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OMB Control #0694-0110 Expires 12/31/2001
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Survey Form
U.S. Department of Commerce
Bureau of Export Administration
Brad Botwin, Director
Strategic Analysis Division
Room 3876, BXA re: AT
U.S. Department of Commerce
Washington, DC 20230
For this report, assistive technology devicewill be defined as any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities. If your organization has not conducted any manufacturing or non-manufacturing activity related to assistive technology devices in the United States since January 1, 1996, you are not required to complete this form. If this is the case, please provide the information requested below and return this page to the address above.
Name of Organization
Address (City, State)
Signature of Authorized Official
Date
Name of Official-Please Print Phone
The undersigned certifies that the information herein supplied in response to this questionnaire is complete and correct to the best of his/her knowledge. The U.S. Code, Title 18 (Crimes and Criminal Procedure), Section 1001, makes it a criminal offense to willfully make a false statement or representation to any department or agency of the United States as to any matter within its jurisdiction.
Company Name:
Signature of Authorized Official:
Title:
Phone Number (with area code):
Fax Number (with area code):
E-Mail address:
Date:
In the event that we have questions regarding your response, please provide below a point of contact with telephone and fax numbers and e-mail address, if different than above.
Point of contact: Title:
Phone Number (with area code):
Fax Number (with area code):
E-Mail address:
ASSISTIVE TECHNOLOGY DEVICE - any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.
COOPERATIVE RESEARCH AND DEVELOPMENT AGREEMENT (CRADA) - a written agreement between a private company and a government agency to work together on a project. In 1986 and 1989, legislation was enacted as part of the Stevenson-Wydler Technology Innovation Act to enable federal laboratories to enter into CRADAs with private businesses and other entities. CRADAs provide the means to leverage R&D efforts and to create teams for solving technological and industrial problems. Through CRADAs, companies or groups of companies can work with one or more federal laboratories to pool resources and share risks in developing technologies.
FACILITY - A site where assistive technology devices or equipment are manufactured and/or related research and development is conducted.
FIRM - An individual proprietorship, partnership, joint venture, association, corporation (including any subsidiary corporation in which more than 50 percent of the outstanding voting stock is owned), business trust, cooperative, trustees in bankruptcy, or receivers under decree of any court, owning or controlling one or more establishments as defined above.
RESEARCH AND DEVELOPMENT (R&D)- includes basic research and applied research in the sciences and in engineering, and design and development of prototype[s], products and processes.
For the purposes of this questionnaire, R&D includes activities carried on by persons trained, either formally or by experience, in the physical sciences including related engineering, and the biological sciences including medicine but excluding psychology, if the purpose of such activity is to do either or both of the following:
Basic Research Pursue a planned search for new knowledge, whether or not the search has reference to a specific application.
Applied Research Apply existing knowledge to problems involved in the creation of a new product or process, including work required to evaluate possible uses, or apply existing knowledge to problems involved in the improvement of a present product or process.
Research and development includes the activities described above whether assigned to separate R&D organizational units of the company or carried out by company laboratories and technical groups not part of an R&D organization. Reporting the R&D activities of such latter groups may require the use of estimates for some of the questions.
SMALL BUSINESS INNOVATION RESEARCH PROGRAM (SBIR) -a program through which federal agenciesfund research and development efforts of a high risk nature that may have excellent commercial potential.The research is carried out by a small business and may not necessarily involve outside collaboration.
SMALL BUSINESS TECHNOLOGY TRANSFER PROGRAM (STTR) -a program through which federal agencies fund cooperative R&D projects involving a small business and a university; an approved, contractor-operated, federally funded research and development center; or a nonprofit research institution.
TECHNOLOGY TRANSFER -a process for implementing a new application for an existing technology.
UNIVERSAL DESIGN - The process of designing products and environments (including assistive technologies) to be usable by people with the widest range of abilities possible, without the need for adaptation or specialized design. Seven Principles of Universal Design have been developed. They include:
UNITED STATES - Includes the fifty States, Puerto Rico, the District of Columbia, the Virgin Islands, American Samoa, and the Trust Territories of the Pacific Islands.
