OMB Control Number: 2577-XXXX
Expiration Date: XX/XX/XXXX
Information Collection Requirements
The information collection requirements contained in this proposed rule have been approved by the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520) and assigned OMB Control Number 2577-XXXX. In accordance with the Paperwork Reduction Act, HUD may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection displays a currently valid OMB control number.
Wait List Household Survey
(Last revised: 7/23/08)
For non-disabled, non-elderly households on the waiting list for public housing or housing choice voucher assistance. Survey is for households on the waiting list at PHAs in the 25-PHA sample.
Contents of Survey Instrument
Consent Form for Rent Study Household Survey…………………………p.2
Section I: Waiting List Questions……………………………………..p.3
Section II: Housing Quality Questions…………………………………p.7
Section III: Demographic and Household Composition Questions……..p.11
Section IV: Work Questions…………………………………………….p.14
Section V: Non-Work Income Questions………………………………p.18
Section VI: Rent and Expenditure Questions……………………………p.20
Section VII: Hardship Questions…………………………………………p.27
Section VIII: Shopping Questions…………………………………………p.28
Section IX: Preference Questions………………………………………..p.30
Section X: Contact Information Sheet…………………………………..p.34
Notes
We will collect and record information prior to interview to trigger appropriate skip patterns and fill-ins: (i) Housing Agency Name; (ii) Type of waiting list or assistance (HCV/PH); (iii) Local TANF name and name of TANF agency (iv) Name of sample member to ensure we are interviewing the correct person; and (v) month and year survey being administered for appropriate reference in questions.
Capital letter responses on the survey are not read to respondent.
Information in brackets indicates that language needs to be auto-inserted based on pre-survey information or based on responses to earlier comments.
Consent Form for Household Survey
The Department of Housing and Urban Development is conducting a study of their housing assistance programs. They are conducting a survey to learn about the experiences of people on the waiting list for housing assistance. The survey is being done by researchers from Abt Associates, a private research company with extensive survey experience.
You were selected for the survey because you and your family are on the waiting list for [a housing choice voucher/ public housing] at [housing agency name]. We would like to find out about the reasons that people like you apply for housing assistance and about how housing assistance can best help you. Your answers will not be reported to the [housing agency name] and will not in any way affect your qualifying for housing assistance or your position on the waiting list. We hope that you will participate in our survey. Your experiences and opinions are very important to the study.
Your participation in our survey will consist of an interview that lasts about 40 minutes.
We are conducting interviews with about 1,500 people. We will also follow-up with approximately 300 people a year from now. You will never be named in any reports about the study. Only results from groups of people will be reported. We are committed to protecting the privacy, to the extent permitted by law, of every individual who takes part in our survey.
We will ask you questions about your current income and employment, how you are meeting your housing and other needs, and what you expect from participation in a housing assistance program. Your participation in our survey is voluntary. You can refuse to answer any questions if you like. You may stop the survey at any time or skip specific questions. You will not lose any services or benefits if you decide not to participate in the survey, skip specific questions, or stop the interview.
At this time, we would like your permission to interview you. If you agree to be interviewed, please check the box below and sign and date the form.
YES. I have read this form and want to participate in this study. I understand that this information will be kept private, and that neither my name nor the names of my family members will ever be used in any study report.
___________________________ ___________________________ ____________
Name (Print) Signature Date
Please feel free to contact Brenda Rodriquez, Abt Associates Survey Director, at 617-349-2544 (a toll call) if you have questions about this study. You may also contact Marianne Beauregard with Abt at 617-349-2852 (a toll call) if you have any questions or concerns about your rights as a study participant.
Please keep a copy of this form for your own records.
I. WAITING LIST QUESTIONS (WL)
I am going to start out the survey with questions about your decision to apply for housing assistance.
WL1: How many years have you been on the waiting list for [a housing choice voucher/public housing] at [housing agency name]?
NUMBER OF YEARS __________ 1-96 SKIP TO WL2
LESS THAN ONE YEAR 00
DON’T KNOW -1 SKIP TO WL2
REFUSED -2 SKIP TO WL2
WL1a . RECORD THE NUMBER OF MONTHS.
NUMBER OF MONTHS __________ 01-11
LESS THAN ONE MONTH 00
DON’T KNOW -1
REFUSED -2
WL2: Are you also on the waiting list for [a housing choice voucher/ public housing – whichever one person isn’t listed on our pre-survey form] at [housing agency name]?
YES 1
NO 2
REFUSED 7
DON’T KNOW 8
WL3: Are you on the waiting list for either a housing choice voucher or public housing at any other housing agency?
YES 1
NO 2
REFUSED 7
DON’T KNOW 8
WL4:When you applied to be on the waiting list, did [housing agency name] ask you about any of the following items about your household? Did the [housing agency name] ask you…
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Yes (=1) |
No (=2) |
REF (=7) |
DK (=8) |
A |
whether you or someone in your household is working for pay? |
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B |
whether you or someone in your household is in a work training program? |
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C |
whether you or someone in your households has a disability? |
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D |
whether you are homeless or about to become homeless? |
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E |
whether you or someone in your household is a veteran? |
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F |
your current address? |
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WL5 (If yes to any WL4 items): Did [housing agency name] tell you that the answer to any of those questions meant that you would receive housing assistance sooner? (PROMPT IF NEEDED: Did they tell you that you would be higher up on the waiting list if any of those things applied to you?)
YES…………………………………………………………………………………….1
NO………………………………………………………………………………2 Skip to WL7
REFUSED……………………………………………………………………..7 Skip to WL7
DON’T KNOW………………………………………………………………..8 Skip to WL7
WL6: Which of the items about your household would mean that you would receive housing assistance sooner, according to the information [housing agency name] gave you when you applied to be on the waiting list?
