HPS Phase 3.10 Que HPS Phase 3.10 Questionnaire
Household Pulse Survey Phase 3.10
PART A, ATTACH A_Phase 3.10 Questionnaire
OMB: 0607-1013
Phase 3.10 Household Pulse Survey
Intro Welcome! Thank you for
participating in the Household Pulse Survey sponsored by
the U.S. Census Bureau and other federal agencies.
This survey will help measure the impact of social and
economic factors, including ongoing impacts of coronavirus (COVID-19)
on topics like:
employment status
food security
housing security
physical and mental
wellbeing.
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
a cooperative effort across many government agencies to provide
critical, up-to-date information on the U.S. population. Completing
this 20-minute survey will help federal, state, and local agencies
identify emergent issues in your community.
PRA
We estimate that
completing this voluntary survey will take 20 minutes on average.
Send comments regarding this estimate or any other aspect of this
survey to adrm.pra@census.gov.
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. Federal law protects your privacy and keeps your answers confidential (Title 13, United States Code, Section 9 and Title 5, U.S. Code, Section 552a).
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.
The uses of your 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).”
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. 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 (1)
Español (2)
Display This Question:
If This survey is available in English and Spanish. Please select the language in which you prefer t... = English
Or This survey is available in English and Spanish. Please select the language in which you prefer t... = Español
leadin1 These questions are for statistical purposes only.
Display This Question:
If This survey is available in English and Spanish. Please select the language in which you prefer t... != English
And This survey is available in English and Spanish. Please select the language in which you prefer t... != Español
leadin1 These questions are for statistical purposes only.
|
D1 What year were you born? Please enter a number.
________________________________________________________________
Skip To: End of Survey If Condition: What year were you born? Pl... Is Greater Than 2005. Skip To: End of Survey.
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 __________________________________________________
D3 What is your race? Please select all that apply.
White (specify) __________________________________________________
Black or African American (specify) __________________________________________________
American Indian or Alaska Native (specify) __________________________________________________
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (specify) __________________________________________________
Native Hawaiian
Chamorro
Samoan
Other Pacific Islander (specify) __________________________________________________
D4 What is the highest degree or level of school you have completed? Select only one answer.
Less than high school (1)
Some high school (2)
High school graduate or equivalent (for example GED) (3)
Some college, but degree not received or is in progress (4)
Associate’s degree (for example AA, AS) (5)
Bachelor's degree (for example BA, BS, AB) (6)
Graduate degree (for example master's, professional, doctorate) (7)
Now married (1)
Widowed (2)
Divorced (3)
Separated (4)
Never married (5)
D6 What sex were you assigned at birth, on your original birth certificate?
Male (1)
Female (2)
D7 Do you currently describe yourself as male, female or transgender?
Male (1)
Female (2)
Transgender (3)
None of these (4)
****OR****
D7 How do you currently describe yourself (mark all that apply)?
Male (1)
Female (2)
Transgender (3)
Nonbinary (4)
I use a different term __________________
Display This Question:
If What sex were you assigned at birth, on your original birth certificate? = Male
And Do you currently describe yourself as male, female or transgender? = Female
Or If
What sex were you assigned at birth, on your original birth certificate? = Male
And Do you currently describe yourself as male, female or transgender? = Transgender
Or If
What sex were you assigned at birth, on your original birth certificate? = Male
And Do you currently describe yourself as male, female or transgender? = None of these
Or If
What sex were you assigned at birth, on your original birth certificate? = Female
And Do you currently describe yourself as male, female or transgender? = Male
Or If
What sex were you assigned at birth, on your original birth certificate? = Female
And Do you currently describe yourself as male, female or transgender? = Transgender
Or If
What sex were you assigned at birth, on your original birth certificate? = Female
And Do you currently describe yourself as male, female or transgender? = None of these
D8 Just to confirm, you were assigned "${D6/ChoiceGroup/SelectedChoices}" at birth and now you describe yourself as "${D7/ChoiceGroup/SelectedChoices}". Is that correct?
Yes (1)
No (2)
Display This Question:
If Just to confirm, you were assigned "${q://QID263/ChoiceGroup/SelectedChoices}" at birth and now y... = No
Carry Forward Displayed Choices from "What sex were you assigned at birth, on your original birth certificate?"
