Financial Services Survey

Hello and thank you for being a part of the Q-Insights database!

We would like to invite you to participate in a study about financial services. The study will run Janury 22nd-23rd in Sherman Oaks and you will be paid $175 via check as a thank you.

If you are interested in participating, please complete the questionnaire below. If you pre-qualify a recruiter will be in touch with you to ask a few additional qualifying questions.

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* 1. What is your gender?

Male

Female

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* 2. What is your age?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. What is your employment status?

Full time

Part time

Self Employed

Temporarily unemployed

Homemaker or stay at home parent

Retired

Student

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* 4. Which of the following categories includes your total income of your household?

Less than $50,000

$50,000- $75,000

$75,000-$100,000

$100,000-$150,000

$150,000-$250,000

$250,000-$500,000

$500,000-$1 million

$1 million or higher

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* 5. Do you personally have any of the following types of financial accounts or products?

Checking

Savings

Credit card

Pension plan

401k

Annuities

Stocks

Bonds

Other (please specify)

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* 6. Which of the following best describes your role in making financial decisions in your household?

I am the primary financial decision maker in my household

I share the financial decision-making responsibility equally with someone else in my household

I am not involved in those decisions

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* 7. Do you currently have any of the following types of insurance?

Homeowners or condo insurance

Renters insurance

Life insurance provided by employer

Life insurance you have obtained on your own

Health insurance from your employer

Long term care insurance

Supplemental medical insurance

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* 8. How likely are you to obtain or renew the following?

	Not at all likely	Somewhat unlikely	Somewhat likely	Very Likely
401K	401K Not at all likely	401K Somewhat unlikely	401K Somewhat likely	401K Very Likely
An annuity	An annuity Not at all likely	An annuity Somewhat unlikely	An annuity Somewhat likely	An annuity Very Likely
Life insurance you obtained on your own	Life insurance you obtained on your own Not at all likely	Life insurance you obtained on your own Somewhat unlikely	Life insurance you obtained on your own Somewhat likely	Life insurance you obtained on your own Very Likely
Health insurance obtained yourself	Health insurance obtained yourself Not at all likely	Health insurance obtained yourself Somewhat unlikely	Health insurance obtained yourself Somewhat likely	Health insurance obtained yourself Very Likely
Long term care insurance	Long term care insurance Not at all likely	Long term care insurance Somewhat unlikely	Long term care insurance Somewhat likely	Long term care insurance Very Likely
Supplemental medical insurance	Supplemental medical insurance Not at all likely	Supplemental medical insurance Somewhat unlikely	Supplemental medical insurance Somewhat likely	Supplemental medical insurance Very Likely

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* 9. Which of these best describes your household’s total investable assets? Investable assets include investments such as CDs, mutual funds, money market accounts, stocks, and so forth but does not include personal retirement accounts such as IRAs, or assets you have accumulated through your work such as a 401k, or the value of your primary residence or any business assets

Less than $25,000

$25,000 to less than $50,000

$50,000 to less than $100,000

$100,000 to less than $150,000

$150,000 to less than $250,000

$250,000 to less than $500,000

$500,000 to less than $1 million

$1 million or higher

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* 10. Which of the following best describes your race or ethnic background?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

Other (please specify)

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* 11. What is the highest level of education that you’ve completed?

Some High School

High School Graduate

Some College

College Graduate

Post Graduate

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* 12. What is your marital status?

Married

Never Married

Divorced or seperated

Widowed

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* 13. Do you have children?

Yes

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* 14. How many children do you have in each age group? Do these children live in your house?

Under 18 years

18 years or older

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* 15. Do you plan to have any children in the next five years?

Yes

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* 16. What is your contact info

Name

Email Address

Phone Number