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MENTIONED (=1) |
NOT MENTIONED (=2) |
REF (=7) |
DK (=8) |
A |
Someone is working for pay |
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B |
Someone is in a work training program |
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C |
Someone has a disability |
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D |
I am (my household is) homeless |
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E |
Someone is a veteran |
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F |
My current address |
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WL7: (If on waiting list for public housing): Did you apply to live in a specific public housing development or developments?
YES …………………………………………………………………………………………1
NO……………………………………………………………………………2 skip to WL8
REFUSED…………………………………………………………………….7 skip to WL8
DON’T KNOW……………………………………………………………….8 skip to WL8
WL7a: If [housing agency name] offers you a unit in a public housing development that you did not apply for, would you accept the offer and move in there?
YES……………………………………………………………………………1
NO…………………………………………………………………………….2
REFUSED……………………………………………………………………..7
DON’T KNOW………………………………………………………………..8
WL8: We would like to know why you applied for assistance at the time you did. Did you apply for assistance at that time because ….
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YES (=1) |
NO (=2) |
REF (=7) |
DK (=8) |
A |
You recently lost your job? |
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B |
You had difficulties paying for housing for awhile? |
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C |
Your family size increased? |
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D |
You reached or were getting near the time limit on (TANF/Local name)? |
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E |
Your rent had increased a great deal? |
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F |
You were asked to leave house by someone else in the house? |
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G |
You were evicted from your house by your landlord? |
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H |
You were homeless and living in a shelter or on the streets? |
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You had become widowed, divorced, or partner left? |
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J |
(voucher WL only)You wanted to move to a better neighborhood? |
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(voucher WL only) You wanted to move to a better quality house or apartment? |
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L |
Were there any other reasons you applied for housing assistance at that time? (If YES, specify ___________________ |
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WL9: Did any of the following people encourage you to apply for housing assistance?
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YES (=1) |
NO (=2) |
REF (=7) |
DK (=8) |
a |
A friend or relative? |
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b |
Case manager or other worker at the (TANF/local name) agency? |
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Case manager or other worker at the Social Security office? |
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d |
An emergency shelter or transitional housing provider or someone else who helps people who are homeless? |
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Someone at your church or house of worship? |
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WL10 : When do you expect to be offered (a housing choice voucher/public housing unit)?
Within the next six months 1
Six months to 1 year from now 2
One to two years from now 3
Two or three years from now 4
Four or more years from now 5
REFUSED 7
DON’T KNOW 8
WL11: We are interested in how your need for housing assistance changed while you have been on the waiting list. Which of the following statements best describes how your need for housing assistance changed between the time you applied and now?
I probably no longer need housing assistance 1
My situation is a lot better, but I still need assistance 2
My situation is a little better, but I still need assistance 3
My situation is about the same as when I applied 4
My situation is a little worse and I need assistance more now
than when I applied 5
My situation is a lot worse and I need assistance more now
than when I applied 6
REFUSED 7
DON’T KNOW 8
II. HOUSING QUALITY QUESTIONS (HQ)
Now, I’d like to ask you some questions about where you live now.
HQ1: Do you…
Rent your own room, apartment, or home, 1 skip to HQ1b
Own your own home, 2 skip to HQ1b
Live with friends and pay part of the rent or mortgage, 3 skip to HQ3
Live with friends and do not pay rent, 4 skip to HQ3
Live with family and pay part of the rent or mortgage 5
Live with family and do not pay rent, 6
Or live in a group shelter? 7 skip to Section 3
HOMELESS 8 skip to Section 3
INCARCERATED 9 skip to Section 3
DORM OR BARRACKS 10 skip to Section 3
HOSPITAL/NURSING HOME/SPECIAL SCHOOL 11 skip to Section 3
OTHER (Specify ______) 95 skip to HQ3
REFUSED 97 skip to HQ3
DON’T KNOW 98 skip to HQ 3
HQ1a (If live with family): What is your relationship to the family member that you are living with? Is the family member you are living with …
Your own or your partner’s parent 1
Your own or your partner’s brother or sister 2
Your own or your partner’s grandparent 3
Your own or your partner’s uncle or aunt 4
Your own or your partner’s cousin 5
REFUSED 97
DON’T KNOW 98
HQ1b (If rent own room, apartment, or home): Do you currently receive any government housing assistance, such as through public housing, Section 8, or a Housing Choice Voucher?
YES…………………………………………………………………………………1 (skip to HQ2)
NO…………………………………………………………………………………..2
REFUSED…………………………………………………………………………..7
DON’T KNOW……………………………………………………………………..8
HQ1c (If rent own room, apartment, or home): Are you paying lower rent because the federal, state, or local government is paying for part of your rent?
YES………………………………………………………………………………………….…1 (skip to HQ2)
NO……………………………………………………………………………..2
REFUSED……………………………………………………………………7
DON’T KNOW………………………………………………………………8
HQ1d: Have you ever lived in public housing or used a housing choice voucher?
YES…………………………………………………………………………..1
NO……………………………………………………………………………2 (skip to HQ2)
REFUSED……………………………………………………………………3 (skip to HQ2)
DON’T KNOW………………………………………………………………4 (skip to HQ2)
HQ1e: When was that? Was it …
Less than one year ago?………………………………………………1
Between one and two years ago?….…………………………………2
Between two and five years ago?…………………………………….3
More than five years ago?……………………………………………4
REFUSED……………………………………………………………7
DON’T KNOW……………………………………………………….8
HQ2: How many years have you lived at your current address?