D6_correction Please confirm or correct your answer to the following question: ${D6/QuestionText}
Male (1)
Female (2)
Display This Question:
If Just to confirm, you were assigned "${q://QID263/ChoiceGroup/SelectedChoices}" at birth and now y... = No
Carry Forward Displayed Choices from "Do you currently describe yourself as male, female or transgender?"
D7_correction Please confirm or correct your answer to the following question: ${D7/QuestionText}
Male (1)
Female (2)
Transgender (3)
None of these (4)
D9_original Which of the following best represents how you think of yourself?
Gay or lesbian (1)
Straight, that is not gay or lesbian (2)
Bisexual (3)
Something else (4)
I don’t know (5)
D10 How many total people – adults and children – currently live in your household, including yourself? Please enter a number.
________________________________________________________________
D11 How many people under 18 years-old currently live in your household? Please enter a number.
________________________________________________________________
Display This Question:
If If How many people under 18 years-old currently live in your household? Please enter a number. Text Response Is Greater Than 0
D12 In your household, are there… Select all that apply.
Children under 5 years old? (1)
Children 5 through 11 years old? (2)
Children 12 through 17 years old? (3)
Display This Question:
If If How many people under 18 years-old currently live in your household? Please enter a number. Text Response Is Greater Than 0
D13 During the school year that began in the Summer / Fall of 2023, how many children in this household were enrolled in Kindergarten through 12th grade or grade equivalent? Enter whole numbers for all that apply.
Number enrolled in a public school (1) __________________________________________________
Number enrolled in a private school (2) __________________________________________________
Number homeschooled, that is not enrolled in public or private school (3) __________________________________________________
None (4)
D14 Are you or your spouse currently
serving in the U.S. Armed Forces (Active Duty, Reserve, or National
Guard)?
Reserve and Guard members/spouses who are
full-time active duty (AGR/FTS/AR) or currently "activated"
should select the "Reserve or National Guard" response(s).
Select all that apply.
No (1)
Yes, I'm serving on active duty (2)
Yes, I'm serving in the Reserve or National Guard (3)
Yes, my spouse is serving on active duty (4)
Yes, my spouse is serving in the Reserve or National Guard (5)
If no to D14:
D15 Have you or your spouse ever served
in the U.S. Armed Forces (Active Duty, Reserve, or National
Guard)?
No (1)
Yes, I served on active duty (2)
Yes, I served in the Reserve or National Guard (3)
Yes, my spouse served on active duty (4)
Yes, my spouse served in the Reserve or National Guard (5)
leadin2 The next set of questions ask about COVID-19 vaccination.
VAC1 Have you received at least one dose of a COVID-19 vaccine?
Yes (1)
No (2)
Display This Question:
If Have you received at least one dose of a COVID-19 vaccine? = Yes
VAC2 How long ago was your most recent dose of the COVID-19 vaccine or booster?
On or after September 1, 2022 (1)
Before September 1, 2022 but less than a year ago (2)
More than a year ago (3)
Display This Question:
If If In your household, are there… Select all that apply. q://QID268/SelectedChoicesCount Is Greater Than or Equal to 1
VAC5_rev For the children in this household, how long ago was their most recent dose of the COVID-19 vaccine or booster?
Display This Question:
If In your household, are there… Select all that apply. = Children under 5 years old?
VAC5_1 Children under 5 years old
On or after December 9, 2022 (1)
Before December 9, 2022
Not vaccinated (4)
Display This Question:
If In your household, are there… Select all that apply. = Children 5 through 11 years old?
VAC5_2 Children 5-11 years old
On or after October 12, 2022 (1)
Before October 12, 2022
Not vaccinated (4)
Display This Question:
If In your household, are there… Select all that apply. = Children 12 through 17 years old?
VAC5_3 Children 12-17 years old
On or after September 1, 2022 (1)
Before September 1, 2022
Not vaccinated (4)
VAC8_B Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?
Yes (1)
No (2)
Display This Question:
If Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or labor... = Yes
|
VAC8_C When did you test positive or were told you have or had COVID-19? Select all that apply.
Within the last four weeks (1)
More than four weeks ago, but within the last year (2)
More than a year ago (3)
Display This Question:
If When did you test positive or were told you have or had COVID-19? Select all that apply. = Within the last four weeks
Or When did you test positive or were told you have or had COVID-19? Select all that apply. = More than four weeks ago, but within the last year
TREAT1 Paxlovid and Lagevrio are oral antiviral medications that can be prescribed by a doctor to treat COVID-19. Did you take Paxlovid or Lagevrio for your most recent COVID-19 infection?
