Skip to: [SSBF 2003 Home] [Printable Version (PDF)]

2003 SSBF: Methodology Appendix XX Screen Reader version ^♣

Appendix XX

Drop/Add Form for Services and Institutions

FOR SUPERVISOR USE ONLY

Exhibit #5

Dropped or Added

Financial Institution and Service Form

Please complete this form WITH A SUPERVISOR if you are conducting an

interview and the respondent remembers a financial institution or service after

you have already gone through the appropriate section of the interview,

remembers that a particular loan or service is not related to business, or an

institution was entered under the wrong service category.

Section A: Case Information and Institution Name

Complete this section for EACH dropped or added service. NOTE: A service that was entered in the wrong category (e.g., a line of credit that should be a mortgage) must be dropped AND added, please submit these forms together.

DATE:

INTERVIEWER NAME:

SU-ID (ALSO KNOWN AS CASE ID)

INSTITUTION NAME:

CIRCLE ONE: DROP ADD MOVE DROP MOVE ADD

FINANCIAL SERVICE: (Below, circle action and one type of service per form.

Additional services require additional forms. ONE SERVICE PER FORM ONLY)

DEPOSIT: Checking, Savings

COMPLETE "SECTION B" ON BACK OF FORM

LOAN: Line of Credit, Capital Lease, Mortgage, Motor Vehicle, Equipment, Other Loan (see Q7)

COMPLETE "SECTION C" ON BACK OF FORM

OTHER: Transaction Service, Cash Management Service, Credit-related Service,

Trust Service, Brokerage Service, Card-processing Service

THIS FORM IS NOW COMPLETE.

IF THE SERVICE WAS DROPPED, THlS FORM IS NOW COMPLETE.

2003 Survey of Small Business Finances

Interviewer Reference Manual

Page 1 of 2

Section B: Checking or Savings Accounts

1. Current balance, or balance as of last statement: $

Section C: Loans

1. Number of loans at institution named above:

2. Total credit limit (for lines of credit only):

3. Amount owed on loan(s) currently:

4. Was a personal guaranty, cosigner, etc. required? YES NO

5. Was collateral required? YES (Ask 5a) NO

5a. What collateral was required? (Circle all that apply)

1) inventory or accounts receivable YES NO

2) equipment or vehicles YES NO

3) business securities or deposits YES NO

4) business real estate YES NO

5) personal real estate YES NO

6) other personal assets YES NO

7) other (please describe:) YES NO

Describe:

6. For lines of credit, was a compensating balance in checking or savings required? YES NO

7. If "other loan" selected in Section A, please specify what loan was for:

THIS FORM IS FOR SUPERVISOR USE ONLY.

2003 Survey of Small Business Finances

Interviewer Reference Manual

Page 2 of 2

^♣ 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