NUMBER OF YEARS __________ 1-96 skip to HQ3
LESS THAN ONE YEAR 0
DON’T KNOW -1 skip to HQ3
REFUSED -2 skip to HQ3
HQ2A: RECORD THE NUMBER OF MONTHS.
NUMBER OF MONTHS __________ 01-11
LESS THAN ONE MONTH 00
DON’T KNOW -1
REFUSED -2
HQ3: Not including bathrooms and hallways, how many rooms are there in you house?
READ LIST.
NUMBER OF ROOMS ____________ ( 1 to 9)
TEN OR MORE 10
REFUSED 97
DON’T KNOW 98
HQ3a: How many of the rooms are bedrooms?
NUMBER OF ROOMS ____________ ( 1 to 9)
TEN OR MORE 10
REFUSED 97
DON’T KNOW 98
HQ4:
Overall, how would you describe the condition of your current
(apartment/house)?
Would you say it is in excellent, good,
fair, or poor condition?
EXCELLENT 1
GOOD 2
FAIR 3
POOR 4
REFUSED 97
DON’T KNOW 98
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HQ5: Does your current housing have any of the following problems? |
YES |
NO |
REF |
DK |
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a. Is there mildew, mold, or water damage on any wall, floor, or ceiling? |
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b. Are there any floor problems such as boards, tiles, carpeting or linoleum that are missing, curled, or loose? |
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c. Are there any holes or large cracks where outdoor air or rain can come in? |
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d. In your home, do you smell bad odors such as sewer, natural gas, etc.? |
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e. In the last three months has any bathroom floor been covered by water because of a plumbing problem? |
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f. In the last three months has your toilet not worked for 6 hours or more? |
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g. In the last three months has your electricity not worked for 2 hours or more? |
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h. In cold weather, do you ever need to use your oven to heat your home? |
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i. Do all outside doors and windows have locks that work? |
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HQ 6: Was there ever a time during the past year, that is, since [MONTH/YEAR 12 months ago] when you did not have your own place to stay?
YES 1
NO 2 (skip to Section III)
REFUSED 7 (skip to Section III)
DON’T KNOW 8 (skip to Section III)
HQ 6a: Were you without a place to stay for…. ?
Less than a week…………………………………………………………………..1
Between a week and one month……………………………………………….….2
Between one and two months………………….………………………………….3
More than two months……………….……………………………………………4
REFUSED 7
DON’T KNOW 8
HQ 6b: During the past year, when you did not have your own place to stay, we would like to know about any places where you stayed. Did you….
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YES |
NO |
REF |
DK |
A |
Stay with a relative |
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B |
Stay with a friend |
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C |
Stay in an emergency, domestic violence, or homeless shelter |
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D |
Stay on the street, in a car, or abandoned building |
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HQ 6c (If more than one answer to HQ6b): Which of those places did you stay for the longest period of time during the period when you did not have a place of your own?
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Longest stay |
Not longest stay |
REF |
DK |
a |
With a relative |
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b |
With a friend |
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c |
In an emergency, domestic violence, or homeless shelter |
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d |
On the street, in a car, or abandoned building |
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DEMOGRAPHIC AND HOUSEHOLD COMPOSITION QUESTIONS (DEM)
Now, I’d like to ask you a few questions about yourself and the people you live with.
DEM1: Are you Male or Female?
Male 1
Female 2
DEM2: Are you Hispanic or Latino?
Non-Hispanic/Non-Latino 0
Hispanic/Latino 1
REFUSED 7
DON’T KNOW 8
DEM3: What is your race? Please select one or more.
American Indian or Alaska Native 1
Asian 2
Black or African-American 3
Native Hawaiian or Other Pacific Islander 4
White 5
REFUSED 7
DON’T KNOW 8
DEM4: Which of the following best describes your current marital status?
Single, not living with a partner 1
Single, living with a partner 2
Married
Divorced or separated 4
Widowed 5
REFUSED 7
DON’T KNOW 8
DEM5: What is the highest degree or level of school you have completed?
Nursery School to 8th grade or no schooling 1
9th to 12th grade, but no diploma 2
High School Graduate or Equivalent (for example, GED) 3
Some College 4
Associates Degree 5
Bachelors Degree 6
Masters Degree, Doctorate Degree, or other Professional Degree
(for example, MD, DDS, DVM, LLB, JD) 7
REFUSED 97
DON’T KNOW 98
Now we would like to know something about the people who currently live with you.
DEM6: How many adults age 18 or older do you live with?
NUMBER OF PEOPLE __________ 0-19
TWENTY OR MORE 20
DON’T KNOW -1
REFUSED 2
DEM7: How many children age 17 or younger do you live with?
ZERO/NONE __________ 0 (Skip to DEM9)
NUMBER OF PEOPLE __________ 1-19
TWENTY OR MORE 20
DON’T KNOW -1
REFUSED -2
DEM8: (If DEM7>0) Are any of the children age 6 or younger?
YES 1
NO 2
REFUSED 3
DON’T KNOW 4
Now I’d like to ask about the people who will live with you when you receive your [HCV or public housing unit].
DEM9 (IF DEM 6 and DEM 7=0, Skip to DEM10): When you receive your [HCV or Public Housing unit] will all of the [DEM6] adults and [DEM7] children that you currently live with also live with you then?
YES 1
NO 2
REFUSED 3
DON’T KNOW 4
DEM10: When you receive your [HCV or public housing unit] will anybody new live with you? That is, will anybody who is not currently living with you live in your assisted unit with you?
