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* 1. Q1. Are you a resident of Herkimer County?

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* 2. Q2. What is the name of your municipality or community? For some people, this would mean the town or village in which they live, or it could be their neighborhood. For some people, it could be their subdivision or development.

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* 3. Q3. How long have you lived in your community?

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* 4. How long have you lived in your current residence?

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* 5. How would you rate your current community as a place for people to live as they age?

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* 6. Thinking about your future years, are you more likely to move to a different community, move to a different residence within your current community or stay in your current residence and never move? (CHECK ONLY ONE)

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* 9. How important is it for you to remain in your current community for as long as possible?

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* 10. Which of the following types of homes best describes where you currently live?
(CHECK ONLY ONE)

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* 11. Do you own or rent your primary home, or do you have some other type of living arrangement, like living with a family member or friend?

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* 12. How important is it for you to be able to live independently in your own home as you age?

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* 13. Some people find that they need to make modifications to their residence to enable them to stay there for as long as possible. Does your current residence need any major repairs, modifications, or changes to enable you to stay there for as long as possible?

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* 22. Social Participation, Inclusion and Education Opportunities

How often do you have contact with family, friends, or neighbors who do not live with you?

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* 24. Do you have friends or family that can provide assistance to you?

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* 26. If you chose i. Some other source, please list the source.

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* 29. Job Opportunities

Which of the following best describes your current employment status?

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* 30. How likely is it that you will continue to work as long as possible, rather than choosing to retire and no longer work for pay?

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* 32. Do you work because of a financial necessity?

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* 33. Do you risk losing services if you work? (Examples of services include but are not limited to SNAP benefits, Social Security, etc.)

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* 35. If you have chosen m. Other, please list the resource.

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* 37. Demographics

D1. Are you male, female or transgender?

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* 38. D2. What is your age as of your last birthday?

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* 39. D3. What is your current marital status?

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* 40. D4. Are you or your spouse or partner currently a member of AARP?

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* 42. D6. How many people are in your household?

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* 43. D7. In general, how would you rate your health?

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* 44. D8. Do you have health care insurance coverage on yourself?

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* 45. D9. Does any disability, handicap, or chronic disease keep you or your spouse or partner from participating fully in work, school, housework, or other activities? (CHECK ONLY ONE)

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* 46. D10. A family caregiver is someone who provides care for an adult loved one who is ill, frail, elderly, or has a physical, mental, or emotional disability. This may include helping with personal needs like bathing or dressing, meals, household chores, shopping, transportation, managing medical care or finances, or even visiting regularly to see how they are doing. This adult need not live with you. 

Are you currently a family caregiver providing unpaid care to an adult loved one to help them take care of themselves?

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* 47. D11. How likely is it that you will provide unpaid care to an adult loved one in the future?

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* 48. D12. What is the highest level of education that you completed?

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* 49. D13. Are you of Hispanic, Spanish, or Latino origin or descent?

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* 50. D14. If you are Hispanic or Latino, please indicate which language best represents the language you speak at home?

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* 51. D15. What is your race? (CHECK ALL THAT APPLY)

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* 52. D16. How often do you vote?

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* 53. D17. Do you know how to use the Internet?

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* 54. D18. Do you know how to send e-mail?

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* 55. D19. Which best describes how often you use the Internet?

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* 56. What was your annual household income before taxes in 2020?

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* 57. D21. What is your 5-digit zip code?

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* 58. D22. How would you rate your current community as a place for people to live as they age?

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