Yes (1)
No (2)
Don't know (3)
Display This Question:
If Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or labor... = Yes
PASC1 How would you describe your coronavirus symptoms when they were at their worst?
I had no symptoms (1)
I had mild symptoms (2)
I had moderate symptoms (3)
I had severe symptoms (4)
Display This Question:
If Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or labor... = Yes
PASC2 Did you have any symptoms lasting
3 months or longer that you did not have prior to having coronavirus
or COVID-19?
Long term symptoms may include: tiredness
or fatigue, difficulty thinking or concentrating, forgetfulness, or
memory problems (sometimes referred to as "brain fog"),
difficulty breathing or shortness of breath, joint or muscle pain,
fast-beating or pounding heart (also known as heart palpitations),
chest pain, dizziness on standing, changes to your menstrual cycle,
changes to taste/smell, or inability to exercise.
Yes (1)
No (2)
Display This Question:
If How would you describe your coronavirus symptoms when they were at their worst? = I had mild symptoms
Or How would you describe your coronavirus symptoms when they were at their worst? = I had moderate symptoms
Or How would you describe your coronavirus symptoms when they were at their worst? = I had severe symptoms
Or Did you have any symptoms lasting 3 months or longer that you did not have prior to having corona... = Yes
|
PASC3 Do you have symptoms now?
Yes (1)
No (2)
Display This Question:
If Did you have any symptoms lasting 3 months or longer that you did not have prior to having corona... = Yes
And Do you have symptoms now? = Yes
PASC4 Do these long-term symptoms reduce your ability to carry out day-to-day activities compared with the time before you had COVID-19?
Yes, a lot (1)
Yes, a little (2)
Not at all (3)
COVID-Test2 As of May 11, 2023, health
insurance companies will no longer be required to cover the cost of
COVID-19 tests. You may have to pay a co-pay or deductible for tests
done in a doctor's office or pharmacy, and you may not be reimbursed
for tests you buy at the store. As a result of this change in
policy, will you:
Select all that apply.
Purchase at-home tests without reimbursement (1)
Test less frequently (2)
Not test for COVID-19 at all, even if feeling sick or exposed to COVID-19 (3)
Go to a doctor or pharmacy to receive a lab test instead of an at-home test (4)
I don’t know (5)
EMP_Intro Now we are going to ask about your employment.
EMP1 Have you, or has anyone in your household experienced a loss of employment income in the last 4 weeks? Select only one answer.
Yes (1)
No (2)
EMP2
In the last 7 days,
did you do ANY work for either pay or profit? Select only
one answer.
Yes (1)
No (2)
Display This Question:
If In the last 7 days, did you do ANY work for either pay or profit? Select only one answer. = Yes
EMP3 Are you employed by the government, by a private company, a nonprofit organization or are you self-employed or working in a family business? Select only one answer.
Government (1)
Private company (2)
Non-profit organization including tax exempt and charitable organizations (3)
Self-employed (4)
Working in a family business (5)
Display This Question:
If In the last 7 days, did you do ANY work for either pay or profit? Select only one answer. = No
EMP4 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 (1)
I am/was caring for children not in school or daycare (3)
I am/was caring for an elderly person (4)
I am/was sick or disabled (5)
I am retired (6)
I am/was laid off or furloughed (7)
My employer closed temporarily or went out of business (8)
I do/did not have transportation to work (9)
Other reason, please specify (10) __________________________________________________
Display This Question:
If In the last 7 days, did you do ANY work for either pay or profit? Select only one answer. = Yes
EMP6 What kind of business, industry, or organization is this? That is, what do they make or do where you work? Select only one answer.
Agriculture, Forestry, Fishing and Hunting (1)
Mining, Quarrying, and Oil and Gas Extraction (2)
Utilities (3)
Construction (4)
Manufacturing (5)
Wholesale Trade (6)
Retail Trade (7)
Transportation and Warehousing (8)
Information Technology (9)
Finance and Insurance (10)
Real Estate and Rental and Leasing (11)
Professional, Scientific, and Technical Services (12)
Management of Companies and Enterprises (13)
Administrative and Support Services (14)
Waste Management and Remediation Services (15)
Educational Services (16)
Health Care (17)
Social Assistance (18)
Arts, Entertainment, and Recreation (19)
Accommodation and Food Services (20)
Public Administration (21)
Other Services (except Public Administration) (22)
EMP7
Next, we are going to ask about the childcare arrangements for
children in the household.
