The City of Scranton, Pennsylvania is preparing its FY 2015-2019 Analysis of Impediments to Fair Housing Choice. As part of the planning process, the City is conducting a survey to identify residents’ fair housing concerns, such as acts of discrimination or barriers that might limit the housing choices of families and individuals. 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 the name of the street where you live in the City of Scranton?

* 2. Gender

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

* 4. Age

* 5. Number of persons living in your household?

T