acquiring this
business? Select ONE box only.
Less than high school graduate
High school graduate - Diploma or GED
Technical, trade, or vocational school
Some college, but no degree
Associate Degree
Bachelor’s Degree
Master’s, Doctorate, or Professional Degree
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this business, what was the field of the highest degree completed for Owner
1? (Select all that apply)
 Agriculture, Environmental and Related
 Architecture and Building
 Business or Finance
 Education
 Engineering and Related Technologies
 Food or Hospitality
 Health, Medicine or Pharmacy
 Humanities or Arts
 Information Technology or Computer Science
 Law or Legal Studies
 Mathematics, Economics, or Statistics
 Natural and Physical Sciences
 Social Sciences
 Other (Specify)
_________________________________________
 No Bachelor’s, Master’s, Doctorate, or Professional Degree
 Don’t know

SEX
What is the sex of Owner 1?
Male
Female
AGE
What was the age of Owner 1 as of December 31, 2016?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Was Owner 1 born a citizen of the United States?
Yes
No

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ETHNICITY
Is Owner 1 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - please enter origin below. For example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

RACE
What is Owner 1’s race? NOTE: For this survey, Hispanic origins are not races. Select all that apply.
White
Black or African American
American Indian or Alaska Native - please enter name of enrolled or principal tribe below

Native Hawaiian
Asian Indian
Japanese
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian- please enter race below. For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Other Pacific Islander - please enter race below. For example, Fijian, Tongan, and so on.

Some other race - please enter race below.

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MILITARY SERVICE
Has Owner 1 ever served in any branch of the U.S. Armed Forces, including the Coast Guard, the National Guard, or
Reserve component of any service branch?
Yes
No – Skip to Reasons for Owning the Business
(If yes) Do any of the following characteristics describe Owner 1’s military service? Select all that apply.
Served on active duty military service, not including training for the Reserves or National Guard
Disabled as the result of illness or injury incurred or aggravated during military service
Served on active duty military service after September 11, 2001
Served on active duty military service in 2016
Served in the National Guard or as a reservist of any branch of the U.S. Armed Forces in 2016
None of the above
REASONS FOR OWNING THE BUSINESS
How important to Owner 1 are each of the following reasons for owning this business? (Select one for each row.)
Not
Somewhat
Very
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income/Wanted to build
wealth
Best avenue for my ideas/goods/services
Couldn’t find a job/Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a
role model
Other (Specify)

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Attachment B - 2016 ASE Worksheet

OWNER 2 - If applicable, if not skip to page 18
INITIAL ACQUISITION
How did Owner 2 initially acquire ownership of this business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 2 acquire ownership of this business?
Year
Don’t Know

JOB FUNCTION(S)
In 2016, which of the following were Owner 2’s function(s) in this business? Select all that apply.
Managing day-to-day operations Providing
services and/or producing goods
Financial control with the authority to sign loans, leases, and contracts
None of these functions
AVERAGE NUMBER OF HOURS WORKED
In 2016, what was the average number of hours per week that 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
PRIMARY INCOME SOURCE
In 2016, did this business provide Owner 2’s primary source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this business, how many previous businesses has Owner 2 owned?
0
1
2
3
4
 5 or more

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EDUCATION PRIOR TO OWNING THE BUSINESS
What was the highest degree or level of school Owner 2 completed prior to establishing, purchasing, or acquiring this
business? Select ONE box only.
Less than high school graduate
High school graduate- Diploma or GED
Technical, trade, or vocational school
Some college, but no degree Associate
Degree
Bachelor’s Degree
Master’s, Doctorate, or Professional Degree
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this business, what was the field of the highest degree completed for Owner
2? (Select all that apply)
 Agriculture, Environmental and Related
 Architecture and Building
 Business or Finance
 Education
 Engineering and Related Technologies
 Food or Hospitality
 Health, Medicine or Pharmacy
 Humanities or Arts
 Information Technology or Computer Science
 Law or Legal Studies
 Mathematics, Economics, or Statistics
 Natural and Physical Sciences
 Social Sciences
 Other (Specify)
_________________________________________
 No Bachelor’s, Master’s, Doctorate, or Professional Degree
 Don’t know
SEX
What is the sex of Owner 2?
Male
Female
AGE
What was the age of Owner 2 as of December 31, 2016?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Was Owner 2 born a citizen of the United States?
Yes
No

