Attachment A: Phase 3 COVID-19 Household Pulse Survey, Revised to Reflect Inclusion of Intent to Vaccinate Questions and Other Items Marked for Deletion
Phase 3 COVID-19 Household Pulse Survey
Intro
Welcome! Thank
you for participating in the Household Pulse Survey During
COVID-19 sponsored by the U.S. Census Bureau and other
federal agencies.
This survey will help
measure the impact of coronavirus (COVID-19) on topics like:
employment status
food security
housing security
education disruptions
physical and mental wellbeing.
In this survey we
refer to the coronavirus (COVID-19) as coronavirus.
This survey is also available in Spanish. If you would like to
change your language selection, please use the drop down menu in the
upper right corner of each page to select the language in which you
prefer to complete the survey.
Intro2
This
survey is not the 2020 Census.
This survey is a
cooperative effort across many government agencies to provide
critical, up-to-date information about the impact of the coronavirus
(COVID-19) pandemic on the U.S. population. Completing this
20-minute survey will help federal, state, and local agencies
identify coronavirus (COVID-19) related issues in your community.
PRA
The
U.S. Census Bureau is required by law to protect your information.
The Census Bureau is not permitted to publicly release your responses
in a way that could identify you. We are conducting this voluntary
survey under the authority of Title 13, United States Code,
Sections 8(b), 182 and 196 to study the economic impacts of the
COVID-19 pandemic in the United States. Federal law protects your
privacy and keeps your answers confidential (Title 13, United States
Code, Section 9). Per the Federal Cybersecurity Enhancement Act of
2015, your data are protected from cybersecurity risks through
screening of the systems that transmit your data.
We estimate that completing this survey will take 20 minutes on average. Send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to adrm.pra@census.gov. This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-1013, confirms this approval and expires on 10/31/2023. We are required to display this number to conduct this survey.
Your privacy is protected by the Privacy Act (Title 5, U.S. Code, Section 552a). Routine uses of these data are limited to those identified in the Privacy Act System of Record Notice titled, “SORN COMMERCE/Census-3, Demographic Survey Collection (Census Bureau Sampling Frame).” The Census Bureau can use your responses only to produce statistics, and is not permitted to publicly release your responses in a way that could identify you.
To learn more about this survey go to: https://www.census.gov/householdpulsedata.
** U.S. Census Bureau Notice and Consent Warning **
You are accessing a United States Government computer network. Any information you enter into this system is confidential. It may be used by the Census Bureau for statistical purposes and to improve the website. If you want to know more about the use of this system, and how your privacy is protected, visit our online privacy webpage at http://www.census.gov/about/policies/privacy/privacy-policy.html.
Use of this system indicates your consent to collection, monitoring, recording, and use of the information that you provide for any lawful government purpose. 1 So that our website remains safe and available for its intended use, network traffic is monitored to identify unauthorized attempts to access, upload, change information, or otherwise cause damage to the web service. Use of the government computer network for unauthorized purposes is a violation of Federal law and can be punished with fines or imprisonment (PUBLIC LAW 99-474).
language This
survey is available in English and Spanish. Please select the
language in which you prefer to complete the survey.
If
you would like to change your language selection later, please use
the drop down menu in the upper right corner of each page to select
the language in which you prefer to complete the survey.
English
Español
display_Q42 These questions are for statistical purposes only.
|
Q1 What year were you born? Please enter a number.
________________________________________________________________
Q2 Are you… Select only one answer.
Male
Female
Q3 Are you of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin ________________________________________________
Q4 What is your race? Please select all that apply.
White
Black or African American
American Indian or Alaska Native (specify) ________________________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (specify) ________________________________________________
Native Hawaiian
Chamorro
Samoan
Other Pacific Islander (specify) ________________________________________________
Q5 What is the highest degree or level of school you have completed? Select only one answer.
Less than high school
Some high school
High school graduate or equivalent (for example GED)
Some college, but degree not received or is in progress
Associate’s degree (for example AA, AS)
Bachelor's degree (for example BA, BS, AB)
Graduate degree (for example master's, professional, doctorate)
Q6 What is your marital status? Select only one answer.
Now married
Widowed
Divorced
Separated
Never married
Q7 How many total people – adults and children – currently live in your household, including yourself? Please enter a number.
