Easthampton Community Development Block Grant Survey Question Title * 1. How many persons are there in your household? Question Title * 2. Is this a single-parent head of household? Yes No Question Title * 3. If yes to #2, is the head of the household male or female? Male Female Question Title * 4. Are any household members disabled or handicapped? Yes No If yes, how many. Question Title * 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 Question Title * 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 Question Title * 7. Property Address Done