WORK FOR OTHERS (WFO) - research conducted or technical assistance provided by a federal laboratory for either a different federal entity or a private organization. Work is fully funded by the recipient agency or organization.
Organization Identification
A1. Organization Address: Provide the name and address of your organization.
Firm Name:
Address:
City, State, Zip:
A2. Additional Facilities:If your organization has additional facilities also involved in any manufacturing or other activities related to assistive technology, please list them below.
| Facility Name | City, State, Country |
A3. Parent Firm/Joint Ventures: If your organization is wholly or partly owned by another firm, indicate the name and address of the parent firm and extent of ownership. Indicate whether the relationship is a joint venture.
Firm Name: ___________________________________________________________
City, State, Zip: ___________________________________________________________
% ownership_______% Joint Venture? Yes No
A4. Organization Activities: Please indicate the nature of your assistive technology business by checking the appropriate box(es):
| Primary Business | Secondary Business | |
| Basic Research | ||
| Applied Research & Development | ||
| Product Testing | ||
| Manufacturing | ||
| Assembly | ||
| Distribution | ||
| Consulting |
A5. Product Categories
Below is a list of product categories for assistive technology devices derived from a list of major classifications developed by the National Institute on Disability and Rehabilitation Research (NIDRR). Indicate (T ) what type(s) of assistive technology equipment/devices you manufacture, assemble, perform research in connection with, develop, or design. Item lists under the categories are not all inclusive; select the closest category.
| Product Category | T |
|---|---|
| A. Architectural Elements (e.g., door opening/closing devices, door levers, lifts and elevators, ramps, safety equipment) | |
| B. Communication Devices(including both high and low technology devices, such as augmentative and alternative communication devices (AAC), speech synthesizers, communication boards and board overlays, conversation books) | |
| C. Telecommunications(e.g., wireless and wireline telephones, text telephones (TTY), amplified telephones, talking pagers) | |
| D. Sensory Aids (non-computer based devices, such as hearing aids, assistive listening devices, tactile aids for the deaf/blind, alerting devices, braille notetakers) | |
| E. Computers (e.g., hardware, software, accessories, including screen readers, large print software, optical character recognition equipment, refreshable braille displays) | |
| F. Environmental Controls(e.g., remotely controlled door openers, telephones, lights, televisions) | |
| G. Aids to Daily Living (e.g., aids for hygiene, dressing and undressing, toiletting, washing, bathing, showering, manicure and pedicure, hair care, dental care, facial care and skin care, housekeeping, handling and manipulating products, and orientation) | |
| H. Mobility (e.g., transportation safety, vehicle lifts and ramps, walking/standing aids, wheelchairs, seating systems, other types of wheeled mobility) | |
| I. Orthotics/Prosthetics(e.g., spinal orthotic systems, upper/lower limb orthotic systems, hybrid orthotic systems, upper limb prostheses, upper/lower limb prosthetic systems, non-limb prostheses, functional electrical stimulators) | |
| J. Recreation/Leisure/Sports (e.g., accessible toys, indoor games, arts and crafts, photography, physical fitness, gardening, camping, hiking, fishing, hunting, shooting, sports equipment, musical instruments) | |
| K. Modified Furniture/Furnishings (e.g., tables, light fixtures, sitting furniture, beds and bedding, adjustable height furniture, work furniture) | |
| L. Other (Please Specify: ________________________________) |
B I.1 Competitors and Competitive Prospects
Competitors: Who are your 5 major competitors, domestic or foreign?
| Company Name & Country |
| 1. |
| 2. |
| 3. |
| 4. |
| 5. |
Your Market Share:What is your company’s estimated share of the U.S. and world markets for your assistive technology products?
U.S.________% World________%
Competitive Prospects: Please rate how you expect your overall competitive prospects to change over the next 5 years:
Improve greatly
Improve somewhat
Stay the same
Decline somewhat
Decline greatly
BI.2 Foreign Competition:
Do foreign producers of assistive technology devices have any advantages over your firm that are unrelated to the quality or features of your products?