YES 1
NO 2
REFUSED 3
DON’T KNOW 4
DEM11: (IF DEM9 = NO or DEM10=YES) How many adults age 18 or older will live with you in your assisted unit?
NUMBER OF PEOPLE __________ 0-19
TWENTY OR MORE 20
DON’T KNOW -1
REFUSED -2
DEM12: (IF DEM9=No or DEM10=YES) How many children age 17 or younger will live with you in your assisted unit?
NUMBER OF PEOPLE __________ 0-19
TWENTY OR MORE 20
DON’T KNOW -1
REFUSED -2
DEM15: In what year were you born?
__ __ __ __ (acceptable range: 1900 to 1990)
DON’T KNOW ………………………………………-1
REFUSED …………………………………-2
CURRENT WORK QUESTIONS (WORK)
Now, I would like to ask some questions about your household’s work experience.
WORK1: Last week, did you do any work for pay?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
WORK1a: (If No to WORK1) What is the main reason that you did not work for pay last week?
DO NOT READ LIST. ACCEPT ONE RESPONSE ONLY.
RETIRED 1
DISABLED 2
UNABLE TO WORK 3
HAS JOB BUT TEMPORARILY ABSENT 4
COULDN’T FIND ANY WORK 5
CHILD CARE PROBLEMS 6
FAMILY RESPONSIBILITIES 7
IN SCHOOL OR OTHER TRAINING 8
WAITING FOR A NEW JOB TO BEGIN 9
OTHER (SPECIFY): _______________________ 10
REFUSED 97
DON’T KNOW 98
WORK2 (If yes to Work1): Last week, did you have more than one job, including part-time and weekend work)
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
WORK2a (If yes to WORK2): How many hours a week do you usually work at your main job? By main job, we mean the one at which you usually work the most hours.
Hours each week__________________
WORK3 (If yes to WORK2): Is your main employer a….
Private company…………………………………………………………………….....1
Non-profit organization………………………………………………………………..2
Government agency……………………………………………………………………3
Relative…………………..…………………………………………………………….4
Neighbor………………….…………………………………………………………....5
Or are you self-employed…………………………………………………………..….6
Other (Specify)…………………………………………………………………………7
REFUSED……………………………………………………………………………97
DON’T KNOW………………………………………………………………………98
WORK4: (If yes to WORK1): What is the easiest way for you to describe your total earnings before taxes or other deductions at your main job: hourly weekly, annually, or on some other basis?
HOURLY …………………………………………….1
DAILY………………………………………………..2
WEEKLY……………………………………………..3
BIWEEKLY (EVERY TWO WEEKS)………………4
TWICE MONTHLY………………………………….5
ANNUALLY………………………………………….6
OTHER: (SPECIFY)…………………………………..7
REFUSED……………………………………………..97
DON’T KNOW……………………………………….98
ENTER DOLLAR AMOUNT $_______________
REFUSED
DON’T KNOW
WORK4b I have entered your [hourly/daily/weekly/biweekly/monthly/annual] wage as $ [amount from WORK4a. Is this correct?
YES
NO (Go back to WORK4a)
WORK5: During the past year, have you been out of work for any period of time?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
WORK5a (If yes to WORK 5): How many weeks or months were you out of work?
Number of weeks________
Number of months_______
WORK6: Is anyone else in your household working for pay?
YES 1
NO 2 (skip to Sect. V)
REFUSED………………………………………………………………….7 (skip to Sect. V)
DON’T KNOW 8 (skip to Sect. V)
WORK6a (If yes to WORK6): Are any of the other persons working age 18 or older?
YES 1
NO 2 (Skip to Sect V)
REFUSED……………………………………………………………7 (Skip to Sect V)
DON’T KNOW 8 (Skip to Sect V)
WORK7: (If yes to WORK 1 and WORK6a): Are any of the other adults working more hours per week than you?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
WORK8 (If yes to WORK6a): Will all of the other working adults live with you after you get your [housing voucher/public housing unit]?
YES 1 (skip to Sect V)
NO 2
REFUSED…………………………………………………………………..7 (skip to Sect V)
DON’T KNOW 8 (skip to Sect V)
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Mentioned(=1) |
Not Mentioned (=2) |
A |
PERSON’S INCOME WOULD MAKE ME INELIGIBLE FOR HOUSING ASSISTANCE |
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B |
PERSON’S INCOME WOULD MEAN I WOULD PAY MORE RENT
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C |
I PREFER TO LIVE ON MY OWN/BE INDEPENDENT |
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D |
LIVING WITH THAT PERSON IS A TEMPORARY ARRANGEMENT |
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E |
PERSON PLANS TO MOVE TO ANOTHER CITY/AREA |
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F |
SPLIT UP/DIVORCED/SEPARATED |
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G |
OTHER (SPECIFY): ____________________________________ |
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H |
REFUSED (to give any reason) |
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I |
DON’T KNOW (any reason) |
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WORK10: Would your decision about that person living with you after you get your [voucher/public housing unit] be different if his or her income would not make a difference in the amount of rent you will pay?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
Non-Work Sources of Income (INCOME)
INCOME1. In addition to working, people often have other sources of cash income. I am going to read you a list of sources of income and for each source, tell me whether your or any of the people you live with receive this type of income.
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Yes (=1) |
No (=2) |
REF (=7) |
DK (=8) |
A |
Public assistance or welfare from [name of TANF agency]? |
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B |
Child support or alimony? |
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C |
Payments to you for providing foster care? |
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D |
Unemployment compensation? |
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E |
Supplemental Security Income (SSI) or another disability payment? |
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F |
Social Security retirement benefits? |
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G |
Another type of government pension? |
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H |
A pension from private work ? |
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INCOME2: Please try to estimate the cash total income that you and the people you live with get each month from work and also from the sources of income we’ve just talked about. Include income from small jobs like babysitting and also include help from your family or friends that you get on a regular basis. You may want to take a minute think about this and add up the amounts.
