NeedsAssessmt.Survey.form[1]

NEEDS ASSESSMENT SURVEY

General Instructions

1. Please complete this survey in full as it applies to your organization or firm. Tear out pages as needed to type or write your responses.

2. If the answer space provided is not adequate, please continue your response on a separate piece of paper, indicating the question number.

1. This voluntary questionnaire consists of three parts:

I Firm Background

II Needs Assessment

III Competitive Enhancement Efforts

4. Questions related to this form should be directed to Elizabeth Powell (epowell@bis.doc.gov or at (202)-482-7418) or Ryan Barnes (rbarnes@bis.doc.gov or at (202)-482-2397), Trade and Industry Analysts, U.S. Department of Commerce, or by fax at (202) 482-5361.

5. After making a copy of your completed response for your records, please email the completed survey to the following address: xxxx.

6. If responding by mail, return within 30 days to:

Bureau of Industry and Security

Office of Technology Evaluations

Room 1093

U.S. Department of Commerce

Washington, DC 20230

This Needs Assessment Survey is conducted pursuant to the Defense Production Act of 1950, as amended. Information furnished herewith is deemed confidential and will not be published or disclosed except in accordance with Section 705 of the Defense Production Act of 1950, as amended (50 U.S.C App. Sec. 2155). Section 705 prohibits the publication or disclosure of this information unless the President determines that its withholding is contrary to the national defense. The information will be protected pursuant to the appropriate exemptions from disclosure under the Freedom of Information Act (FOIA), should it be the subject of a FOIA request.

Notwithstanding any other provision of law, no person is required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.

BURDEN ESTIMATE AND REQUEST FOR COMMENT

Public reporting burden for this voluntary collection of information is estimated to average 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 collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information to: BIS Information Collection Officer, Room 6883, Bureau of Industry and Security, U.S. Department of Commerce, Washington, D.C. 20230, and to the Office of Management and Budget, Paperwork Reduction Project (OMB Control No.0694-00083), Washington, D.C. 20503.

OMB Control No. 0694-0083 Expiration Date: xx/xx/2024

NEEDS ASSESSMENT SURVEY

I. Firm Background

1. Firm Name and Address:

Name

Address

City, State Zip

2. Ownership: If your firm is wholly or partly owned by another company, please give its name, location, and percent of ownership.

Name

City, State Zip

Country Percent of Ownership: %

3. Person to Contact Regarding this Survey:

Name Title

Phone ( ) Fax ( )

E-Mail address Website

4. Type of Organization: Indicate with a check () the primary and secondary functions of your firm.

Primary Secondary

Manufacturer  

Research Organization  

Distributor  

Broker  

Reseller  

Service ~ specify:____________________  

Academic  

Other ~ specify:_______________________  

5. Please briefly describe your business, including the products or services that you provide. Attach a website link or copy of a brochure or annual report describing your firm and product line.

6. Indicate the type of work your company does. Choose as many as are applicable.

 Research and development

 Product and design engineering (tooling, new processes, etc.)

 Manufacturing systems development and management

 Material preparation (casting, forming, molding, forging, etc.)

 Material finishing (machining, coating, plating, assembly, etc.)

 Inspection and quality control

 Test and evaluation

 Other:

7. Please indicate your firm's approximate total sales for the following years by placing a check () in the appropriate boxes.

	2018	2019	2020	2021 (est.)
<$250,000				
$250,000-<$500,000				
$500,000-<$1,000,000				
$1,000,000-<$5,000,000				
$5,000,000-<$10,000,000				
>$10,000,000				

8. Please estimate the percent of your total sales going to defense endmarkets for the years below.

	2018	2019	2020	2021 (est.)
% Defense	%	%	%	%

9. Please estimate the percent of your total sales that were exported for the years below.

	2018	2019	2020	2021 (est.)
% Exported	%	%	%	%

If you do not currently export, do you plan to export in the future?  Yes  No

10. Please provide the total number of your employees for the years listed below, providing estimates where necessary.

2018	2019	2020	2021 (est.)

11. How do you view the competitive prospects for your firm's operations over the next three years?

MARKET SHARE will... TECHNOLOGICAL CAPABILITIES will...

 improve greatly  improve greatly

 improve somewhat  improve somewhat

 stay the same  stay the same

 decline somewhat  decline somewhat

 decline greatly  decline greatly

Please explain the reasoning behind your response.

NEEDS ASSESSMENT SURVEY

II. Needs Assessment

So that we can better address your areas of interest, please check () the box(es) corresponding to the types of assistance that would be most helpful to your firm's growth and development needs. The appropriate federal laboratories and government agencies will follow up on your responses.

1. Federally Developed Technology: Acquiring and/or commercializing federally developed technology, including licenses and cooperative agreements, market potential, financial requirements and funding sources, technology and expertise requirements, and the patent process.

 Yes  No

2. Research and Development Programs: Joint R&D efforts to promote dual-use technologies, spin-on, spin-off applications, including the Advanced Technology Program at the Department of Commerce, which offers matching funds for development of high-risk technologies, and the Small Business Innovation and Research Initiative, which provides funding for early stage proof-of-concept and technology demonstration projects.

 Yes  No

3. Dual Use Science & Technology Program: The Department of Defense is seeking

to work with companies on the cutting edge of technology and innovation in the fast-

growing commercial sector. Firms, particularly those that traditionally have not worked

with the military, are being invited to participate. This program offers matching funds

for development of commercial technologies.