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ETHNICITY
Is Owner 2 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin- please enter origin below. For example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

RACE
What is Owner 2’s race? NOTE: For this survey, Hispanic origins are not races. Select all that apply.
White
Black or African American
American Indian or Alaska Native - please enter name of enrolled or principal tribe below

Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - please enter race below. For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Other Pacific Islander - please enter race below. For example, Fijian, Tongan, and so on.

Some other race - please enter race below.

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MILITARY SERVICE
Has Owner 2 ever served in any branch of the U.S. Armed Forces, including the Coast Guard, the National Guard, or
Reserve component of any service branch?
Yes
No – Skip to Reasons for Owning the Business
(If yes) Do any of the following characteristics describe Owner 2’s military service? Select all that apply.
Served on active duty military service, not including training for the Reserves or National Guard
Disabled as the result of illness or injury incurred or aggravated during military service
Served on active duty military service after September 11, 2001
Served on active duty military service in 2016
Served in the National Guard or as a reservist of any branch of the U.S. Armed Forces in 2016
None of the above
REASONS FOR OWNING THE BUSINESS
How important to Owner 2 are each of the following reasons for owning this business? (Select one for each row.)
Not
Somewhat
Very
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income/Wanted to build
wealth
Best avenue for my ideas/goods/services
Couldn’t find a job/Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a
role model
Other (Specify)

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Attachment B - 2016 ASE Worksheet

OWNER 3 - If applicable, if not skip to page 18
INITIAL ACQUISITION
How did Owner 3 initially acquire ownership of this business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 3 acquire ownership of this business?
Year
Don’t Know

JOB FUNCTION(S)
In 2016, which of the following were Owner 3’s function(s) in this business? Select all that apply.
Managing day-to-day operations Providing
services and/or producing goods
Financial control with the authority to sign loans, leases, and contracts
None of these functions
AVERAGE NUMBER OF HOURS WORKED
In 2016, what was the average number of hours per week that 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
PRIMARY INCOME SOURCE
In 2016, did this business provide Owner 3’s primary source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this business, how many previous businesses has Owner 3 owned?
0
1
2
3
4
 5 or more

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1
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Attachment B - 2016 ASE Worksheet

EDUCATION PRIOR TO OWNING THE BUSINESS
What was the highest degree or level of school Owner 3 completed prior to establishing, purchasing, or acquiring this
business? Select ONE box only.
Less than high school graduate
High school graduate - Diploma or GED
Technical, trade, or vocational school
Some college, but no degree
Associate Degree
Bachelor’s Degree
Master’s, Doctorate, or Professional Degree
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this business, what was the field of the highest degree completed for Owner
3? (Select all that apply)
 Agriculture, Environmental and Related
 Architecture and Building
 Business or Finance
 Education
 Engineering and Related Technologies
 Food or Hospitality
 Health, Medicine or Pharmacy
 Humanities or Arts
 Information Technology or Computer Science
 Law or Legal Studies
 Mathematics, Economics, or Statistics
 Natural and Physical Sciences
 Social Sciences
 Other (Specify)
_________________________________________
 No Bachelor’s, Master’s, Doctorate, or Professional Degree
 Don’t know
SEX
What is the sex of Owner 3?
Male
Female
AGE
What was the age of Owner 3 as of December 31, 2016?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Was Owner 3 born a citizen of the United States?
Yes
No

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Attachment B - 2016 ASE Worksheet

ETHNICITY
Is Owner 3 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - please enter origin below. For example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

RACE
What is Owner 3’s race? NOTE: For this survey, Hispanic origins are not races. Select all that apply.
White
Black or African American
American Indian or Alaska Native - please enter name of enrolled or principal tribe below

Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - please enter race below. For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Other Pacific Islander - please enter race below. For example, Fijian, Tongan, and so on.

