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Easthampton Community Development Block Grant Survey
1.
How many persons are there in your household?
2.
Is this a single-parent head of household?
Yes
No
3.
If yes to #2, is the head of the household male or female?
Male
Female
4.
Are any household members disabled or handicapped?
Yes
No
If yes, how many.
5.
Please indicate the number of people in your household for each age group provided below.
Under 5 yrs.
5 to 17 yrs.
18 to 20 yrs.
21 to 24 yrs.
25 to 34 yrs.
35 to 44 yrs.
45 to 54 yrs.
55 to 59 yrs.
60 to 64 yrs.
65 to 74 yrs.
75 to 84 yrs.
85 yrs. & over
6.
Based upon the size of your household, which of the following most nearly approximates your household's income? (Please check appropriate line)
1 person $0-32,950
1 person $32,951-52,750
1 persons over $52,750
2 persons $0-37,650
2 persons $37,651-60,250
2 persons over $60,250
3 persons $0-42,350
3 persons $42,351-67,800
3 persons over $67,800
4 persons $0-47,050
4 persons $47,051-75,300
4 persons over $75,300
5 persons $0-50,850
5 persons $50,851-81,350
5 persons over $81,350
6 persons $0-54,600
6 persons $54,601-87,350
6 persons over $87,350
7 persons $0-58,350
7 persons $58,351-93,400
7 persons over $93,400
8 persons $0-62,150
8 persons $62,151-99,400
8 persons over $99,400
*
7.
Property Address
(Required.)
