EITC Tax Campaign 2019: SURVEY EITC Tax Campaign 2019: Survey Survey for income tax filers through Central California Legal Service's EIC Tax Campaign. Question Title * 1. TODAY'S DATE: ex. 02/05/2019 Question Title * 2. Your zip code: 93210 93234 93242 93602 93605 93606 93607 93608 93609 93611 93612 93613 93616 93621 93622 93624 93625 93626 93627 93628 93630 93631 93634 93640 93641 93642 93646 93648 93650 93651 93652 93654 93656 93657 93660 93662 93664 93667 93668 93675 93701 93702 93703 93704 93705 93706 93707 93708 93710 93711 93714 93715 93717 93718 93720 93721 93722 93725 93726 93727 93728 93729 93744 93745 93747 93755 93771 93772 93773 93774 93775 93778 93779 93790 93794 93888 93201 93207 93218 93219 93221 93223 93227 93235 93244 93247 93256 93257 93258 93260 93261 93265 93267 93270 93271 93272 93274 93275 93277 93278 93279 93286 93290 93291 93292 93603 93615 93618 93647 93666 93670 93673 93202 93204 93212 93230 93232 93239 93245 93246 93620 93635 93661 93665 95303 95312 95315 95317 95322 95324 95333 95334 95340 95341 95344 95348 95365 95369 95374 95388 95306 95311 95318 95338 95345 95389 95305 95309 95310 95321 95327 95335 95346 95370 95372 95373 95379 95383 other Other (please specify) Question Title * 3. Gender: Male Female Other (please specify) Question Title * 4. Age: 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 5. Ethnicity White Black/African-American Hispanic Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Other (please specify) Question Title * 6. What is your PRIMARY LANGUAGE? Spanish English Hmong Other (please specify) Question Title * 7. Is this your first time filing taxes through the CCLS: EITC TAX CAMPAIGN? Yes No Question Title * 8. If question 7 is YES, then how did you hear about our tax assistance site? CCLS Facebook Friend/Relative Flyer Outreach event CCLS office/staff CCLS website TV/Radio Newspaper MyFreeTaxes site search IRS.gov site search Referral from another agency CalEITC4Me.org The California Endowment Other (please specify) Question Title * 9. What is your FILING STATUS for Tax Year 2018? Single Married Filing Jointly Married Filing Separately Head of Household Qualifying Widow/Widower Question Title * 10. What was your TOTAL INCOME for Tax Year 2018? $1 - $5,000 $5,001 - $10,000 $10,001 - $15,000 $15,001 - $20,000 $20,001 - $25,000 $25,001 - $30,000 $30,001 - $35,000 $35,001 - $40,000 $40,001 - $45,000 $45,001 - $50,000 $50,001 - $55,000 $55,000-$66,000+ Question Title * 11. How many DEPENDENTS did you claim for TAX YEAR 2018? 1 2 3 4 5 6 7 8 9 10 Question Title * 12. How much total FEDERAL REFUND did you receive? *Do NOT enter $ sign or commas $ Question Title * 13. How much EARNED INCOME CREDIT (EITC) did you receive? *Do NOT enter $ sign or commas $ Question Title * 14. Have you received EARNED INCOME CREDIT before? Yes No Question Title * 15. How much TOTAL STATE REFUND did you receive? DO NOT enter $ sign or commas. $ Question Title * 16. How much CAL EITC did you receive? DO NOT enter $ sign or commas. $ Question Title * 17. How will you be using your TAX REFUND? Help purchase a home Purchase a car Pay for Health Insurance Put into savings Pay my bills Pay school tuition Buy daily needs (i.e. food, clothes, etc.) Other (please specify) Question Title * 18. If CCLS is unable to offer this free tax assistance next year, how will you be filing your 2019 taxes? I will complete the forms myself. I will use an IRS VITA site. I will use a paid chain tax store (ex. H&R Block). I will use a paid tax software (ex. TurboTax, TaxACT, TaxSlayer) I will use a local paid tax professional. I will not file not my taxes. I don't know what I would do yet. Other (please specify) Question Title * 19. Would you like more information on any of the following? Affordable Care Act (Obamacare) Deferred Action for Childhood Arrivals (DACA) PG&E and Utilities CalFresh CalEITC4Me.org Medical Health insurance for kids Question Title * 20. OPTIONALWe would love to hear about how our tax assistance site or your tax refund has affected you. If you'd like to share your story, please provide your contact information and a 1 to 2 sentence summary of your story. We will contact you soon. Thank you for participating in this CCLS survey! Name: City: Email or Phone: Story summary: Done
