Hurricane Irma Business Recovery Survey Hurricane Irma Relief/Recovery Survey Please complete the Partners for Self-Employment Business Damage Assessment survey on how Hurricane Irma may have affected local business operations in Miami Dade County. This will help us determine how we can offer assistances to your business. OK What is your full contact information? (Email, phone number, Address) Question Title * 1. What is your full contact information? (Email, phone number, Address) Full name: Email: Phone number: Full Address(City, State, Zip): OK What is the name and type of business you have? Question Title * 2. What is the name and type of business you have? Business Name: Type Of Business: Federal Tax ID (FEIN): State Tax ID: OK Did your business suffer damage due to the Hurricane? Question Title * 3. Did your business suffer damage due to the Hurricane? Yes No If yes, what was the of type damage suffered? OK Did you or will you lose business due to this emergency/disaster? Question Title * 4. Did you or will you lose business due to this emergency/disaster? Yes No If so, when did the impact start and end? OK Do you have an estimate of the cost to your business due to this emergency/disaster? Question Title * 5. Do you have an estimate of the cost to your business due to this emergency/disaster? OK Are you currently open for business? Question Title * 6. Are you currently open for business? Yes No Open in Alternate Location If no, when do you anticipate reopening? OK How many employees (Full Time and Part Time) do you currently have? Question Title * 7. How many employees (Full Time and Part Time) do you currently have? Sole Proprietor 2-5 5-10 10+ OK Did you lay-off employees, or will you lay off employees? Question Title * 8. Did you lay-off employees, or will you lay off employees? Yes No If yes, number of temporary lay-offs and the lay-off period in days? OK Have you registered with FEMA? Question Title * 9. Have you registered with FEMA? Yes No OK Other key factors hindering business operations (Select all that apply) Question Title * 10. Other key factors hindering business operations (Select all that apply) Access to business Debris removal Product Supply Financial / business loans Short-term capital/Long-term capital Customer base Employees' transportation Construction / contractor needs Insurance settlement Training / personnel Water damage Other (please specify) OK DONE