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* 1. Please provide your business name (Optional)

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* 2. Please provide your business county (check all where your business has a physical location)

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* 3. Please provide your business zip code (Optional)

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* 5. Please provide your primary product or service.

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* 6. Is your business considered essential by local policy? 

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* 7. Please select Ownership type best fits your business (check all that apply).

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* 10. How long can you sustain business operations given the current situation? 

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* 11. What type of relief or assistance would help your business?

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* 12. Have you applied or do you plan to apply for existing relief programs? (check all that apply)

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* 13. How has COVID-19 affected your staffing capacity in the past 30 days?

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* 14. If you have laid off employees or contract workers, what percentage of your workforce?

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* 15. Do you feel that COVID-19 will affect your staffing capacity in the next 30 days?

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* 16. If you plan to lay off employees or contract workers in the next 30 days, what percentage of your workforce do you expect to lay off?

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* 17. If you are planning to add staffing, what type of jobs are you hiring for?

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* 18. Which of the following business obligations will be a challenge to meet in the next 30 days?

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* 19. How much did your gross income to change in the past 30 days compared to this time last year?

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* 20. How much do you expect your gross income to change in the next 30 days compared to the same period last year?

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* 21. Have you seen any disruption to your supply chain within the past 60 days due to issues related to COVID-19?

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* 22. Please indicate which of the following COVID-19-related developments has affected your business (check all that apply)

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* 23. Are you providing assistance to any temporarily or permanently laid off workers? If so, what type of assistance? 

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