Demographics

* 1. Are you

* 2. What is your age?

* 3. Who are you filling this out for?

* 4. My zip code is:

* 5. How many people currently live in your household?

* 6. Do you have children?  

* 7. How many children are you a parent of or guardian for and live in your household (aged 18 or younger only)?

* 9. Which of the following categories best describes your employment status?

* 10. If applicable, which of the following categories best describes your spouse's employment status?

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