Form Sbo-2 - Survey Of Business Owners And Self-Employed Persons - 2012 Page 3
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2
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410022028
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Owner 1
Owner 2
Please answer the following questions about Owner 1
Please answer the following questions about Owner 2
listed in
on Page 2.
listed in
on Page 2.
5
5
7
11
What is the sex of Owner 1?
What is the sex of Owner 2?
Male
Female
Male
Female
NOTE: Please answer BOTH Question
about
NOTE: Please answer BOTH Question
about
8
12
Hispanic origin and Question
about race. For
Hispanic origin and Question
about race. For
9
13
this survey, Hispanic origins are not races.
this survey, Hispanic origins are not races.
8
12
Is Owner 1 of Hispanic, Latino or Spanish origin?
Is Owner 2 of Hispanic, Latino, or Spanish origin?
No, not of Hispanic,
No, not of Hispanic,
Yes, Puerto Rican
Yes, Puerto Rican
Latino, or Spanish origin
Latino, or Spanish origin
Yes, Mexican, Mexican Am.,
Yes, Mexican, Mexican Am.,
Yes, Cuban
Yes, Cuban
Chicano
Chicano
Yes, another Hispanic, Latino, or Spanish origin - Print
Yes, another Hispanic, Latino, or Spanish origin - Print
origin, for example, Argentinean, Colombian, Dominican,
origin, for example, Argentinean, Colombian, Dominican,
Nicaraguan, Salvadoran, Spaniard, and so on.
Nicaraguan, Salvadoran, Spaniard, and so on.
C
C
9
13
What is Owner 1’s race? Mark
all that apply.
What is Owner 2’s race? Mark
all that apply.
White
Black or African Am.
White
Black or African Am.
American Indian or Alaska Native - Print name of
American Indian or Alaska Native - Print name of
enrolled or principal tribe.
enrolled or principal tribe.
C
C
Asian Indian
Japanese
Native Hawaiian
Asian Indian
Japanese
Native Hawaiian
Guamanian or
Guamanian or
Chinese
Korean
Chinese
Korean
Chamorro
Chamorro
Filipino
Vietnamese
Samoan
Filipino
Vietnamese
Samoan
Other Asian -
Other Pacific
Other Asian -
Other Pacific
Print
Print
Islander -
Islander -
race, for example,
Print
race, for example,
Print
Hmong, Laotian, Thai,
race, for example,
Hmong, Laotian, Thai,
race, for example,
Pakistani, Cambodian,
Fijian, Tongan,
Pakistani, Cambodian,
Fijian, Tongan,
and so on.
and so on.
and so on.
and so on.
C
C
C
C
Some other race - Print race
Some other race - Print race
C
C
10
A. Has Owner 1 ever served in any branch of the U.S.
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A. Has Owner 2 ever served in any branch of the U.S.
Armed Forces, including the Coast Guard, the National
Armed Forces, including the Coast Guard, the National
Guard, or a Reserve component of any service branch?
Guard, or a Reserve component of any service branch?
Yes
No
Yes
No
B. (If Yes) Do any of the following characteristics describe
B. (If Yes) Do any of the following characteristics describe
Owner 1’s military service? Mark
all that apply.
Owner 2’s military service? Mark
all that apply.
Served on active duty military service, not including
Served on active duty military service, not including
training for the Reserves or National Guard
training for the Reserves or National Guard
Disabled as the result of illness or injury incurred
Disabled as the result of illness or injury incurred
or aggravated during military service
or aggravated during military service
Served on active duty military service after
Served on active duty military service after
September 11, 2001
September 11, 2001
Served on active duty military service in 2012
Served on active duty military service in 2012
Served in the National Guard or as a reservist of
Served in the National Guard or as a reservist of
any branch of the U.S. Armed Forces in 2012
any branch of the U.S. Armed Forces in 2012
None of the above
None of the above
Please turn to the next page to continue.
§+#5=¤
FORM SBO-2
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