Some other race- please enter race below.

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Attachment B - 2016 ASE Worksheet

MILITARY SERVICE
Has Owner 3 ever served in any branch of the U.S. Armed Forces, including the Coast Guard, the National Guard, or
Reserve component of any service branch?
Yes
No – Skip to Reasons for Owning the Business
(If yes) Do any of the following characteristics describe Owner 3’s military service? Select all that apply.
Served on active duty military service, not including training for the Reserves or National Guard
Disabled as the result of illness or injury incurred or aggravated during military service
Served on active duty military service after September 11, 2001
Served on active duty military service in 2016
Served in the National Guard or as a reservist of any branch of the U.S. Armed Forces in 2016
None of the above
REASONS FOR OWNING THE BUSINESS
How important to Owner 3 are each of the following reasons for owning this business? (Select one for each row.)
Not
Somewhat
Very
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income/Wanted to build
wealth
Best avenue for my ideas/goods/services
Couldn’t find a job/Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a
role model
Other (Specify)

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Attachment B - 2016 ASE Worksheet

OWNER 4 - If applicable, if not skip to page 18
INITIAL ACQUISITION
How did Owner 4 initially acquire ownership of this business? Select all that apply.
Founded or started
Purchased
Inherited
Received transfer of ownership or gift
INITIAL ACQUISITION YEAR
In what year did Owner 4 acquire ownership of this business?
Year
Don’t Know

JOB FUNCTION(S)
In 2016, which of the following were Owner 4’s function(s) in this business? Select all that apply.
Managing day-to-day operations Providing
services and/or producing goods
Financial control with the authority to sign loans, leases, and contracts
None of these functions
AVERAGE NUMBER OF HOURS WORKED
In 2016, what was the average number of hours per week that 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
PRIMARY INCOME SOURCE
In 2016, did this business provide Owner 4’s primary source of personal income?
Yes
No
PRIOR BUSINESS OWNERSHIP
Prior to establishing, purchasing, or acquiring this business, how many previous businesses has Owner 4 owned?
0
1
2
3
4
 5 or more

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EDUCATION PRIOR TO OWNING THE BUSINESS
What was the highest degree or level of school Owner 4 completed prior to establishing, purchasing, or acquiring this
business? Select ONE box only.
Less than high school graduate
High school graduate - Diploma or GED
Technical, trade, or vocational school
Some college, but no degree
Associate Degree
Bachelor’s Degree
Master’s, Doctorate, or Professional Degree
FIELD OF HIGHEST DEGREE PRIOR TO OWNING THE BUSINESS
Prior to establishing, purchasing, or acquiring this business, what was the field of the highest degree completed for Owner
4? (Select all that apply)
 Agriculture, Environmental and Related
 Architecture and Building
 Business or Finance
 Education
 Engineering and Related Technologies
 Food or Hospitality
 Health, Medicine or Pharmacy
 Humanities or Arts
 Information Technology or Computer Science
 Law or Legal Studies
 Mathematics, Economics, or Statistics
 Natural and Physical Sciences
 Social Sciences
 Other (Specify)
_________________________________________
 No Bachelor’s, Master’s, Doctorate, or Professional Degree
 Don’t know
SEX
What is the sex of Owner 4?
Male
Female
AGE
What was the age of Owner 4 as of December 31, 2016?
Under 25
45-54
25-34
55-64
35-44
65 or over
US CITIZENSHIP
Was Owner 4 born a citizen of the United States?
Yes
No

15

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ETHNICITY
Is Owner 4 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin - please enter origin below. For example, Argentinean,
Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

RACE
What is Owner 4’s race? NOTE: For this survey, Hispanic origins are not races. Select all that apply.
White
Black or African American
American Indian or Alaska Native - please enter name of enrolled or principal tribe below

Asian Indian
Japanese
Native Hawaiian
Chinese
Korean
Guamanian or Chamorro
Filipino
Vietnamese
Samoan
Other Asian - please enter race below. For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Other Pacific Islander - please enter race below. For example, Fijian, Tongan, and so on.

