ASG COVID ECONOMIC IMPACT SURVEY

AMERICAN SAMOA GOVERNMENT COVID-19 ECONOMIC IMPACT SURVEY

This survey will help to identify changes in the territory's business community due to the pandemic. The data collected will also help determine what assistance is needed. Where exact totals are not readily available, we encourage you to use your best estimates. CONFIDENTIALITY IS MAINTAINED UNDER TITLE 13 OF THE AMERICAN SAMOA STATISTICAL ACT 2003.
E.I.N.
Employer Identification Number
Date

MonthDayYear
Name of Business
Place of Business/Village:
Name of Respondent

First NameLast Name
What year was your business established?
Telephone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
1. Has your business been affected by Covid-19? If so, select all that apply and/or specify:

Other
2a. Please select the industry that best describes your business.
2b. What is your business's main activity that brings in the most revenue?
Example: Catering, Landscaping, Retail, Taxi-Transportation, Fast Food Services, Security, Farming, Fitness...

3a. What is the Full-time, Part-time employee count and payroll amounts for the beginning of March 2019, 2020, 2021 and 2022?

Rows	Full- time Employees (Count)	Part-time Employees (Count)	Payroll Total (Dollar Amount)
March 2019
March 2020
March 2021
March 2022

3b. Please select your payroll frequency:

4. What are the Total Annual sales, receipts, shipments or revenue ($) for 2019, 2020, 2021 and 2022?

Rows	Total Amount ($)
2019
2020
2021
2022

5a. Did your business have any virtual operations before the Covid-19 shutdown?

5b. What percentage of Annual sales, receipts, shipments or revenue were a result of e-commerce or virtual transactions for 2019, 2020, 2021 and 2022?

Rows	Percentage of Sales (%)
2019
2020
2021
2022

5c. Did your business have an alternative operation due to the Covid-19 shutdown? If yes, please give a short description. If No type "No".
For example: We were managing hotel operations but switched to a quarantine site.
6. Have you received any Covid-19 assistance from the government, non-government organizations or other associations?

Other
7. What business assistance from the American Samoa Government would be most beneficial for you?
Should be Empty:

AMERICAN SAMOA GOVERNMENT COVID-19 ECONOMIC IMPACT SURVEY