This survey is sponsored by the Atlantic County Division of Public Health to help determine the unmet health, mental health and social services needs of residents who were directly impacted by Superstorm Sandy. Your responses will remain confidential and you will not be asked to provide your name, address, or any other identifying information.

Thank you for your participation.

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* 1. What is the name of the town in which you live?

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* 2. How old are you?

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* 3. Are you male or female?

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