Some other race - please enter race below.

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MILITARY SERVICE
Has Owner 4 ever served in any branch of the U.S. Armed Forces, including the Coast Guard, the National Guard, or
Reserve component of any service branch?
Yes
No – Skip to Reasons for Owning the Business
(If yes) Do any of the following characteristics describe Owner 4’s military service? Select all that apply.
Served on active duty military service, not including training for the Reserves or National Guard
Disabled as the result of illness or injury incurred or aggravated during military service
Served on active duty military service after September 11, 2001
Served on active duty military service in 2016
Served in the National Guard or as a reservist of any branch of the U.S. Armed Forces in 2016
None of the above
REASONS FOR OWNING THE BUSINESS
How important to Owner 4 are each of the following reasons for owning this business? (Select one for each row.)
Not
Somewhat
Very
Important
Important
Important
Wanted to be my own boss
Flexible hours
Balance work and family
Opportunity for greater income/Wanted to build
wealth
Best avenue for my ideas/goods/services
Couldn’t find a job/Unable to find employment
Working for someone else didn’t appeal to me
Always wanted to start my own business
An entrepreneurial friend or family member was a
role model
Other (Specify)

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Business Specific Questions
The next questions apply to the entire business and only require one response from the respondent regardless of how
many owners were entered.
ONE FAMILY MAJORITY OWNERSHIP
In 2016, did two or more members of one family own the majority of this business? (Family refers to
spouses/unmarried partners, parents/guardians, children, siblings, or close relatives.)
Yes
No
JOINT OWNERSHIP
Did spouses/unmarried partners jointly own this business?
Yes
No – Skip to Business Aspirations
EQUAL OPERATION
Was this business operated equally by both spouses/unmarried partners?
Yes, equally operated by spouses/unmarried partners
No, primarily operated by Owner 1
No, primarily operated by Owner 2
BUSINESS ASPIRATIONS
Where would the owner(s) like this business to be in five years? Select one
Larger in terms of sales or profits
About the same amount of sales or profits
Smaller in terms of sales or profits
Other (specify)

FUNDING FROM OWNER(S)
For 2016, what was the total amount of money that the owner(s) personally put into the business? Your best estimate is
fine. Please report in thousands.
Include:
 Investments from personal savings
 Personal retirement accounts
 Home equity loans
 Personally borrowed funds
$
,000
YEAR OF BUSINESS ESTABLISHMENT
In what year was this business originally established?
Don’t know