I’m going to read out different income ranges. Please tell me within which range your household’s cash income falls. You may want to take minute to think about this and add things up.
Between 0 and $200 per month …………………………………….1
Between $201 and $500……………………………………………..2
Between $501 and $1000.,…………………………………………..3
Between $1001 and $1500………………………………………….4
Between $1501 and $2000…………………………………………..5
Between $2001 and $2500…………………………………………..6
More than $2500 per month…………………………………………7
REFUSED……………………………………………………………97
DON’T KNOW………………………………………………………98
(Interviewer check: If answer is between 0 and $500, go back over the types of income to be included and ask then ask if you recorded the correct information. Record that you went back and asked here and correct respondent’s answer as necessary
YES, RE-CHECKED INCOME BECAUSE ORIGINAL ANSWER WAS <=500 PER MONTH…1
NO, DIDN’T RECHECK INCOME BECAUSE IT WAS ABOVE $500 PER MONTH ………….2
INCOME3: Does your household participate in the Food Stamps program?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
INCOME4: Did you receive a check from the Internal Revenue Service in the last year because you qualified for the Earned Income Tax Credit?
YES 1 (skip to Income4b)
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
INCOME4a (If no to INCOME 4): Has anyone told you that you might be eligible for the Earned Income Tax Credit?
YES 1
NO 2 (skip to Income5)
REFUSED…………………………………………………………………..7 (skip to Income5)
DON’T KNOW 8 (skip to Income5)
INCOME4b (IF Yes to INCOME 4a or Income ): Who told you about the Earned Income Tax Credit?
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Yes |
NO |
REF |
DK |
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[Housing Agency Name] /Housing Authority,/PHA |
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[Name of the TANF agency] or another social welfare agency |
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An agency that helps people prepare for work or find jobs |
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A church or worship group |
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A relative |
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A neighbor or friend |
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OTHER |
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|
VI. RENT AND EXPENDITURE QUESTIONS (RENT)
Now I’m going to ask you some questions about your current rent and other expenses.
RENT1 (Only ask if pay some rent according to answer to HQ1): Altogether in the month just past, what did you pay as rent to the landlord? We are interested only in knowing the amount of the rent payment that you or the family you head paid, not any amount that may have been paid by other people or by a government agency:
PER MONTH: $__ __ __ __ .00 (FOUR DIGITS, ROUNDED TO DOLLAR)
DON’T KNOW -1
REFUSED -2
RENT1a: I have entered (amount from RENT1) as the amount you paid last month for your rent. Is this correct?
YES 1
NO (GO BACK TO RENT1) 2
PER MONTH: $__ __ __ __ .00 (FOUR DIGITS, ROUNDED TO DOLLAR)
DON’T KNOW -1
REFUSED -2
RENT2a: I have entered (amount from RENT2) as the amount you and the family you head paid last month for your mortgage. Is this correct?
YES 1
NO (GO BACK TO RENT2) 2
RENT3: Altogether in the month just past, what did you pay for utilities that were not already included as part of the rent or mortgage payment? By all utilities, I mean electricity, heat, gas, and water, and not including telephone and cable services. We are interested only in knowing the total amount of utility payment that you and the family you head paid.
UTILITIES LAST MONTH: $__ __ __ __ .00 (FOUR DIGITS, ROUNDED TO DOLLAR)
NO PAYMENT/INCLUDED IN RENT OR IN CONDO FEE -3
DON’T KNOW -1
REFUSED -2
RENT3a: I have entered (amount from RENT2) as the amount you and the family you head paid last month for your utilities. Is this correct?
YES 1
NO (GO BACK TO RENT2) 2
RENT4: What is the total amount of all utility payments that you and the family you head pay out of your pocket for a typical month—that is not a month with unusually high or low heat or air conditioning bills?
UTILITIES TYPICAL MONTH: $__ __ __ __ .00
(UP TFOUR DIGITS, ROUNDED TO DOLLAR)
RENT4a: I have entered (amount from RENT4) as the amount you and the family you head you pay in a typical month for utilities. Is this correct?
YES 1
NO (GO BACK TO RENT4) 2
My next questions are about other things you spend money on, besides housing, such as food, furniture and appliances, transportation, health care, and childcare.
RENT5: People buy food from different kinds of places such as supermarkets, grocery stores, warehouse clubs, convenience stores, restaurants, cafeterias, and vending machines. Thinking about all the different kinds of places where you and all the members of your household buy food, how much, altogether, does your households usually spend on food in an average week, including purchases made with Food Stamps?
Food purchases $__ __ __ __ (FOUR DIGITS, WHOLE NUMBERS ONLY)
RENT5a: I have entered [amount from RENT5] as the amount you and all the members of your household spend on food in an average week. Is this correct?
YES 1
NO (GO BACK TO RENT5) 2
Food purchases with Food Stamps $_____________ (FOUR DIGITS, WHOLE NUMBERS ONLY)
NO FOOD STAMPS
REFUSED
DON’T KNOW
RENT6: Do you get any of your food by going to a food pantry or another place that makes food or meals available for free?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
RENT7: In the past month did you purchase or rent any furniture or any household appliances (i.e., microwaves, washers/dryers, dishwashers, stoves, TV sets, etc.)?