 Yes  No

4. Manufacturing Technology Deployment: Determination of current capabilities relative to state-of-the-market technology, including assessment of current technology usage, business and manufacturing practices, and implementation of new technology.

 Yes  No

5. Manufacturing Technology Demonstration: Assistance in the selection and implementation of new and emerging technologies, including rapid prototyping, equipment demonstration, and access to appropriate facilities and excess/salvage equipment.

 Yes  No

6. Manufacturing Processes: Assistance with metrology, process design, quality/

ISO 9000 training, materials, maintenance, and scrap & rework.

 Yes  No

7. Energy and Environmentally Conscious Manufacturing: Information regarding green manufacturing, compliance with EPA and state regulations, and conservation.

 Yes  No

8. Exporting: Counseling on basic exporting strategies, export promotion assistance, and export licensing.

 Yes  No

9. Best Manufacturing Practices (BMP) Program: The BMP program was organized

to identify cutting-edge developments in the manufacturing sector, disseminate information on these practices to the industrial base, and develop methods for U.S. industry to use the data. The BMP data is public, non‑proprietary information which BMP makes broadly available through the internet and in print form.

 Yes  No

10. Financing:

 Loans  Equity Capital  Export Financing

 Guarantees  Export Credit Insurance

 Small Business Insurance Export Policy

 Project Finance (limited recourse financing); repayment depends on cash flows

11. Electronic Commerce: Learn to utilize the latest technologies to communicate with your customers. Information provided on Electronic Data Interchange, Internet Web Page Development, Standardized General Mark-Up Language (SGML), and Hyper Text Mark-Up Language (HTML).

 Yes  No

12. Federal Facilities and Equipment: Information provided regarding the availability of manufacturing capabilities and excess federal facilities & equipment in multiple states for on-site use, lease, or possible purchase.

 Yes  No

NEEDS ASSESSMENT SURVEY

III. Competitive Enhancement and Diversification Efforts

1. Please describe your activities to enhance your firm’s overall competitiveness. Specify any new product areas and geographical markets you are exploring or concentrating on.

2. What percentage of your sales is spent on research and development? %

3. What percentage of your sales is spent on test and evaluation? %

4. Has your R&D focus changed over the last five years?  Yes  No

Comments:

6. Please rate each of the following technology areas according to its importance to your near-term (1-3 years) research and development efforts. Check () the appropriate column for each technology.

TECHNOLOGY AREAS		Very Important	Somewhat Important	Not Important
Biotechnology
Chemicals
Communications
Computer Hardware
Computer Software
Energy/Power Systems
Environmental Issues
Factory Automation
Fiber Optics, Lasers
Optoelectronics
Manufacturing Equipment
Materials
Medical
Pharmaceuticals
Test & Measurement
Transportation
Sensors & Actuators
Systems Integration
Other, please specify:
Other, please specify:

7. From the list above, identify the two most important technology areas for your firm.

Most Important 2nd Most Important

8. Are there technologies that you need assistance with?  Yes  No

Are there technologies that you would like to obtain to use in an R&D, testing and

evaluation, or commercialization capacity?  Yes  No

Please discuss.

9. Are there any facilities or assets that you need to develop, produce, and/or test and

commercialize products?  Yes  No

Please discuss.

10. Do you have any patents that you would like to license?  Yes  No

Please discuss.

11. Are your employees adequately trained and qualified?  Yes  No

Would you like assistance in training your employees?  Yes  No

Please discuss.

12. We are interested in knowing which methods, other than internal development, manufacturers have used or plan to use to develop the technologies they need. For each item in the matrix below, enter a check mark in the column which is true for your company. You may check more than 1 column for any item.

	My Company...
	has done	plans to do	would consider	has no interest in	don't know
Licensing a technology
Partnering with an outside organization to jointly develop a technology
Hiring a research & development organization to develop a technology or solve a technical problem
Personnel Exchanges
Cooperative Research and Development Agreements (CRADAs)
Acquiring Software
Joining a consortium of companies that jointly develops a technology
Work For Others (WFO) Arrangements

13. Please list the federal and state agencies you use consistently or have worked with and describe the nature of your activity or partnership.

Agency
1.
2.
3.

14. Would you be interested in working with government laboratories on new or additional product and/or technology development projects?

 Yes  No

Do you know how to access the expertise and resources of the federal laboratories?

 Yes  No

15. Within the next five years, what percentage of your firm’s defense-oriented operations need to be converted to commercial production? Please check () the appropriate box below.

 100%  75%  50%  25%  less than 25%  0%

16. Has your firm already diversified any defense-oriented operations?  Yes  No

Is your firm in the process of diversification?  Yes  No

Does your firm plan to diversify any defense-oriented operations?  Yes  No

Comments:

17. Within the next five years, what percentage of your firm’s NASA-oriented operations need to be converted to commercial production? Please check () the appropriate box below.

 100%  75%  50%  25%  less than 25%  0%

18. Has your firm already diversified any NASA-oriented operations?  Yes  No

Is your firm in the process of diversification?  Yes  No

Does your firm plan to diversify any NASA-oriented operations?  Yes  No

Comments:

19. How many hours did your company dedicate to completion of this survey?

20. Additional comments? There are many topics which impact your company that this survey has not addressed. Please discuss some of these; what would your company (you) recommend?