FRANCHISE OPERATION
In 2016, did all or part of this business operate as a franchise?
Yes
No
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CAPITAL FUNDING
For the owners reported, what was the source(s) of capital used to start or initially acquire this business? If you did not
report any owners, skip to Amount of Capital Needed to Start or Initially Acquire Business. Select all that apply.
Personal/family savings of owner(s)
Personal/family assets other than savings of owner(s)
Personal/family home equity loan
Personal credit card(s) carrying balances
Business credit card(s) carrying balances
Government-guaranteed business loan from a bank or financial institutions, including SBA-guaranteed loans
Business loan from a bank or financial institution
Business loan from a federal, state, or local government
Business loan/investment from family/friend(s)
Investment by venture capitalist(s)
Grants
Other source(s) of capital
Don’t know
None needed – Skip to Funding from Family, Friends, and Employees
AMOUNT OF CAPITAL NEEDED TO START OR INITIALLY ACQUIRE BUSINESS
For the owners you reported, what was the total amount of capital used to start or initially acquire this business?
(Capital includes savings, other assets, and borrowed funds of owner(s).)
Less than $5,000
$100,000 - $249,999
$5,000 - $9,999
$250,000 - $999,999
$10,000 - $24,999
$1,000,000 - $2,999,999
$25,000 - $49,999
$3,000,000 or more
$50,000 - $99,999
Don’t know
FUNDING FROM FAMILY, FRIENDS, AND EMPLOYEES
For 2016, what was the amount of money this business received from family, friends, and employees? Your best
estimate is fine. Please report in thousands.
$
,000
FUNDING FROM BANKS OR OTHER FINANCIAL INSTITUTIONS
For 2016, what was the total amount of money this business borrowed from a bank or other financial institutions,
including business loans, a business credit card carrying a balance, or a business line of credit? Include all draws on a
business line of credit, even if paid off during the year. Your best estimate is fine. Please report in thousands.
$
,000
FUNDING FROM OUTSIDE INVESTORS
For 2016, what was the total amount of money this business received from angel investors, venture capitalists, or other
businesses in return for a share of ownership in this business? Your best estimate is fine. Please report in thousands.
(An “angel investor” is an affluent individual who provides capital for a business start-up, usually in exchange for
convertible debt or ownership equity.)
$
,000

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FUNDING FROM GOVERNMENT GRANTS
For 2016, what was the total amount of money this business received from government grants (such as the Small
Business Innovation Research (SBIR) and/or Small Business Technology Transfer (STTR) programs)? Your best estimate is
fine. Please report in thousands.
$
,000
NEW FUNDING RELATIONSHIPS
In 2016, did this business attempt to establish any new funding relationships (for example, loans, investments, or gifts)
with any of the following sources? (Select one for each row)
Yes, received total
Yes, but did not
amount of the
receive the total
No
funding requested
amount requested
Other owner(s) (if applicable)
Family, friends, or employees
Banks, credit unions, or other financial institutions
Home equity loans in name of business owners
Credit cards
Trade credit (for example, buy now, pay later)
Angel Investors
Venture capitalists
Other investor businesses
Crowdfunding platform (for example, Prosper, Kickstarter, etc.)
Grants (for example., Federal government’s Small Business
Technology Transfer Program (STTR) or Small Business
Innovation Research Program(SBIR)
Other (Specify)

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BUSINESS BANKING RELATIONSHIPS
In 2016, were this business’s banking relationships with the same financial institutions as any of the owner’s personal
banking relationships? Banking relationships include business checking or savings accounts, credit cards, loans, etc. Select
one.
 Yes
 No – Skip to Outstanding Loans
 The owners had no business banking relationships – Skip to Outstanding Loans
 Don’t know – Skip to Outstanding Loans
BANKING RELATIONSHIP DURATION
How long were the owners' personal banking relationships in place before financial transactions were first conducted by
this business? Select one.
 0 - 1 month
 2 - 5 months
 6 - 12 months
 More than 12 months
 Don’t know
OUTSTANDING LOANS
In 2016, was this business required to provide collateral or loan guarantee for any outstanding loan? Select one.
 Business did not have an outstanding loan
 Yes
 No
 Don’t Know
PURCHASES ON ACCOUNT
In 2016, did this business make any purchases on account or using trade credits? Trade credits are invoice payment terms a
business establishes with their suppliers allowing them to purchase goods or services now and at a later date.
 Yes
 No
AVOIDANCE OF ADDITIONAL FINANCING
At any time during 2016, did this business need additional financing?
 Yes, business needed additional financing and the owner(s) chose not to apply
 Yes, business needed additional financing and the owner(s) did apply - Skip to Profitability
 No, business did not need additional financing – Skip to Profitability
AVOIDANCE OF ADDITIONAL FINANCING CONTINUED
Why did this business choose not to apply for additional financing? (Select all that apply)
Did not think business would be approved by lender
Did not want to accrue debt
Decided the financing costs would be too high
Preferred to reinvest the business profits instead
Felt the loan search/application process would be too time consuming
Decided the additional financing was no longer needed
Decided to wait until funding conditions improved
Decided to wait until company hit milestones to be in stronger position to raise funds
Other (Specify)

