Emergency Rental Assistance Program - Tenant Survey Question Title * 1. Have you or someone in your household been affected financially by COVID-19 (qualified for Unemployment Benefits or experienced a reduction in income) ? Yes No Question Title * 2. Are you or someone in your household behind in paying rent? Yes No Question Title * 3. What is your monthly rent Below $1000.00 $1000.00 to $1500.00 $1500.00 to $2000.00 $2000.00 to $ 2500.00 $2500.00 to $3000.00 Above $ 3000.00 Question Title * 4. How much rent arrears do you owe? $0.00 $0.00 to $1000.00 $1000.00 to $2500.00 $2500 to $5000.00 $5000.00 to $7500.00 $7500.00 to $10,000.00 more than 10,0000.00 Question Title * 5. How many months are you behind in paying your rent ? 0 months 1 to 3 months 3 to 6 months 6 to 9 months 9 to 12 months more than 12 months Question Title * 6. What is your ZIP code ? 10901 Airmont 10952 Airmont 10954 Bardonia 10911 Bear Mountain 10913 Blauvelt 10960 Central Nyack 10952 Chestnut Ridge 10965 Chestnut Ridge 10977 Chestnut Ridge 10920 Congers 10923 Garnerville 10960 Grandview 10969 Grandview on Hudson 10980 Grassy Point 10927 Haverstraw 10931 Hillburn 10952 Monsey 10901 Montebello 10970 Mount Ivy 10954 Nanuet 10956 New City 10977 New Hempstead 10977 New Square 10960 Nyack 10962 Orangeburg 10964 Palisades 10965 Pearl River 10968 Piermont 10970 Pomona 10974 Sloatsburg 10960 South Nyack 10976 Sparkill 10977 Spring Valley 10980 Stony Point 10901 Suffern 10952 Suffern 10982 Tallman 10983 Tappan 10984 Thiells 10986 Tomkins Cove 10960 Upper Grandview 10960 Upper Nyack 10989 Valley Cottage 10952 Wesley Hills 10977 Wesley Hills 10993 West Haverstraw 10994 West Nyack Question Title * 7. Area Median Income 1 person 2 people 3 people 4 people 5 people6 people 7 people 8 people 50% AMI $39,800 $45,500 $51,200 $56,850 $61,400 $65,950 $70,500 $75,050 80% AMI $63,700 $72,800 $81,900 $90,950 $98,250 $105,550 $112,800 $120,100Looking at this chart, what is your household's total income for your household size ? Below 50% Area Median Income (AMI) Between 50% Area Median Income (AMI) and 80% Area Median Income( AMI) Above 80% Area Median Income( AMI) Done