Small Business Administration (SBA) Economic Declaration Survey Request

COVID-19 Economic Impact Survey - Winston County, MS

This survey is to compile information for the State of Mississippi (MEMA) and the Small Business Administration in an effort to declare our State as a disaster area from the COVID-19 crisis. This information collected will only be used for these purposes and will not be shared by outside sources, individuals, or businesses. The collected information is critical to opening Winston County for the Economic Injury Disaster Loans (EIDL) to small businesses. This survey will remain active until Winston County has received the designation, and the applications for EIDLs are available.

Question Title

* 1. Is your business located in Winston County, Mississippi?

Yes

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* 2. Name and address of the affected business

Name of Business Owner

Business Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Do you consent to be contacted directly by the Winston Partnership to verify information to the State of Mississippi and the Small Business Administration for the purposes of having you area declared a disaster area?

Yes

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* 4. Did your business suffer from a direct economic impact due to the COVID-19 crisis?

Yes

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* 5. If "Yes", what month and year did the impact start?

Date / Time

Date

Time

AM/PM

Small Business Administration (SBA) Economic Declaration Survey Request

COVID-19 Economic Impact Survey - Winston County, MS

Question Title

* 1. Is your business located in Winston County, Mississippi?

Question Title

* 2. Name and address of the affected business

Question Title

* 3. Do you consent to be contacted directly by the Winston Partnership to verify information to the State of Mississippi and the Small Business Administration for the purposes of having you area declared a disaster area?

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* 4. Did your business suffer from a direct economic impact due to the COVID-19 crisis?

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* 5. If "Yes", what month and year did the impact start?

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* 6. What were your business revenues during that period?

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* 7. What were your business revenues during the same time period of the prior year?

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* 8. Amount of business interruption insurance received or anticipated, if any?

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* 9. Provide a brief explanation of what adverse economic effects the disaster has had on your business.

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* 10. How many people did you employ prior to the disaster?

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* 11. How many people did you employ after the disaster?

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* 12. Please estimate your dollar loss to real property (if owned).

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* 13. Please enter your dollar loss to contents (machinery and equipment, furniture and fixtures, inventory, leasehold improvements, etc.).

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* 14. Insurance recovery (anticipated) for property.