At any time in the last
4 weeks,
were any children in the household unable to attend daycare or
another childcare arrangement as a result of child care being closed,
unavailable, unaffordable, or because you are concerned about your
child’s safety in care? Please include before school
care, after school care, and all other forms of childcare that were
unavailable. Select
only one answer.
Yes (1)
No (2)
Not applicable (3)
EMP8 Which if any of the following occurred in the last 4 weeks as a result of childcare being closed, unavailable, unaffordable, or because you are concerned about your child’s safety in care? Select all that apply.
You (or another adult) took unpaid leave to care for the children (1)
You (or another adult) used vacation, or sick days, or other paid leave in order to care for the children (2)
You (or another adult) cut your work hours in order to care for the children (3)
You (or another adult) left a job in order to care for the children (4)
You (or another adult) lost a job because of time away to care for the children (5)
You (or another adult) did not look for a job in order to care for the children (6)
You (or another adult) supervised one or more children while working (7)
Other (specify) (8) ______________________________________________
None of the above (9)
EMPUI1 Since June 1, 2023, have you applied for Unemployment Insurance (UI) benefits? Select only one answer.
Yes (1)
No (2)
EMPUI2 Since June 1, 2023, have you received Unemployment Insurance (UI) benefits? Select only one answer.
Yes (1)
No (2)
Display This Question:
If Since January 1, 2023, have you received Unemployment Insurance (UI) benefits? Select only one an... = Yes
EMPUI3 Have you received Unemployment Insurance (UI) benefits in the last 7 days? Select only one answer.
Yes (1)
No (2)
INFLATE1 In the area where you live and shop, do you think prices in general have changed in the last 2 months? Select only one answer.
I think prices have increased (1)
I do not think prices have changed (2)
I think prices have decreased (3)
I do not know (4)
Display This Question:
If In the area where you live and shop, do you think prices in general have changed in the last 2 mo... = I think prices have increased
INFLATE2 How stressful, if at all, has the increase in prices in the last 2 months been for you? Select only one answer.
Very stressful (1)
Moderately stressful (2)
A little stressful (3)
Not at all stressful (4)
Display This Question:
If In the area where you live and shop, do you think prices in general have changed in the last 2 mo... = I think prices have increased
INFLATE3 What changes, if any, have you made or do you plan to make to cope with the increase in prices? Select all that apply.
Shop at stores that offer lower prices, look for sales, and/or use coupons (1)
Switch from name brand to generic products (2)
Purchase less meat and/or fresh produce (3)
Go out to eat less often or order food for delivery less often (4)
Cancel or reduce subscription services (for example, streaming services, meal delivery services, cell phone plan) (5)
Cancel or decrease plans to attend events (6)
Drive less or change mode of transportation (for example, bike or take public transportation instead of drive) (7)
Delay major purchases (for example, home repair/renovation, vacations, vehicles, home appliances, cell phone or computer) (8)
Delay medical treatment (for example, refill prescription, surgery) (9)
Work additional job(s)/shift(s) to supplement income (10)
Contribute less to savings and/or retirement accounts (11)
Increase use of credit cards, loans, and/or pawnshops (12)
Decrease use of utilities (for example, cooling, heating, water, electricity) (13)
Move to less expensive housing (14)
Ask friends and/or family for help (15)
Change or reduce plans for childcare arrangements to save money (16)
Utilize benefits from charities (17)
Other (18)
I have not made any changes (19)
INFLATE4 In the area you live and shop, how concerned are you, if at all, that prices will increase in the next 6 months? Select only one answer.
Very concerned (1)
Somewhat concerned (2)
A little concerned (3)
Not at all concerned (4)
display_SPN The next questions ask about your household's activities in the last 7 days. Please only include experiences that occurred in the last 7 days.
SPN4
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 (1)
A little difficult (2)
Somewhat difficult (3)
Very difficult (4)
SPN5_DAYSTW In the last 7 days, have any of the people in your household teleworked or worked from home?
