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.
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Employer Identification Number
Date
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-
Month
-
Day
Year
Name of Business
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Place of Business/Village:
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Name of Respondent
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First Name
Last Name
What year was your business established?
*
Telephone Number:
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Please enter a valid phone number.
Email Address:
*
1. Has your business been affected by Covid-19? If so, select all that apply and/or specify:
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Revenue Loss
Employment Reduction
Halted Operations
Capacity Reductions
Other
2a. Please select the industry that best describes your business.
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Please Select
21 Mining
22 Utilities
23 Construction
31-33 Manufacturing
42- Wholesale Trade
44-45 Retail Trade
48-49 Transportation and Warehousing
51 Information
52 Finance and Insurance
53 Real Estate and Rental and Leasing
54 Professional, Scientific and Technical Services
55 Management of Companies and Enterprises
56 Administrative and Support, Waste Management and Remediation Services
61 Educational Services
62 Health Care and Social Assistance
71 Arts, Entertainment, and Recreation
72 Accommodation and Food Services
81 Other Services (except Public Administration)
2b. What is your business's main activity that brings in the most revenue?
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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?
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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:
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Please Select
Daily
Weekly
Bi-weekly
Monthly
Quarterly
Semi-Annualy
Annually
4. What are the Total Annual sales, receipts, shipments or revenue ($) for 2019, 2020, 2021 and 2022?
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Total Amount ($)
2019
2020
2021
2022
5a. Did your business have any virtual operations before the Covid-19 shutdown?
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Yes
No
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?
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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".
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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?
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Yes, from the Government
Yes, from a Non-government organization
No
Other
7. What business assistance from the American Samoa Government would be most beneficial for you?
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Business Tax Credits
Line of Credit
Small Business Application Assistance
Business Loans (TBAS/DBAS)
Financial Assistance Program
Employee Resources
Submit
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