Yes No
Are your foreign competitors able to manufacture their products less expensively?
Yes No
Comments:
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.3 Universal Design
BI.3a Who do you consider to be the target market for your products, and what type(s) of disability(ies) do they have?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.3b Do your product developers consider individuals who are aging with the accommodated disability(ies)?
Yes No
If yes, please comment.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.3cDo your product developers ever include in their design processes consideration for individuals with more than one disability?
Yes No
If yes, please comment.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.3dHas your company explored potential applications of your products for individuals who have no disability?
Yes No
If yes, please comment.
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.3e Would you be interested in learning more about these possibilities, which are
part of the universal design process?
Yes No
BI.4 Customer Input. Does your company use focus groups or any other mechanisms to gather ergonomic, human factor, and other relevant user information for incorporation into the design of your products?
Yes No
If yes, please discuss these mechanisms.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
BI.5 Partnering
BI.5a. Private Assistance
Within the last 3 years, has your firm submitted a proposal for research funding related to assistive technology to any private foundations or firms?
Yes No
If yes, provide this information for each proposal. Attach an additional page if needed.
| Name of Foundation or Firm:____________________________________________ Brief Description of Project: ____________________________________________________________________ ____________________________________________________________________ Did you receive funding? Yes ____ No ____ How much funding? 1996:_______ 1997:_______ 1998:_______ |
| Name of Foundation or Firm:____________________________________________ Brief Description of Project: ____________________________________________________________________ ____________________________________________________________________ Did you receive funding? Yes ____ No ____ How much funding? 1996:_______ 1997:_______ 1998:_______ |
BI.5b. SBIR Application
In the last 3 years, has your firm submitted a research proposal related to assistive technology under the Small Business Innovation Research (SBIR) program?
Yes No
If yes, please indicate which agency(ies) offered the SBIR.
U.S. Dept. of Agriculture î Environmental Protection Agency
U.S. Dept. of Commerce î Natl. Aeronautics & Space Admin.
U.S. Dept. of Defense î National Science Foundation
U.S. Dept. of Education î Nuclear Regulatory Commission
U.S. Dept. of Energy î Other: _____________________
U.S. Dept. of Health and Human Services
U.S. Dept. of Transportation
How many times have you applied? ______
Please briefly summarize your proposal(s):
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
What product(s) or technology(ies) were involved?
____________________________________________________________
____________________________________________________________
Has your firm applied for Phase I funding? Yes No
Did your firm receive funding for Phase I? Yes No
If yes, how much funding? 1996________ 1997________ 1998________
Has your firm applied for Phase II funding? Yes No
Did your firm receive funding for Phase II? Yes No
If yes, how much funding? 1996________ 1997________ 1998________
BI.5c. Cooperation with Laboratories
Has your firm ever worked with either private or government laboratories in the development of assistive technology products or related technologies?
Yes No
If yes, please provide the following information about your cooperative efforts:
| Year(s) | Name of Laboratory | Type of Lab: I=Industry G=Govt. U=University O=Other |
Products or Related Technologies Developed |
Would you be interested in working with government laboratories on new or additional product and/or technology development projects?
Yes No
BI.5c. Cooperation with Laboratories (continued): If yes, listed below are some of the mechanisms available for working with federal laboratories. Please indicate with a T which one(s) would be of interest to you.
| Mechanisms | T |
|---|---|
| Personnel Exchanges | Q |
| Cooperative Research and Development Agreements (CRADAs) | Q |
| Finding Technical Assistance | Q |
| Forming Consortia | Q |
| Acquiring Software | Q |
| Licensing | Q |
| Work For Others (WFO) Arrangements | Q |
Do you know how to access the expertise and resources of the federal laboratories?
Yes No
BI.6 Manufacturing Assistance
What types of manufacturing assistance would increase your firm's output?