________________________________________________________________
|
Q8 How many people under 18 years-old currently live in your household? Please enter a number.
________________________________________________________________
QV1. (RECVDVACC) Have you received a COVID-19 vaccine?
Yes
No – skip to GETVACC
QV2. (DOSES) Did you receive (or do you plan to receive) all required doses?
Yes – skip to HADCOVID
No – go to WHYNOT
QV3. (GETVACC) Once a vaccine to prevent COVID-19 is available to you, would you…
Definitely get a vaccine – skip to PROBE1
Probably get a vaccine - ask WHYNOT
Probably NOT get a vaccine – ask WHYNOT
Definitely NOT get a vaccine – ask WHYNOT
QV4. (WHYNOT) Which of the following, if any, are reasons that you [only probably will /probably won’t/definitely won’t] [get a COVID-19 vaccine/won’t receive all required doses of a COVID-19 vaccine]? (Select all that apply)
Scripter: randomize
I am concerned about possible side effects of a COVID-19 vaccine
I don’t know if a COVID-19 vaccine will work
I don’t believe I need a COVID-19 vaccine – go to WHYNOT2
I don’t like vaccines
My doctor has not recommended it
I plan to wait and see if it is safe and may get it later
I think other people need it more than I do right now
I am concerned about the cost of a COVID-19 vaccine
I don’t trust COVID-19 vaccines
I don’t trust the government
Other (please specify: _____) [ANCHOR]
QV5. (WHYNOT2) (If don’t believe I need a COVID-19 vaccine) Why do you believe that you don’t need a COVID-19 vaccine? (Select all that apply)
Scripter: randomize
I already had COVID-19
I am not a member of a high-risk group
I plan to use masks or other precautions instead
I don’t believe COVID-19 is a serious illness
I don’t think vaccines are beneficial
Other (please specify: _____) [ANCHOR]
QV6. HADCOVID Has a doctor or other health care provider ever told you that you have COVID-19?
Yes
No
Not Sure
Q9 Have you, or has anyone in your household experienced a loss of employment income since March 13, 2020? Select only one answer.
Yes
No
Q10 Do you expect that you or anyone in your household will experience a loss of employment income in the next 4 weeks because of the coronavirus pandemic? Select only one answer.
Yes
No
Q11 Now we are
going to ask about your employment.
In the
last 7 days, did you do ANY work for either pay or
profit? Select only one answer.
Yes
No
Q12 Are you employed by government, by a private company, a nonprofit organization or were you self-employed or working in a family business? Select only one answer.
Government
Private company
Non-profit organization including tax exempt and charitable organizations
Self-employed
Working in a family business
Q13 What is
your main reason for not working for pay or profit? Select only
one answer.
I did not work because:
I did not want to be employed at this time
I am/was sick with coronavirus symptoms
I am/was caring for someone with coronavirus symptoms
I am/was caring for children not in school or daycare
I am/was caring for an elderly person
I was concerned about getting or spreading the coronavirus
I am/was sick (not coronavirus related) or disabled
I am retired
My employer experienced a reduction in business (including furlough) due to coronavirus pandemic
I am/was laid off due to coronavirus pandemic
My employer closed temporarily due to the coronavirus pandemic
My employer went out of business due to the coronavirus pandemic
Other reason, please specify ________________________________________________
Q13a Working from home is sometimes referred to as telework. Did any adults in this household substitute some or all of their typical in-person work for telework because of the coronavirus pandemic, including yourself? Select only one answer.
Yes, at least one adult substituted some or all of their typical in-person work for telework
No, no adults substituted their typical in-person work for telework
No, there has been no change in telework
Q14a Since March 13, 2020, have you applied for Unemployment Insurance (UI) benefits? Select only one answer.
Yes
No
Q14b Since March 13, 2020, did you receive Unemployment Insurance (UI) benefits? Select only one answer.
Yes
No
Q14d Do you currently receive Social Security benefits (Retirement, Disability, or Survivors), Supplemental Security Income (SSI) benefits, or Medicare benefits? Select only one answer.
Yes
No
Q14e Did you apply or attempt to apply for Social Security benefits (Retirement, Disability, or Survivors), Supplemental Security Income (SSI) benefits, or Medicare benefits after March 13, 2020? Select only one answer.