YES, PURCHASED 1
YES, RENTED 2
DID NOT PURCHASE OR RENT……………………………………..3
Don’t Know 7
REFUSED 8
RENT7a (If answered yes, purchased): Altogether, how much did these items cost?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
Between $500 and $1000 4
More than $1000 5
Don’t Know 7
REFUSED 8
RENT7b (If answered, yes, rented): Altogether, what is the monthly rental price of these items:
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
Between $500 and $1000 4
More than $1000 5
Don’t Know 7
REFUSED 8
RENT8: In the past month, did you purchase any clothing (including shoes) for yourself or other members of your family?
YES 1
NO 2
Don’t Know 7
REFUSED 8
RENT8a: What was the total amount spent on clothing and shoes?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
Between $500 and $1000 4
More than $1000 5
Don’t Know 7
REFUSED 8
RENT9: Do you or does someone who lives with you own a car?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
RENT9a (If yes to RENT 9): How much per year do you spend for car insurance?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
Between $500 and $1000 4
More than $1000 5
Not insured………………………………………………………………6
Don’t Know 7
REFUSED 8
RENT9b (If yes to RENT 9): How much per month do you spend for gasoline?
$______________PER MONTH
REFUSED
DON’T KNOW
RENT9c (If yes to RENT 9): Over the past year, how much did you spend on car repairs?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
Between $500 and $1000 4
More than $1000 5
Don’t Know 7
REFUSED 8
RENT10: How much per month do you pay for all of the following that you may have at home or for your personal use or the use of the other people you live with: telephone, cell phone, cable TV, dish or satellite TV, computer or internet hookups?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
More than $500 5
Don’t Know 7
REFUSED 8
RENT11: How much per month do you spend on health insurance for yourself and your family?
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
More than $500 4
Don’t Know 7
REFUSED 8
RENT 12: How much do you spend per month on visits to doctors or dentists and buying medicines and medical items? Do not include amounts that are covered by insurance.
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
More than $500 4
Don’t Know 7
RENT 13: (If answer to DEM7 is 1 or more children) Do you have any out-of-pocket expenses for childcare—that is, payments to a childcare center or to a relative, neighbor, or someone else who takes care of your child or children on a regular basis?
YES 1
NO 2
REFUSED…………………………………………………………………..7
DON’T KNOW 8
RENT 13a (If yes to RENT13): How much do you pay per month to a child care center, a relative, a neighbor, or someone else for childcare:
Less than $50 1
Between $50 and $100 2
Between $100 and $500 3
More than $500 4
Don’t Know 7
RENT 14: Thinking about all of the expenditures I’ve asked you about other than rent and utilities, how much in total are your living expenses for a typical month? You may want to take a minute to add things up.
Between 0 and $200 per month …………………………………….1
Between $201 and $500……………………………………………..2
Between $501 and $1000.,…………………………………………..3
Between $1001 and $1500………………………………………….4
Between $1501 and $2000…………………………………………..5
Between $2001 and $2500…………………………………………..6
More than $2500 per month…………………………………………7
REFUSED……………………………………………………………97
DON’T KNOW………………………………………………………98
RENT 15: In a typical recent month recently, how would you describe your total cash household expenses: Have your expenses been more than, about the same as, or less than your total income from all sources?
EXPENSES
MORE THAN INCOME………………………….1
EXPENSES
ABOUT THE SAME AS INCOME………………2
EXPENSES
LESS THAN INCOME…………..……………….3
REFUSED……………………………………………………….7
DON’T KNOW………………………………………………….8
|
|
YES (=1) |
NO (=2) |
REF (=7) |
DK (=8) |
A |
TOOK LOAN FROM A FINANCIAL INSTITUTION
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B |
TOOK LOAN FROM A PAWN SHOP
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C |
TOOK LOAN FROM A RELATIVE OR FRIEND |
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D |
RELATIVE HELPED ME OUT WITH A GIFT
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E |
FRIEND HELPED ME OUT WITH A GIFT
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F |
CHURCH HELPED ME OUT WITH A GIFT
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G |
DIDN’T PAY ALL MY BILLS THAT MONTH
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H |
OTHER (specify):________________________
|
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|
|
TOOK LOAN FROM A FINANCIAL INSTITUTION
|
=1 |
TOOK LOAN FROM A PAWN SHOP
|
=2 |
TOOK LOAN FROM A RELATIVE OR FRIEND |
=3 |
RELATIVE HELPED ME OUT WITH A GIFT
|
=4 |
FRIEND HELPED ME OUT WITH A GIFT
|
=5 |
CHURCH HELPED ME OUT WITH A GIFT
|
=6 |
DIDN’T PAY ALL MY BILLS THAT MONTH |
=7 |
OTHER |
=8 |
REFUSED |
=97 |
DON’T KNOW |
=98 |
VII. HARDSHIP QUESTIONS (HARD)
Now I am going to ask you some questions about problems that people sometimes have making ends meet.
HARD 1: In the past 30 days, did (you/you or other adults in your family) ever cut the size of your meals or skip meals because there wasn’t enough money for food?
YES 1
NO 2
REFUSED 3
DON’T KNOW 4
HARD 2 (Only for those answering pay some rent to HQ1): During the past 12 months, were you ever more than 15 days late paying your rent?
YES 1
NO 2
NOT APPLICABLE 3
REFUSED 7
DON'T KNOW 8
HARD 3: During the last 12 months, have you been evicted from a home for any reason?
YES 1
NO 2
REFUSED 3
DON'T KNOW 4
HARD 3a (If yes to Hard 3) Why were you evicted?