BI.7 Changes in Product Line
Select (T ) the option that best represents your company’s approach to new products:
BI.8 Emerging Technologies
BI.8a. Select the option that best represents your company’s approach to new technologies:
BI.8b. For each of the following technologies, please indicate (by writing a 1, 2, 3, 4, or 5 in the box next to each row) to indicate whether these technologies.....
Also, indicate (X) if you are interested in free consulting assistance from the member laboratories of the Federal Laboratory Consortium (FLC) for any of the technologies listed.
| Technology Description | 1-5 | Free FLC Consulting? (X) |
|---|---|---|
| Electronic Components & Systems | ||
| Board-level Electronics | ||
| Lasers/Optics | ||
| Integrated Circuits | ||
| Software Programs | ||
| Mechanical Components | ||
| Fastening, Joining & Assembly | ||
| Ferrous and Nonferrous Metals | ||
| Composite Materials | ||
| Plastics and Non-Metals | ||
| Sensors/Transducers | ||
| Test/Measurement Instruments | ||
| Motion Control Equipment | ||
| Fluid Power & Handling Devices | ||
| Energy Cells | ||
| Other: _____________________ | ||
| Other: _____________________ |
BI.9 Potential Obstacles:
Please indicate your perception of the following as potential obstacles to your business. Use the scale below to score each item from 0-5.
0. Not an obstacle at all
1. Only a minor obstacle
2. Average difficulty obstacle
3. Moderately difficult obstacle
4. Extremely difficult obstacle
5. Insurmountable obstacle
Competitiveness
___Foreign Competition
___Tariffs and trade barriers
___ Reliance on foreign parts and components
___ Lack of US suppliers for manufacturing equipment
___General state of the U.S. economy
___Other (specify)
Market Information
___Inadequate information regarding the demand for your product
___ Inadequate information regarding the physical parameters of usability of your product for persons with disabilities
___Other (specify)
Legal Issues
___ Generally litigious environment
___ Obtaining FDA approval
___ Environmental and health regulations
___ U.S. Government auditing policies and tax laws
___Other (specify)
Labor and Production
___ High U.S. labor costs
___ Problems with production scheduling and product development
___ Lack of automation/robotics
___Poor education system
___Labor turnover
___Other (specify)
Other
___Other (specify)
BI.10 Employment
BI.10a Workforce and Job Skills
For 1997, 1998, and 1999 (estimated), enter the total number of full-time equivalent workers for your organization employed in activities related to assistive technology devices at all facilities in the United States, including part-time employees, that are employed at year end.
| 1997 | 1998 | 1999 (est.) | |
|---|---|---|---|
| Total |
For each year reported above, please divide your total number of employees into the following categories, estimating where necessary:
| JOB CATEGORY | 1997 | 1998 | 1999 (est.) |
|---|---|---|---|
| Scientists, Engineers and Technicians | |||
| Healthcare Professionals | |||
| Manufacturing | |||
| Assembly | |||
| Marketing/Sales/General & Administrative | |||
| Other ________________________ | |||
| Other ________________________ |
BI.10b Employment Issues
Are any of the following items current or projected employment issues that may adversely affect your assistive technology manufacturing or R&D operations? If so, please describe them below:
shortages of certain skills ________________________________________________
_______________________________________________________________________
excessive turnover ______________________________________________________
_______________________________________________________________________
liability claims _________________________________________________________
_______________________________________________________________________
other _______________________________________________________________
BI.11 Government and Private Organization Funding
Choose a number from the scale below to indicate the impact of the following AT market forces:
Scale:
Very adverse impact: 1
Negative impact: 2
No impact: 3
Positive impact: 4
Very beneficial impact: 5
| Description | Enter 1-5 |
| Decreased Government R&D funding | |
| Access to low cost capital | |
| Managed care | |
| State Medicaid | |
| Medicare | |
| Private insurance reimbursement | |
| Workman's compensation | |
| Other sources of funding to consumer to offset purchase price | |
| Decreased vocational rehabilitation funding | |
| Tax credits and/or incentives for purchase of assistive technology devices | |
| Tax credits and/or incentives for creation of accessible facilities | |
| Other: ________________________________________________ | |
| Other: ________________________________________________ | |
| Comments: |
|
BII.1 R&D Expenditures:
Please indicate your total expenditures for assistive technology R&D in dollars for 1997 through 1999, providing estimates for 1999. For each year, indicate the amount of funding received from the sources listed (both internal and external).
