Phase 2 Intake Survey

1. Which of the following technologies/devices do you have access to on a regular basis?

(Please select all that apply.)

• Desktop computer

• Wireless laptop, notebook, or netbook computer

• Standard feature phone (i.e., cell phone that is not a smart phone)

• Android or iPhone smart phone

• Other smart phone (e.g., Windows phone, Blackberry)

• Tablet device (e.g. iPad, Kindle Fire)

• None of the above

2. How often do you access the internet? (Please select only one.)

• Several times a day

• Daily

• 2 or 3 times a week

• Weekly

• 2 or 3 times a month

• Monthly

• Less than monthly

• Never (Please skip to question 6 )

3. Which device(s) do you use to access the Internet? (Please select all that apply.)

• Desktop computer

• Wireless laptop, notebook, or netbook computer

• Android or iPhone smart phone

• Other smart phone (e.g., Windows phone, Blackberry)

• Tablet device (e.g. iPad, Kindle Fire)

• Other, please specify:_____________________

• None, I do not have access to the Internet

4. What kind of services do you use to access the Internet? (Please select all that apply.)

• Wi-Fi at places I visit

• Internet service where I work

• Subscription to Internet service at my home

• Subscription to a mobile phone data plan

• Prepaid service on my phone

5. Where do you use the internet? (Please select all that apply.)

• At home

• At work

• At a public place such as a coffee shop or library

• While on-the-go (in transit, while walking, etc.)

• Other, please specify: _________________

6. We are interested in your views on how technology influences your life. Please tell us how much you agree with the following statements. (Please circle one number in each row.)

	Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree
A. Technology gives me more freedom of mobility	1	2	3	4	5
B. Sometimes, I think that technology systems are not designed for use by ordinary people	1	2	3	4	5
C. Technology makes me more productive in my personal life	1	2	3	4	5
D. Other people come to me for advice on new technologies	1	2	3	4	5
E. People are too dependent on technology to do things for them	1	2	3	4	5
F. I keep up with the latest technological developments in my areas of interest	1	2	3	4	5

7. Which of the following financial products/services do you personally have or use? (Please select all that apply.)

• Checking account(s)

• Savings account(s)

• CDs

• Credit card(s)

• Debit card(s) linked to a bank account

• Pre-paid card(s) not linked to a bank account, and not phone or gift cards

• Loans, such as student loans, auto loans, etc.

• Electronic accounts, such as PayPal, Google Wallet, Venmo, Square, etc.

• Financial tracking/guidance app, such as Mint.com, YNAB, etc.

• Stocks, bonds, and/or mutual funds for long-term savings

• None of the above

8. Some people find it useful to take out a payday loan to manage their money. In your case, have you taken out a payday loan or payday advance at a place other than a bank in the last 12 months?

• Yes

• No

9. Some people meet financial needs using a pawnbroker, also called a “pawn shop.” In the last 12 months, have you left an item at a pawn shop as collateral because a cash loan was needed, and not just to sell an unwanted item?

• Yes

• No

10. Some stores allow people to rent to own items such as furniture or appliances. I do not mean stores that offer installment plans or layaway plans. In the last 12 months, did you rent anything from a rent-to-own store because it couldn’t be financed any other way?

• Yes

• No

11. Auto title loans use a car title to borrow money for a short period of time. They are NOT loans used to purchase a car. In the last 12 months, did you take out an auto title loan?

• Yes

• No

12. In the last 12 months, have you taken out a tax refund anticipation loan, or used a tax preparation service to receive your tax refund faster than the IRS would provide it?

• Yes

• No

13. In the 12 months were you charged any of these bank fees? If so, how many times:

Bank Fees	None	2-3 times	4-6 times	7+ times	Don’t Know
Low Balance fees
Overdraft or Non sufficient fund fee
Account Maintenance Fees

14. Think about the ways your household has paid bills in the past 12 months. Which of the following are the most important to you when selecting a way to pay for your expenses? (Please select only three.)

• Makes record-keeping simple

• Receive reminders to pay my expenses

• Earn rewards or discounts

• Control when payments are made

• Secure/Reduce risk of fraud

• Low or zero cost of paying bills

• Payments are delivered to payee quickly

• Fast to use/saves me time

• Flexible options for paying expenses

• Easy to read statements of expenses paid

• Easy to tell how much I have available to pay

• Has a branch or office I can visit with questions/problems

• Has a telephone number I can call with questions/problems

• Reasonable fees if I overdraw

• Account doesn’t allow me to overdraft

• Flexible if I overdraw

• Other, please specify:_______________________