CASH Questionnaire 2021 Question Title * 1. Contact Information - if no email, write n/a Name Email Address Phone Number OK Question Title * 2. Please check the one that best describes you: Couple filing joint Female Male Other (please specify) OK Question Title * 3. Please select the one that best describes you: African American or Black Caucasian or White Hispanic or Latino Asian Native American or Alaskan Native Native Hawaiian / Other Pacific Islander Two or more race/ethnicities Other race/ethnicity (not listed) OK Question Title * 4. What is your preferred language? English ASL Spanish Chinese Other (please specify) OK Question Title * 5. Household Employment Information: One or more adults working full time One or more adults working part time; no adults working full time No adults working; at least one adult is retired All adults are unemployed (left blank) OK Question Title * 6. Do you have any dependents ( children, foster children, step-children, etc)? Yes No Other (please specify) OK Question Title * 7. Non City Residents: Town/Village OK Question Title * 8. Which of the following would you like to know more about? (Check ALL that apply) Food Stamps/SNAP Emergency Food/List of Food Pantries Low Cost Rental Properties Buying a Home Behind in mortgage and need help Remodeling Loans and Grants Weatherization & Energy Programs Emergency Utility Assistance - refer to 211 Emergency Rent Assistance - refer to 211 IRS and/or NYS tax issues Free Credit Report Budgeting/Fixing Credit/Reducing Debt Student Loan Repayment Assistance Getting an HSE (formerly GED) Job Training and/or Information Small Business/Entrepreneurship Resources Affordable Health Options Free Health Screenings Not Interested in any of the above OK Question Title * 9. Would you like to join our email list? CASH will share information about program updates, community resources, and information about new services and tax workshops, etc. Yes No OK Question Title * 10. Would you like to be a CASH Volunteer? Volunteers are required to utilize an email account. No Yes - I can volunteer this year (now - April, 2021) Yes - I can volunteer next year (Jan - April, 2022) OK Question Title * 11. How would you like to provide input on improving CASH Services? Not Interested Online Survey Focus Group CASH Client Advisory Committee OK Question Title * 12. Save Your Refund is a national project that encourages taxpayers to save at least $50 of their federal refund and enter for a chance to win $100. Are you interested in learning more? Yes - CASH will contact you with information No OK Question Title * 13. Roc Your Refund Program:For Monroe County Residents with dependent(s): Would you like to commit to saving $200 in a US Savings Bond, receive a $25 Wegmans gift card for completing a survey, and have the chance to have your savings matched by up to 50%*? *Not everyone will be chosen to receive a match, those selected will be chosen at random. Yes - CASH will contact you with information No N/A - not a Monroe County resident w/dependent(s) OK Question Title * 14. ROC Your Family’s Future Project:We are looking for taxpayers claiming the Earned Income Tax Credit for the FIRST time to participate in this project. Eligible participants are asked to complete a survey and will receive a $25 Wegmans gift card. Are you interested in learning more? Yes - CASH will contact you with information No Unsure - CASH will contact you with information OK DONE