NON-PAYMENT OF RENT 1
LANDLORD WANTED UNIT FOR SELF OR RELATIVE 2
HOUSEKEEPING 3
DAMAGE TO UNIT 4
BEHAVIOR OF CHILDREN 5
NUISANCE (LOUD MUSIC, PARTIES, ETC.) 6
OTHER (SPECIFY_____________) 95
REFUSED 97
DON’T KNOW 98
HARD 4: During the past 12 months, did you postpone getting medical care or surgery when you needed it because you couldn’t afford to pay for it?
YES…………………………………………………………………………………..1
NO……………………………………………………………………………………2
DID NOT NEED MEDICAL CARE…………………………………………………3
REFUSED…………………………………………………………………………….7
DON’T KNOW ………………………………………………………………………8
VIII. SHOPPING FOR HOUSING QUESTIONS (SHOP)
Now, I would like to ask you about the process of finding and renting housing.
NUMBER OF UNITS____________
REFUSED………………………………………………………………………………..7
DON’T KNOW…………………………………………………………………………..8
SHOP2: (Only ask those answering “rent your own room, apartment, or home” to HQ1 and 2 years or less to HQ2): When you looked for housing units, did you have a specific rent range in mind?
YES……………………………………………………………………………………….1
NO………………………………………………………………………………………..2
REFUSED………………………………………………………………………………..7
DON’T KNOW…………………………………………………………………………..8
SHOP2a (If yes to SHOP 2): What was that rent range in dollars per month?
$_______to $_________ per month
SHOP3 (If on waiting list for voucher): Do you want to remain in your current unit when you receive your voucher, or do you want to move to a different unit?
YES 1
NO 2
REFUSED 3
DON'T KNOW 4
SHOP4 (If on waiting list for voucher): Which of the following is the most important benefit you hope to get out of using a housing voucher?
a better neighborhood 1
a better quality unit 2
a bigger unit…………………………………………………………………3
a single-family house/house with a yard, or…………………………………4
a lower out-of-pocket payment for rent. 5
REFUSED 7
DON'T KNOW 8
SHOP5 (If on waiting list for voucher): How much do you expect your out-of-pocket expense for rent and utilities will be when you use a voucher—I mean the amount you pay the landlord, not the amount the [housing agency name] pays?
RECORD AMOUNT $______________
SHOP6 (If on waiting list for public housing): How much do you expect your out-of pocket expense for rent and utilities will be when you get your public housing unit?
RECORD AMOUNT $______________
SHOP 7 (All respondents): You told me you currently pay for (rent/your mortgage) is (from RENT1 or RENT 2) and for utilities is (from RENT 4). That totals (RENT1+RENT4 or RENT2+RENT4). What is the maximum amount you are willing to pay for rent and utilities once you get your (housing voucher/public housing unit) if you like the housing unit and the neighborhood?
RECORD AMOUNT $______________
IX. PREFERENCE QUESTIONS (PREF)
We are interested in your expectations and your opinions about the voucher and public housing programs. We want to remind you that your answers will be kept private, to the extent permitted by law, and will not affect your housing assistance, but the information is very important to HUD.
PREF1: How many years do you expect to receive housing assistance? Do you expect to receive housing assistance for…
One year? 1
Two or three years? 2
Four or five years?.or 3
Five years or more? 4
LESS THAN ONE YEAR…………………………………………………..5
REFUSED 7
DON’T KNOW 8
PREF2: For the next few questions, I am going to ask you about different systems that can be used to determine the level of (rent public housing families pay/share of the rent you are expected to pay when you use a voucher).
Under the current rules, the (rent public housing families pay/share of rent voucher families pay) each month is about 30 percent of their monthly income. If you have more income, you pay more rent. If you have less income, you pay less rent. Say your monthly income is $500. You pay $150 rent. Say your monthly income is $1000. You pay $300 rent. That is, for every dollar of monthly income, you pay 30 cents in rent.
Do you have any questions about how the current system works? (INTERVIEWER: ANSWER QUESTIONS, AS NEEDED).
I’m going to ask you about that system and also about other systems. I will read two choices for each question. There are no right or wrong answers. Please tell me which of the two choices you would prefer for yourself.
|
Option A |
Option B |
Preference |
PREF2a |
The current assisted housing income-base rent—30 cents for each dollar of net income—and the same amount of time you spend waiting now for housing assistance |
An extra $100 in monthly rent, but one year less time waiting for housing assistance |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF2b |
The current assisted housing income-based rent—30 cents for each dollar of income—and the same amount of time you spend waiting for housing assistance |
An extra $100 in monthly rent, but two years less time waiting for housing assistance |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF2c |
A rent of $150 adjusted only for inflation that does not change when your income goes up or down. The [housing agency name] would not check on your income every year. |
Rent that is 30 cents for each dollar of net income and changes when your net income goes up or down. The [housing agency name] would check on your income every year. |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF2d |
A rent of $250 adjusted only for inflation that does not change when your income goes up or down. The [housing agency name] would not check on your income every year. |
Rent that is 30 cents for each dollar of net income and changes when your net income goes up or down. The [housing agency name] would check on your income every year. |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF2e |
A rent of $350 adjusted only for inflation that does not change when your income goes up or down. The [housing agency name] would not check on your income every year. |
Rent that is 30 cents for each dollar of income and changes when your net income goes up or down. The [housing agency name] would check on your income every year. |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF2f |
Rent that starts at $200 and increases by $50 each year. For example, it would be $250 in the second year and $300 in the third year. |
Rent that is 30 cents for each dollar of net income and changes when your net income goes up or down. You would only be allowed to (stay in your public housing unit/use your voucher) for 6 years. |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF3: I’m going to ask you a few more questions about your opinion on a rent. These questions are more general and don’t have any specific dollar amounts. Would you prefer…
|
Option A |
Option B |
Preference |
PREF3a |
Lower rent, but a longer time waiting for assistance |
Higher rent, but a shorter time waiting for assistance |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF3b |
Rent that does not change when your income goes up or down |
Rent that goes up when your income goes up and down when your income goes down |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
PREF3c |
Rent that increases each year you receive assistance |
Rent that stays the same, but has a time limit on the number of years you can receive assistance |
OPTION A=1 OPTION B=2 REF=7 DK=8 |
For the next few questions, I would like you to think about how the rules should work for people in general who (live in public housing/use a housing voucher), not about your own situation.
