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Skip to content U.S. Department of Transportation/Federal Highway AdministrationU.S. Department of Transportation/Federal Highway Administration
Office of Planning, Environment, & Realty (HEP)

Business Relocation Assistance Retrospective Study

Attachment D - Business Owner Questionnaire

Personal Interview Questionnaire
Version 05/15/2009




Name of Business:


Old Address:

New Address:

Type of Business:

Phone Number:




Tenancy Status:

  Displacement Site: Owner check box Tenant check box
  Replacement Site: Owner check box Tenant check box

Date of Move:

Relocation Payments Received: Yes check box No check box

Moving $

Reestablishment $

In Lieu $

Search $


a. Did you feel that the payments you received were adequate to move and re- establish your business? Yes check box No check box

b. If not, what specific items do you feel you should have been paid for but were not?


a. Did you request advisory assistance from the State? Yes check box No check box

b. In terms of advisory assistance, did the State:

Attempt to determine your needs and preferences? Yes check box No check box
Assist in locating replacement locations? Yes check box No check box
Provide references, contacts and counseling to minimize hardships? Yes check box No check box
Inform you that you could appeal disputed amounts and payments types? Yes check box No check box
Did you specifically ask for any of the above listed services? Yes check box No check box

3. How did you locate your replacement site?

4. Was the payment you received for searching (the search payment) adequate? Yes check box No check box
5. Did you have code-related cost modifications (e.g., building codes) with the new site, building or equipment? Yes check box No check box
6. Approximately what was the total cost of these code-related modifications? Yes check box No check box
7. Do you feel you were treated fairly by the displacing agency? Yes check box No check box

8. How long did it take you to receive payment from the agency?


a. After the completion of the move, did you incur an increase or decrease in business, i.e., clients, profits, etc.? Increase check box Decrease check box

b. What do you feel caused this increase or decrease?

10.If you could design a better program, what changes would you make?

11.What additional services could the displacing agency offer to lessen the impact of business displacements?

12.What was the effect of the move on your employees?

13.Interview remarks:

Interview completed by: Date:

Updated: 9/5/2014
HEP Home Planning Environment Real Estate
Federal Highway Administration | 1200 New Jersey Avenue, SE | Washington, DC 20590 | 202-366-4000