Yes, applied or attempted to apply
No
Q14f What type of benefits did you apply or attempt to apply for after March 13, 2020? Select all that apply.
Social Security Retirement
Social Security Disability
Social Security Survivors
Supplemental Security Income (SSI)
Medicare
Q14g How likely are you to apply for Social Security benefits (Retirement, Disability, or Survivors), Supplemental Security Income (SSI) benefits, or Medicare benefits in the next 12 months? Select only one answer.
Extremely likely
Very likely
Somewhat likely
Not at all likely
Q14h What type of benefits do you think that you will apply for? Select all that apply.
Social Security Retirement
Social Security Disability
Social Security Survivors
Supplemental Security Income (SSI)
Medicare
Q14i How has the coronavirus pandemic affected your decision about applying or not applying for Social Security benefits (Retirement, Disability, or Survivors), Supplemental Security Income (SSI) benefits, or Medicare benefits? Select only one answer.
The coronavirus pandemic has not affected my decision about applying for benefits
I have decided not to apply
I applied or decided to apply earlier than expected
I applied or decided to apply later than expected
Q15 In the last 7 days, if you or anyone in your household received a “stimulus payment,” that is a coronavirus related Economic Impact Payment from the Federal Government, did you: Select only one answer.
Mostly spend it
Mostly save it
Mostly use it to pay off debt
Not applicable, I did not receive the stimulus payment
Q19 What did you and your household mostly spend the most recent “stimulus payment” on? Select all that apply.
Food (groceries, eating out, take out)
Clothing (clothing, accessories, shoes)
Household supplies and personal care products
Household items (TV, electronics, furniture, appliances)
Recreational goods (sports and fitness equipment, bicycles, toys, games)
Rent
Mortgage (scheduled or monthly)
Utilities and telecommunications (natural gas, electricity, cable, internet, cellphone)
Vehicle payments (scheduled or monthly)
Paying down credit card, student loans, or other debts
Charitable donations or giving to family members
Savings or investments
Other, specify ________________________________________________
Q19a In the last 7 days, how difficult has it been for your household to pay for usual household expenses, including but not limited to food, rent or mortgage, car payments, medical expenses, student loans, and so on? Select only one answer.
Not at all difficult
A little difficult
Somewhat difficult
Very difficult
Q19b In the last 7 days, which of the following changes have you or your household made to your spending or shopping? Select all that apply.
More purchases online (as opposed to in store)
More purchases by curbside pick-up (as opposed to in store)
More purchases in-store (as opposed to purchases online or curbside pickup)
Increased use of credit cards or smartphone apps for purchases, instead of using cash
Increased use of cash instead of using credit cards or smartphone apps for purchases
Avoided eating at restaurants
Resumed eating at restaurants
Canceled or postponed in-person medical or dental appointments
Attended in-person medical or dental appointments
Canceled or postponed housekeeping or caregiving services
Resumed or started new housekeeping or caregiving services
Did not make any changes to spending or shopping behavior
Q19c In the last 7 days, for which of the following reasons have you or your household changed spending? Select all that apply.
Usual shopping places were closed or had limited hours (e.g., restaurant, doctor/dentist office, health club, hair salon, child care center, etc.)
Usual shopping places re-opened or increased hours
Concerned about going to public or crowded places or having contact with high-risk people
No longer concerned about going to public or crowded places or having contact with high-risk people
Loss of income
Increased income
Concerns about being laid off or having hours reduced
No longer concerned about being laid off or having hours reduced
Working from home/teleworking
Resumed working onsite at workplace
Concerns about the economy
No longer concerned about the economy
Other, specify: ________________________________________________
Q20 Thinking about your experience in the last 7 days, which of the following did you or your household members use to meet your spending needs? Select all that apply.
Regular income sources like those received before the pandemic
Credit cards or loans
Money from savings or selling assets
Borrowing from friends or family
Unemployment insurance (UI) benefit payments
Stimulus (economic impact) payment
Money saved from deferred or forgiven payments [to meet your spending needs]
Supplemental Nutrition Assistance Program (SNAP)
Q21a
In
the last 7 days, have you taken fewer trips to stores than you
normally would have because of the coronavirus pandemic? Curbside
pick-up should be counted as trips to stores. Select only one
answer.
