Appendix NN

5% Follow-Up: Self-Administered Questionnaire

SU_ID

2003 Survey of Small Business Finances - Short Form

Please answer all questions for: FIRM NAME

1. Is [FIRM NAME] the correct name of your business?	Yes Skip to #2	No Continue
a. Was this business ever called [FIRM NAME]?	Yes	No
b. What is the correct name of your business?
2. During December 2003, was the business in operation under the direction of one or more of the current owners? (A business is in operation if it is generating expenses or revenues.)	Yes	No
3. During [MONTH] 2004, was the business in operation?	Yes	No
4. Is [STREET ADDRESS] the correct address for the business's headquarters or main office?	Yes Skip to #5	$\le$ No Continue
a. Was [STREET ADDRESS] ever the address for the business's headquarters or main office?	Yes	No
5. Does another company own 50% or more of the business?	Yes	No
6. Is the business a nonprofit organization?	Yes	No
7. Is the business owned by a local, state, or federal government agency?	Yes	No
8. How many owners worked in the business during a typical pay period in 2003?w
*9. Other than owners, how many individuals worked in the business during a typical pay period in 2003*(Include individuals that worked in the business but were not on the payroll. Count each worker, whether full-time or part-time, as one individual.)
10. (If you are unsure about your answers to #8 or #9, please answer #10.) Please indicate the approximate number of individuals, including owners, that worked for the business during a typical pay period in 2003.	less than 5 5 to 9 10 to 19 20 to 49	50 to 99 100 to 499 500 or more
11. Our records indicate that the principal activity of the firm is [SIC CATEGORY]. Is this correct?	Yes	No
IF NO: What is the principal activity of the business? That is, what does the business do or make?

Thank you! Please fax this completed survey toll-free to 1-866-435-5637

or mail to NORC, 1 North State St, 16^th floor, Chicago, IL 60602,
no later than Friday, January 7, 2005.

^♣ This version is optimized for use by screen readers. Descriptions for all mathematical expressions are provided in LaTex format. A printable pdf version is available. Return to Text