Fairfield County Impediments to Fair Housing Survey Question Title * 1. Please select the option that best represents you. I am a resident homeowner. I am a resident renter. I am a service provider. Other (please specify) Question Title * 2. How old are you? Under 21 21-34 35-49 50-64 65-80 80+ Question Title * 3. How would you describe yourself? Please select all that apply. White Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 4. Including yourself, how many people live in your home? 1 2 3 4 5 6 or more Question Title * 5. What is your annual household income (including all family members)? Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $150,000 Over $150,000 Question Title * 6. Are you currently receiving any Federal or State monetary assistance (such as TANF, rental assistance)? Yes No Question Title * 7. Which of the following best describes your current living situation? Married/Partnered adult with children under 18 living in home Single Adult/Separated with children under 18 living in home Married/Partnered adult with no children under 18 living in home Single Adult/Separated with no children under 18 living in home Other (please specify) Question Title * 8. How would you rate your current living conditions, with 5 being totally adequate and 1 being totally inadequate? 5 4 3 2 1 Question Title * 9. The federal Fair Housing Act prohibits discrimination in the sale, rental, and financing of housing based on race, color, national origin, religion, sex, familial status, and disability. Of those, which do you think is the most prevalent factor in housing discrimination in our region? Race Color National Origin Religion Sex Familial Status Disability Other (please specify) Question Title * 10. Have you or someone you know experienced housing discrimination in any of the following areas? Renting an apartment. Buying a home. Obtaining a mortgage. Obtaining reasonable accommodations for a disability. Obtaining insurance. None of the above Other (please specify) Question Title * 11. In reference to Q10, did you or the person you know report the discrimination? Yes No N/A Question Title * 12. How well informed do you feel personally about housing discrimination laws? Very well-informed. Somewhat well-informed. Averagely informed Somewhat uninformed. Not at all informed. Question Title * 13. Have you or has someone you know faced any of the following housing-related challenges? Please check all that apply. Housing is too expensive. I am afraid of being evicted. I have a felony/criminal conviction that is making it difficult to secure housing. I don't have adequate access to financing. I can't pay my rent or mortgage. I'm worried about my rent going up. I can't find a landlord that will rent to me. I wanted to buy a home but can't afford it. I am homeless and can't find adequate shelter. I have poor credit that is preventing me from getting a loan. I have a disability and I cannot find a place that has or will make adequate accommodations for me. None of the above Other (please specify) Question Title * 14. Please choose the top three (3) housing issues you think need the most attention. Temporary housing for homeless Rental assistance Foreclosure prevention Access to Fair Housing Affordable rental housing Affordable home ownership Development of new housing First time homebuyer counseling and assistance Homeowner rehabilitation and maintenance Maintenance of rental housing Accessibility for disabled persons Absentee landlords The presence of lead or other toxins in homes Other (please specify) Done