Yes
No
Q21b In the last 7 days, have you taken fewer trips than you normally would have by bus, rail, or ride-sharing services, like Uber and Lyft, because of the coronavirus pandemic? Select only one answer.
Yes
No
Did not use before
Q21c Before the coronavirus pandemic, did you plan to take any overnight trips or trips to places more than 100 miles away in 2020? Include trips you had not made travel reservations or arrangements for in your answer. Select only one answer.
Yes
No
Q24 In the last 7 days, which of these statements best describes the food eaten in your household? Select only one answer.
Enough of the kinds of food (I/we) wanted to eat
Enough, but not always the kinds of food (I/we) wanted to eat
Sometimes not enough to eat
Often not enough to eat
Q24a
Please
indicate whether the next statement was often true, sometimes true,
or never true in the last 7 days for the children living in
your household who are under 18 years old.
"The
children were not eating enough because we just couldn't afford
enough food."
Often true
Sometimes true
Never true
Q25 Why did you not have enough to eat (or not what you wanted to eat)? Select all that apply.
Couldn’t afford to buy more food
Couldn’t get out to buy food (for example, didn’t have transportation, or had mobility or health problems that prevented you from getting out)
Afraid to go or didn’t want to go out to buy food
Couldn’t get groceries or meals delivered to me
The stores didn’t have the food I wanted
Q26 During the last 7 days, did you or anyone in your household get free groceries or a free meal? Select only one answer.
Yes
No
Q27 Where did you get free groceries or free meals? Select all that apply.
Free meals through the school or other programs aimed at children
Food pantry or food bank
Home-delivered meal service like Meals on Wheels
Church, synagogue, temple, mosque or other religious organization
Shelter or soup kitchen
Other community program
Family, friends, or neighbors
Q27a Do you or does anyone in your household receive benefits from the Supplemental Nutrition Assistance Program (SNAP) or the Food Stamp Program? Select only one answer.
Yes
No
display_Q28 The next questions are about how much money you and your household spend on food at supermarkets, grocery stores, other types of stores, and food service establishments, like restaurants and drive-thrus. When you answer these questions, please do not include money spent on alcoholic beverages.
Q28 During the last 7 days, how much money did you and your household spend on food at supermarkets, grocery stores, online, and other places you buy food to prepare and eat at home? Please include purchases made with SNAP or food stamps. Enter amount.
________________________________________________________________
Q28_check You said that you spent $${Q28/ChoiceTextEntryValue}.00 on food at supermarkets, grocery stores, online, and other places during the last 7 days. This amount seems unusually high. Are you sure it is the correct amount?
Yes
No, I need to correct the amount
Q28_correction
Please provide the correct amount (or your best estimate).
During
the last 7 days, how much money did you and your household
spend on food at supermarkets, grocery stores, online, and other
places you buy food to prepare and eat at home? Please include
purchases made with SNAP or food stamps. Enter amount.
________________________________________________________________
Q29 During the last 7 days, how much money did you and your household spend on prepared meals, including eating out, fast food, and carry out or delivered meals? Please include money spent in cafeterias at work or at school or on vending machines. Please do not include money you have already told us about in the previous question (above). Enter amount.
________________________________________________________________
Q29_check You said that you spent $${Q29/ChoiceTextEntryValue}.00 on prepared meals during the last 7 days. This amount seems unusually high. Are you sure it is the correct amount?
Yes
No, I need to correct the amount
Q29_correction
Please provide the correct amount (or your best estimate).
During
the last 7 days, how much money did you and your household spend
on prepared meals, including eating out, fast food, and carry out or
delivered meals? Please include money spent in cafeterias at work or
at school or on vending machines. Please do not include money you
have already told us about in item Q28(above). Enter amount.
