The City of Pittsburgh, Pennsylvania is preparing its FY 2015-2019 Five Year Consolidated Plan, FY 2015 Annual Action Plan, and FY 2015 Analysis of Impediments to Fair Housing Choice for the Community Development Block Grant (CDBG), Home Investment Partnerships (HOME), Emergency Shelter Grant (ESG), and Housing Opportunities for Persons with Aids (HOPWA) Programs. As part of the planning process, the City is conducting a survey to identify residents' needs in the community, ideas on how residents would like to see funds under the CDBG, HOME, ESG, and HOPWA Programs spent, and fair housing concerns, such as acts of discrimination or barriers that might limit the housing choices of families and individuals. In order for the City to address the housing needs of its residents, we request your assistance. Please take a few minutes and complete this confidential questionnaire to the best of your ability. If you are unsure of an answer, or the question does not apply to you, please feel free to skip that question. Thank you for your assistance in helping us to identify residents' needs and Fair Housing issues in the City.

* 1. What is your street name and ZIP Code where you live in the City of Pittsburgh?

* 2. Gender

* 3. Race/Ethnicity (choose all that apply)

* 4. Age

* 5. Number of persons living in your household?

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