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Attachment B - 2016 ASE Worksheet

PROFITABILITY
For 2016, did this business have profits, losses, or break even? (Select one)
Profits
Losses
Break even
NEGATIVE IMPACT ON PROFITABILITY
For 2016, did each of the following negatively impact the profitability of this business? (Select one in each row)
Yes

No

Access to financial capital
Cost of financial capital
Finding qualified labor
Taxes
Government regulations (federal, state, and/or local)
Slow business or lost sales
Customers or clients not making payments or paying late
The unpredictability of business conditions
Changes or updates in technology
Other (Specify)
_________

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Attachment B - 2016 ASE Worksheet

TYPES OF REGULATIONS
For 2016, what impact did each of the following types of government regulations have on this business’s profitability?
(Select one in each row)
Very
Somewhat
Negative Negative

Employee hiring
Workers’ compensation
Occupational health and safety
Health insurance
Employment records
Business and professional licensing
Building and renovation permits
Business registration
Health permits and inspections
Environmental
Trade
Financial
Other (Specify)

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No
Impact

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Somewhat
Positive

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Not
Positive Applicable

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REGULATIONS AND STARTING OR ACQUIRING THE BUSINESS
What impact did regulations have on the ability to initially start or acquire this business?
 Positive impact
 Negative impact
 No impact
 Don’t know
REGULATIONS AND GROWTH OF THE BUSINESS
During 2016, what impact did regulations have on expanding this business’s operations, such as by increasing production,
adding locations, or attaining new customers?
 Positive impact
 Negative impact
 No impact
 Business did not plan to expand operations
 Don’t know

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Attachment B - 2016 ASE Worksheet

REASONS FOR SEEKING BUSINESS ADVICE
During 2016, what was this business’s primary reason(s) for seeking paid or unpaid business advice or mentoring from
others? Select all that apply.
 Employee relations (for example, hiring, workforce retention, employee performance/growth, employee separation)
 Management and day-to-day operations
 Product development and innovation
 Investment and access to capital
 Succession planning and exit strategy
 Increasing sales
 Reducing costs
 Taxes and accounting
 Business finances
 Regulatory compliance
 Technology/ Information Technology
 Key performance indicators and business targets
 Copyrights, trademarks, and patents
 Legal
 Did not seek advice/mentoring – Skip to Exit Strategy
 Other, specify
PROVIDERS OF BUSINESS ADVICE
During 2016, from whom did this business seek the advice or mentoring selected in the ‘Reasons for Seeking Business
Advice’ question? Select all that apply.
 Family (Family refers to spouses or unmarried partners, parents/guardians, children, siblings, or close relatives.)
 Friends
 Professional colleagues
 Employees
 Legal and professional advisors
 Customers
 Suppliers
 Government-supported technical assistance program (for example, Small Business Administration (SBA) Small Business
Development Center, Women's Business Center, or Minority Business Development Agency (MBDA) Business Center)
 Other (Specify)
OUTCOME OF ADVICE OR MENTORING
During 2016, did the advice or mentoring selected in the ‘Reasons for Seeking Business Advice’ question lead to positive
business outcomes or changes in business operation that are anticipated to be positive?
 Yes
 No

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Attachment B - 2016 ASE Worksheet