PREF4: In the system used by most housing agencies, an increase of $100 in net income is usually treated the same whether the increase is from increased earnings or another income source. In both cases, the rent would usually go up by $30. I’m interested in knowing what you think about this. I am going to read some statements. Tell me which statement you most agree with. There are no right or wrong answers. (INTERVIEWER: READ ALL THREE STATEMENTS. ACCEPT ONLY ONE ANSWER.)
Income for all sources should be treated the same. ………………………………………...1
An increase in income from earnings should raise rent less than
an increase in income from welfare………………………………........................................2
An
increase in income from welfare should raise rent less than
an
increase in income from earnings…………………………………………………….….3
REFUSED……………………………………………………………………………..…….7
DON’T KNOW………………………………………………………………………..…….8
PREF5 (If answer to PREF4 is 2): Why should rent go up less when a household has additional income from earnings than when a household has additional income from sources other than work? [PROBE; ANY OTHER REASONS. MARK ALL THAT APPLY.]
EARNINGS ARE TAXED 1
TRANSPORTATION COSTS WHEN WORKING 2
CHILDCARE COSTS WHEN WORKING 3
CLOTHING COSTS WHEN WORKING 4
OTHER COSTS WHEN WORKING 5
EARNINGS ARE HARDER TO HIDE THAN OTHER SOURCES
OF INCOME 6
WORKING IS THE WAY TO GET AHEAD/SELF SUFFICIENT 7
OTHER (specify)_________________________________________
REFUSED 97
DON’T KNOW 98
PREF6: This is another question for which I’d like you to tell me how you think the rules should work for people in general, not for your own situation. Many households in assisted housing currently pay $50 or less per month for rent and utilities in assisted housing. Some people pay nothing. I am going to read some statements. Tell me if which statement you most agree with. (INTERVIEWER: READ ALL FOUR STATEMENTS. ACCEPT ONLY ONE ANSWER).
It’s OK for some people to pay nothing for rent. |
=1 |
Everyone should pay at least $50 per month regardless of their income level, so that more people can be helped. |
=2 |
Everyone should pay at least $75 per month regardless of their income level, so that more people can be helped. |
=2 |
Everyone should pay at least $150 per month regardless of their income level, so that more people can be helped. |
=4 |
REFUSED |
=7 |
DON’T KNOW |
=8 |
PREF 7 (If answer to PREF6 is pay >$0 min rent): If the rule was that everyone had to pay at least a minimum amount, should there be exceptions for:
|
|
Yes (=1) |
No (=2) |
REF (=7) |
DK (=8) |
A |
People age 62 and above? |
|
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B |
People with disabilities? |
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C |
Anyone who has a hard time paying the minimum rent and asks for a delay in paying it? |
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|
PREF 8 (If answer to PREF7C is yes): How many months should people who claim hardship and pay no rent be permitted to delay paying a minimum rent?
1-2 months …………………………………………………………………………….1
3-6 months………………………………………………………………………………2
7-12 months……………………………………………………………………………..3
More than 12 months……………………………………………………………………4
REFUSED……………………………………………………………………………….7
DON’T KNOW………………………………………………………………………….8
X. CONTACT INFORMATION SHEET
Part of this study involves returning to conduct another survey in the future. That survey will ask similar questions. Like this survey, the next one is completely voluntary. Therefore, before we begin, I would like to get some contact information to help us contact you in about 12 months. This information will not be shared with anyone outside of our research staff.
a. What is your first name?_______________________________________
b. What is your last name? _______________________________________
c. What is your street address? _______________________________________
d. City __________________________
e. State _________________________
f. Zip code ______________________
g. What is your telephone number? ( ) ______________
h. Is this number listed under your name?
Yes 1
No (SPECIFY NAME) 2
Do you have a cell or beeper number? ( ) ______________
Yes 1
No (SPECIFY NAME) 2
What is your Social Security Number? ___ ___ ___ / ___ ___ / ___ ___ ___ ___
Can you provide us with the name of a relative who does not live with you, whom we could contact in order to get in touch with you if your address and phone number change?
a. Relative’s first name
b. Relative’s last name
c. Relative’s street address______________________________________________
ADDRESS
d. City
e. State
f. Zip code
g. Relative’s telephone number ( ) ______________
h. Relative’s cell or beeper number ( ) ______________
Can you provide us with the name of a friend who does not live with you, whom we could contact in order to get in touch with you if your address and phone number change?
Friend’s first name
Friend’s last name
Friend’s street address_____________________________________________
ADDRESS
City
State
Zip code
Friend’s telephone number ( ) ______________
Friend’s cell or beeper number ( ) ______________
Thank you very much for your help in answering all these questions. Your participation is important to this study.
INTERVIEW WAS CONDUCTED IN...
ENGLISH 1
SPANISH 2
BOTH 3
| File Type | application/msword |
| File Title | Draft Wait List/New Admissions Household Survey |
| Author | BuronL |
| Last Modified By | Preferred User |
| File Modified | 2008-07-23 |
| File Created | 2008-07-23 |