________________________________________________________________
Q32 Over the last 7 days, how often have you been bothered by the following problems ... Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Not at all
Several days
More than half the days
Nearly every day
Q33 Over the last 7 days, how often have you been bothered by the following problems ... Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Not at all
Several days
More than half the days
Nearly every day
Q34 Over the last 7 days, how often have you been bothered by ... Having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Not at all
Several days
More than half the days
Nearly every day
Q35 Over the last 7 days, how often have you been bothered by ... Feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Not at all
Several days
More than half the days
Nearly every day
Q36 Are you currently covered by any of the following types of health insurance or health coverage plans? Mark Yes or No for each.
|
Yes |
No |
Insurance through a current or former employer or union (through yourself or another family member) |
|
|
Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) |
|
|
Medicare, for people 65 and older, or people with certain disabilities |
|
|
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability |
|
|
TRICARE or other military health care |
|
|
VA (including those who have ever used or enrolled for VA health care) |
|
|
Indian Health Service |
|
|
Other |
|
|
Q37 At any time in the last 4 weeks, did you DELAY getting medical care because of the coronavirus pandemic? Select only one answer.
Yes
No
Q38 At any time in the last 4 weeks, did you need medical care for something other than coronavirus, but DID NOT GET IT because of the coronavirus pandemic? Select only one answer.
Yes
No
Q38a At any time in the last 4 weeks, did you take prescription medication to help you with any emotions or with your concentration, behavior or mental health? Select only one answer.
Yes
No
Q38b At any time in the last 4 weeks, did you receive counseling or therapy from a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker? Include counseling or therapy online or by phone. Select only one answer.
Yes
No
Q38c At any time in the last 4 weeks, did you need counseling or therapy from a mental health professional, but DID NOT GET IT for any reason? Select only one answer.
Yes
No
Q39 Is your house or apartment…? Select only one answer.
Owned by you or someone in this household free and clear?
Owned by you or someone in this household with a mortgage or loan (including home equity loans)?
Rented?
Occupied without payment of rent?
Q39a Which best describes this building? Include all apartments, flats, etc., even if vacant. Select only one answer.
A mobile home
A one-family house detached from any other house
A one-family house attached to one or more houses
A building with 2 apartments
A building with 3 or 4 apartments
A building with 5 to 9 apartments
A building with 10 to 19 apartments
A building with 20 to 49 apartments
A building with 50 or more apartments
Boat, RV, van, etc.
Q40b Is this household currently caught up on rent payments? Select only one answer.
Yes
No
Q40c Is this household currently caught up on mortgage payments? Select only one answer.
Yes
No
Q41 How confident are you that your household will be able to pay your next rent or mortgage payment on time? Select only one answer.
Not at all confident
Slightly confident
Moderately confident
Highly confident
Payment is/will be deferred
Q41a How likely is it that your household will have to leave this home or apartment within the next two months because of eviction? Select only one answer.
Very likely
Somewhat likely
Not very likely
Not likely at all
Q41b How likely is it that your household will have to leave this home within the next two months because of foreclosure? Select only one answer.
Very likely
Somewhat likely
Not very likely
Not likely at all
Q42 At any time during the 2020-2021 school year, will any children in this household be enrolled in a public school, enrolled in a private school, or educated in a homeschool setting in Kindergarten through 12th grade or grade equivalent? Select all that apply.
Yes, enrolled in a public or private school
Yes, homeschooled
Yes, homeschooled (not enrolled in a public or private school)
No
Q43 How has the coronavirus pandemic affected how the children in this household receive education for the 2020-2021 school year? Select all that apply.
Classes normally taught in person at the school were canceled
Classes normally taught in person moved to a distance-learning format using online resources, either self-paced or in real time
Classes normally taught in person moved to a distance-learning format using paper materials sent home to children
Classes normally taught in person changed in some other way -- Please specify: ________________________________________________
The coronavirus pandemic did not affect how children in this household receive education
Q44 How often is a computer or other digital device available to children for educational purposes? Select only one answer.
Always available
Usually available
Sometimes available
Rarely available
Never available
Q45 Is the computer or other digital device …? Select all that apply.
Provided by the children’s school or school district to use outside of school
Provided by someone in the household or family, or it is the child’s
Provided by another source
Q46 How often is the Internet available to children for educational purposes? Select only one answer.
Always available
Usually available
Sometimes available
Rarely available
Never available
Q47 Are Internet services …? Select all that apply.
Paid for by the children’s school or school district
Paid for by someone in the household or family
Paid for by another source
Q47a During the last 7 days, on how many days did the student(s) have live contact with their teachers in person, by phone, or by video? Select only one answer.
