Food Study SIS International Research is conducting compensated interviews and are interested in your opinions. This will be a 2 hour interview. The compensation is 250 dollars. These interviews will be in home interviews. This means that interviewers would come to your residence to conduct these interviews. If this is something that you are open to please complete a short pre-screening survey. OK Question Title * 1. Please let us know how we may reach you. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. What’s your highest level of education? High school Some college College degree Post graduate degree No degree Other OK Question Title * 3. What is your age? OK Question Title * 4. What is your relationship status? Single Dating Married Other OK Question Title * 5. How many people including yourself reside in your household? OK Question Title * 6. Do you have kids? If so how many and what are their ages? OK Question Title * 7. Please tell us your occupation and industry you currently work in? OK Question Title * 8. Please give a short description of your job in less than 2 sentences OK Question Title * 9. Please tell us the last time you participated in market research. Please also let us know the topics of focus groups or compensated interviews you've taken part in. Please list as many as you can remember. OK Question Title * 10. What is your employment status? Student Works part time Works full time Seeking employment Stay at home parent OK Question Title * 11. Please tell us your ethnicity Asian African American Caucasian Mixed Ethnicity Native American Hispanic Other (please specify) OK Question Title * 12. How many paid hours per week do you work? OK Question Title * 13. Please give us an estimation of your personal annual income. Below 25,000 25,000 to 35,000 35,001 to 55,000 55,000-75,000 75-100,000 Over 100,000 OK Question Title * 14. Would you say you live paycheck to paycheck? OK Question Title * 15. what would you would do if a $500 emergency fine came up this month? Would you be able to handle this or would you need to borrow money? Please be detailed with your reply. OK Question Title * 16. Do you run into trouble paying for certain bills or expenses? Please select the ones that applies to. Child Care Healthcare Rent Groceries Transportation Other (Specify) I don’t have trouble OK Question Title * 17. If you had a $400 emergency expense tomorrow, would you still have enough money left to cover your bills? OK Question Title * 18. Rank in Order of importance of matters to you when you buy food? on a scale of 1-5 where 5 is the highest 1 2 3 4 5 Nutrition 1 2 3 4 5 Cost 1 2 3 4 5 Convenience 1 2 3 4 5 Taste 1 2 3 4 5 Feeling Full OK Question Title * 19. In the last 12 months, have you ever been worried that the food you brought home would run out before you could buy more?" Yes No OK Question Title * 20. In the last 12 months, has the food you've brought home actually run out before you could buy more? Yes No OK Question Title * 21. Q19: Do you have health insurance? Yes No OK Question Title * 22. If Yes what health insurer are you with? OK Question Title * 23. Are you on any of the following plans, please select: Medicaid Medicare Dual-eligible None of the above OK Question Title * 24. Have you used any other community programs or social services in the last 6 months? OK Question Title * 25. How did you hear about this survey? OK Thank you for taking our survey. Those who match the initial requirements will receive a call back. OK DONE