1997 |
1998 |
1999 (est.) |
|
|---|---|---|---|
| TOTAL | $_______.00 | $_______.00 | $_______.00 |
| Internal Funding | $_______.00 | $_______.00 | $_______.00 |
| External Funding: | |||
| Federal Government: | |||
| SBIR Phase 1 (How many?___) | $_______.00 | $_______.00 | $_______.00 |
| SBIR Phase 2 (How many?___) | $_______.00 | $_______.00 | $_______.00 |
| STTR Phase 1 (How many?___) | $_______.00 | $_______.00 | $_______.00 |
| STTR Phase 2 (How many?___) | $_______.00 | $_______.00 | $_______.00 |
| Other Grants | $_______.00 | $_______.00 | $_______.00 |
| Contracts | $_______.00 | $_______.00 | $_______.00 |
| Other Federal | $_______.00 | $_______.00 | $_______.00 |
| Other Public | $_______.00 | $_______.00 | $_______.00 |
| Private Contracts | $_______.00 | $_______.00 | $_______.00 |
| Private Foundations | $_______.00 | $_______.00 | $_______.00 |
| Other Private Sources | $_______.00 | $_______.00 | $_______.00 |
BII.2 Capital Expenditures:
Capital Expenditures are costs incurred in the acquisition of assets used in the production of assistive technology-related capital plant and equipment. Please provide dollar amounts for the expenditures your firm incurred (whether paid in the year or in a subsequent year) in dollars for 1997 through 1999. For each year, indicate your sources (internal or external) for capital funding.
| 1997 | 1998 | 1999 (est.) | |
|---|---|---|---|
| TOTAL | $___________.00 | $___________.00 | $___________.00 |
| Internally Funded | $___________.00 | $___________.00 | $___________.00 |
| Externally Funded | $___________.00 | $___________.00 | $___________.00 |
BII.3 Sales by Region:
Please provide the sales by region for all assistive technology devices and equipment. Include all intracompany transfers/transports at their fair market value, reported in dollars.
| 1997 | 1998 | 1999 (est.) | |
|---|---|---|---|
| TOTAL SALES: | $___________.00 | $___________.00 | $___________.00 |
| United States | $___________.00 | $___________.00 | $___________.00 |
| Canada/Mexico | $___________.00 | $___________.00 | $___________.00 |
| Western Europe | $___________.00 | $___________.00 | $___________.00 |
| Eastern Europe | $___________.00 | $___________.00 | $___________.00 |
| South America | $___________.00 | $___________.00 | $___________.00 |
| Central America | $___________.00 | $___________.00 | $___________.00 |
| Middle East | $___________.00 | $___________.00 | $___________.00 |
| Asia/Pac. Rim | $___________.00 | $___________.00 | $___________.00 |
| Africa | $___________.00 | $___________.00 | $___________.00 |
| Australia | $___________.00 | $___________.00 | $___________.00 |
| Other__________ | $___________.00 | $___________.00 | $___________.00 |
Please provide your sales in units of assistive technology devices and equipment.
1997: _________ 1998: _________ 1999 (est.): _________
BII.4 Profitability
Please report your net income for all activities related to assistive technology.
1997: $_________.00 1998: $_________.00 1999 (est.): $_________.00
What percentage of your firm’s total net income is attributable to your assistive technology activities?
1997: ____% 1998: ____% 1999 (est.): ____%
FINAL REPORT. Would you like to receive a copy of the final report prepared in connection with this assessment?
Yes No
ADDITIONAL COMMENTS. If there are other issues not covered in this survey that you think are relevant to our analysis of this industry and that can assist your firm in becoming more competitive, please discuss them below. Thank you for your input.