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* 1. Which county do you live in?

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* 2. How long have you lived in this county?

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* 3. Are you the head of your household?

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* 4. What is your housing situation?

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* 5. Were you or your family homeless within the past 12 months?

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* 6. How many times have you moved within the last 12 months?

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* 7. Would you like to know more about buying your own home?

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* 8. What is your age?

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* 9. What is your gender?

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* 10. What is your racial or ethnic group?

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* 11. What language(s) do you speak at home?

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* 12. How many adults, counting yourself, live in your household?

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* 13. How many children (ages birth to 17) are in your household?

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* 14. What are the ages of the adults currently living in your house?

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* 15. What are the ages of the children currently living in your house?

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* 16. What is your family type?

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* 17. Is anyone else in your household completing this survey?

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* 18. Is anyone in your household disabled?

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* 19. If yes, what age are they?

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* 20. What is the highest level of education you've completed?

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* 21. Does your household have a source of income?

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* 22. Do you have health insurance?

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* 23. What is your employment status?

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* 24. Do you receive any of the following?

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* 25. What is your monthly income? 

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* 26. Do you spend more than 50% of your household income on housing?

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* 27. Check all household health insurance(s)?

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* 28. Where do you receive most of your medical care?

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* 29. Are you or someone in your family in the military?

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* 30. If yes, are they on active duty?

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* 31. Do you have reliable phone service?

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* 32. Do you have reliable internet service?

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* 33. Do you have reliable transportation?

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* 34. Are you able to use public transportation?

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* 35. Do you have a bank or credit union account?

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* 36. Have you lost your home because you could not pay rent or mortgage within the past 12 months?

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* 37. Have you been unable to obtain food or been unable to meet your utility obligations within the past 12 months?

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* 38. Have you lost your means of transportation within the past 12 months?

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* 39. Who provides care for your children?

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* 40. What is the distance to your nearest Head Start center?

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* 41. How many hours of childcare do you need per week?

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* 42. Which days of the week do you work?

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* 43. What are your typical work hours each day?

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* 44. Do your work hours rotate on a regular basis?

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* 45. In the past year, have you taken a payday or title loan?

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* 46. Do you pay to have your checks cashed?

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* 47. Were you or your household impacted by COVID-19?

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* 48. How were you or your household impacted by COVID-19?

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* 49. Please choose the 5 issues concerning you the most about your Household.

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* 50. Please choose the 5 issues concerning you the most about your Neighborhood.

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* 51. How do you think your situation has changed this year?

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* 52. How do you think your situation will be next year?

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