EXIT STRATEGY
Which of the following best describes this business’s current exit strategy for any of the owners? An exit strategy is a plan
the business owners create to describe how they intend to exit the business and capture their investment. Select all that
apply.
 Walk away from the business
 Liquidate or sell off assets and repay the business’s liabilities
 Sell the business to employees or managers (for example, offer an Employee Stock Ownership Program (ESOP),
management buy-out, or employee buy-out)
 Sell or merge the business with another firm
 Sell the business to another individual that is not an owner of the same business
 Sell or transfer ownership to another owner of the same business
 Sell or transfer ownership of the business to a family member(s) that is not an owner of the same business
 Prepare an Initial Public Offering (IPO)
 Other (Specify)
Business does not currently have an exit strategy for any owner
TYPES OF CUSTOMERS
In 2016, which of the following types of customers accounted for 10% or more of this business’s total sales of goods
and/or services? Select all that apply.
Federal government
State and local government, including school districts, transportation authorities, etc.
Other businesses and/or organizations, including distributors of your product(s)
Individuals
CUSTOMER LOCATIONS
During 2016, where were this business’s customers or clients located? Round to the nearest whole percent. Your best
estimate is fine. If none, report “0.”
Same region as the business
%
Outside of the region but within U.S. (Domestic)
%
Outside the United States (International)
%
Total
100%
SALES OR EXPORTS OUTSIDE THE UNITED STATES
In 2016, what percent of the business’s total sales of goods and/or services consisted of exports outside the United
States?
.0%
None
Don’t know
OPERATIONS OUTSIDE THE UNITED STATES
In 2016, did this business have operations outside the United States?
Yes
No
OUTSOURCING OR TRANSFERS OUTSIDE THE UNITED STATES
In 2016, did this business outsource or transfer any business function and/or service to another company outside the
United States?
Yes
No

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Attachment B - 2016 ASE Worksheet

LANGUAGE
In 2016, which language(s) did this business conduct transactions with its customers? Select all that apply.
English
German
Portuguese
African language(s)
Hindi/Urdu
Russian
Arabic
Italian
Spanish
Chinese
Japanese
Tagalog
French
Korean
Vietnamese
French Creole
Polish
Other

TYPES OF WORKERS
In 2016, which of the following types of workers were used by this business? Select all that apply.
Full-time paid employees (workers who received a W-2)
Part-time paid employees (workers who received a W-2)
Paid by day laborers
Temporary staffing obtained from a temporary help service
Leased employees from a leasing service or a professional employer organization
Contractors, subcontractors, independent contractors, or outside consultants (workers who received a 1099 or
payment from another company)
None of the above
EMPLOYEE BENEFITS
In 2016, which of the following employee benefits were paid totally or partly by this business? Select all that apply.
Health insurance
Contributions to retirement plans, including 401(k), Keogh, etc.
Profit sharing and/or stock options
Paid holidays, vacation, and/or sick leave
Tuition assistance and/or reimbursement
None of the above
WEBSITE
In 2016, did this business have a website?
Yes
No
E-COMMERCE
In 2016, did this business have any e-commerce sales? (E-commerce sales 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, extranet, EDI network,
electronic mail, or other online system. Payment may or may not be made online.)
Yes
No – Skip to Home Operation
(If yes) In 2016, 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
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Attachment B - 2016 ASE Worksheet

HOME OPERATION
In 2016, did this business operate primarily from somebody’s home?
Yes
No
COPYRIGHTS, TRADEMARKS, AND PATENTS
In 2016, did this business own one or more of the following? Select all that apply.
Copyright
Patent (granted)
None
Trademark
Patent (pending)

BUSINESS ACTIVITY
In 2016, did any of the following characteristics describe the activity of this business? Select all that apply.
Operated less than 40 hours per week on average
Operated less than 12 months
Seasonal business (for example, fireworks sales or tax preparer)
Operated occasionally (for example, event organizer or guest speaker)
None of the above
CURRENTLY OPERATING
Is this business currently operating?
Yes – Skip to Remarks
No
CEASE OPERATION
Did the operations cease for any of the following reasons? Select all that apply.
Owner’s military deployment
Lack of business loans/credit
Owner’s illness or injury
Lack of personal loans/credit
Owner(s) retired
Started another business
Owner(s) deceased
Sold this business
Operated for a specific or one-time event
Other
Inadequate cash flow or low sales
REMARKS
Please use this space for any explanations that may be essential in understanding your reported data.

THANK YOU

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