None
1 day
2-3 days
4 or more days
Q48a During the last 7 days, about how many hours did the student(s) spend doing learning activities on their own? Do not include time spent with teachers or other household members. Enter the total number of hours for all students. If none, enter 0.
________________________________________________________________
Q48b During the last 7 days, about how much time did the student(s) typically spend on all learning activities relative to a school day before the coronavirus pandemic? Select only one answer.
Much less than a school day before the coronavirus pandemic
A little bit less than a school day before the coronavirus pandemic
As much as a school day before the coronavirus pandemic
A little bit more than a school day before the coronavirus pandemic
Much more than a school day before the coronavirus pandemic
QPS1 Before the coronavirus pandemic, how many members of your household, including yourself, were planning to take classes this fall from a college, university, community college, trade school, or other occupational school (such as a cosmetology school or a school of culinary arts)? Please enter a number.
________________________________________________________________
QPS2
Thinking
of all the members of your household who were planning to take
classes from a college, university, community college, trade school,
or other occupational school this fall, what type of program(s)
are the classes a part of? Select all that apply.
Certificate or diploma program from a school that provides occupational training (usually a 2-year program, often leading to a license, such as cosmetology)
Associate's degree program (usually a 2-year degree)
Bachelor's degree program (usually a 4-year degree)
Graduate degree program (for example, Master's, PhD, MD)
Another credential program not listed above
Classes that are not part of a credential program
QPS3 Thinking of all the members of your household who were planning to take classes from a college, university, community college, trade school, or other occupational school this fall, has the coronavirus pandemic resulted in any of the changes listed below? Select all that apply.
Plans to take classes this fall have not changed.
All plans to take classes this fall have been canceled.
Classes will be in different formats in the fall (for example, change from in-person to online).
Fewer classes will be taken this fall.
More classes will be taken this fall.
Classes will be taken from a different institution.
Classes will be taken for a different kind of certificate or degree.
QPS4 Why did household members’ plans to take classes this fall change? Select all that apply.
Had coronavirus or concerns about getting coronavirus
Caring for someone with coronavirus
Caring for others whose care arrangements are disrupted (e.g., loss of day care or adult care programs)
Institution changed content or format of classes (e.g., from in-person to online)
Changes to financial aid
Changes to campus life
Uncertainty about how classes/program might change
Not able to pay for classes/educational expenses because of changes to income from the pandemic
Some other reason related to the pandemic, please specify ________________________________________________
Q50 In 2019 what was your total household income before taxes? Select only one answer.
Less than $25,000
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 and above
residence The U.S. Census Bureau is interested in understanding geographic differences in experiences with the coronavirus pandemic. To help us analyze survey responses across the entire United States, please provide your complete current street address below. Your address information will only be used for statistical analyses conducted by the U.S. Census Bureau and will not be used for any other purpose or shared with any other parties.
Address Number ________________________________________________
Street Name ________________________________________________
Apt Unit ________________________________________________
City ________________________________________________
State ________________________________________________
Zip ________________________________________________
bestmethod Because we are interested in how coronavirus experiences change over time, we may contact you again in the coming weeks. What is the best way for us to contact you?
Text message
bestnumber To help us contact you, please provide the best phone number to reach you.
________________________________________________________________
bestemail To help us contact you, please provide the best email address to reach you.
________________________________________________________________
Feedback_pandemic
Thank you.
Is there anything else related to
the coronavirus pandemic you would like to tell us?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Q69 That concludes the survey. Please click on the “Submit” button when you are finished.
Thank you for participating in the Household Pulse Survey.
If you have any questions about this survey please visit https://www.census.gov/householdpulsedata. You can validate that this survey is a legitimate federally-approved information collection using the U.S. Office of Management and Budget approval number 0607-1013, expiring on 10/31/2020.
If you need help during this time, here are some resources that may help:
General: https://www.coronavirus.gov/
Meal finder for kids: https://www.fns.usda.gov/meals4kids
Unemployment services: https://www.usa.gov/unemployment
Page
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Phase 2 COVID-19 Household Pulse Survey |
| Author | Qualtrics |
| File Modified | 0000-00-00 |
| File Created | 2021-01-12 |