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2. CARES Act Grant Business Survey

   All information will be kept confidential.

4. Business Name
6. Business Address
8. Business Phone
9. Business Email
10. Business Website
12. Business Owner/Operator
14. Type of Business
15. How long have you been in business?
17. What is your current number of employees?
18. What were your number of employees before COVID?
20. What were your approximate annual sales in 2021?
    -- Select One --Less than $50,000$50,000-$99,999$100,000-$149,999$150,000-$199,999$200,000-$499,999$500,000-$1,000,000More than $1,000,000
21. What were your total assets in 2021?
    -- Select One --$0-$249,999$250,000-$499,999$500,000-$999,999$1,000,000-$2,000,000Greater than $2,000,000
23. What was your percent change in sales 2019 to 2020?
24. What was your percent change in sales 2020 to 2021?
26. Did COVID-19 impact your business?

    1. Yes
    2. No
27. Describe how COVID-19 impacted your business.
29. Did you receive funding through the Paycheck Protection Program?

    1. Yes
    2. No
31. Did you receive any other state or federal funding?

    1. Yes
    2. No
32. Describe what other funding you received.
34. Do you plan on expanding your business this year?

    1. Yes
    2. No
35. Do you plan on closing your business this year?

    1. Yes
    2. No
37. Did you have any problems getting employees back after the COVID shut down or reduction in hours?

    1. Yes
    2. No
    3. Did not do any layoffs
39. Are you having difficulty hiring new employees?

    1. Yes
    2. No
40. Are you having difficulty retaining employees?

    1. Yes
    2. No
42. Have increased labor costs impacted your business?

    1. Yes
    2. No
43. Describe how your business was impacted.
45. Are you having problems getting supplies?

    1. Yes
    2. No
46. Describe the problems getting supplies.
48. Do you need assistance training employees?

    1. Yes
    2. No
49. Have you visited the Rensselaer County One Stop Center?

    1. Yes
    2. No
50. Would you like information about the One Stop Center?

    1. Yes
    2. No
52. Do you have any issues with infrastructure?

    1. Yes
    2. No
53. Describe your issues with infrastructure.
55. Do you have any other needs for your business?

    1. Yes
    2. No
56. Describe your other needs.
58. Would you like your business listed on a webpage for Rensselaer County businesses?

    1. Yes
    2. No
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60. 1. Receive an email copy of this form.
61. Email address

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