Yes, for 1-2 days (1)
Yes, for 3-4 days (2)
Yes, for 5 or more days (3)
No (4)
Display This Question:
If In the last 7 days, have any of the people in your household teleworked or worked from home? = Yes, for 1-2 days
Or In the last 7 days, have any of the people in your household teleworked or worked from home? = Yes, for 3-4 days
Or In the last 7 days, have any of the people in your household teleworked or worked from home? = Yes, for 5 or more days
And If
In the last 7 days, did you do ANY work for either pay or profit? Select only one answer. = Yes
SPN5_DAYSTW_2 In the last 7 days, have you teleworked or worked from home?
Yes, for 1-2 days (1)
Yes, for 3-4 days (2)
Yes, for 5 or more days (3)
No (4)
SPN6 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 (1)
Credit cards or loans (2)
Money from savings or selling assets or possessions (including withdrawals from retirement accounts) (3)
Borrowing from friends or family (4)
Unemployment insurance (UI) benefit payments (5)
Money saved from deferred or forgiven payments (to meet your spending needs) (6)
Supplemental Nutrition Assistance Program (SNAP) (7)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (8)
School meal debit/EBT cards (9)
Government rental assistance (10)
Other, specify: (11) __________________________________________________
FD1 Getting enough food can also be a problem for some people. 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 (1)
Enough, but not always the kinds of food (I/we) wanted to eat (2)
Sometimes not enough to eat (3)
Often not enough to eat (4)
Display This Question:
If Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Enough, but not always the kinds of food (I/we) wanted to eat
Or Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Sometimes not enough to eat
Or Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Often not enough to eat
And If
If How many people under 18 years-old currently live in your household? Please enter a number. Text Response Is Greater Than 0
FD2
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 (1)
Sometimes true (2)
Never true (3)
Display This Question:
If Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Enough, but not always the kinds of food (I/we) wanted to eat
Or Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Sometimes not enough to eat
Or Getting enough food can also be a problem for some people. In the last 7 days, which of these sta... = Often not enough to eat
FD3 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 (1)
Couldn’t get to store to buy food (for example, didn’t have transportation, have mobility or health limitations that prevent you from getting out) (2)
Couldn’t go to store due to safety concerns (3)
None of the above (4)
FD4 During the last 7 days, did you or anyone in your household get free groceries from a food pantry, food bank, church, or other place that provides free food? Select only one answer.
Yes (1)
No (2)
Display This Question:
If If How many people under 18 years-old currently live in your household? Please enter a number. Text Response Is Greater Than 0
FD5 Do any of the children in this household... Select all that apply.
Receive free meals at school (1)
Pay for reduced-price meals at school (2)
Pay for full-price meals at school (3)
Pick up free meals at a school or other location (4)
Receive or use an EBT card to help buy groceries (5)
Eat free meals at a location other than school (6)
Have free meals delivered (7)
None of the above (8)
FD6_new Do you or does anyone in your household receive benefits from… Select all that apply.
Supplemental Nutrition Assistance Program (SNAP) or Food Stamp Program (1)
WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) (2)
None of these (3)
Display This Question:
If Do any of the children in this household... Select all that apply. = Pay for reduced-price meals at school
Or Do any of the children in this household... Select all that apply. = Pay for full-price meals at school
Or Do any of the children in this household... Select all that apply. = None of the above
And If
In your household, are there… Select all that apply. = Children 5 through 11 years old?
Or In your household, are there… Select all that apply. = Children 12 through 17 years old?
FD7_new Does having to pay for the food children eat at school make it difficult for your household to pay for other expenses?
Yes (1)
No (2)
SHORTAGE1: [UNIVERSE: All]
In the past month, have you or a member of your household been directly affected by the following… ?
Shortage of a medicine or medication that requires a prescription or is given by provider, pharmacist, or hospital (1)
Shortage of a medicine or medication that is sold over the counter (without a prescription) (2)
Shortage of a medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc (3)
Shortage of other critical products, please specify (4)
None (5)
SHORTAGE2A: [Universe: SHORTAGE1:
1:3, 4] Please discuss how you or a member of your household
responded or was affected by the shortage. Select all that apply.
Changed to available substitutes or alternatives (1)
Delayed or stopped use because product was not available (2)
Delayed or canceled care, procedure or treatment because product was not available (3)
Rationed or re-used products (4)
Spent more money, time finding substitutes or alternatives (5)
Consulted a medical professional or other sources (6)
Experienced negative health impacts due to adverse events, delayed or canceled care (7)
Experienced negative mental impacts such as distress (8)
I don’t know (9)
Other, specify (10)
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 dollar amount.
________________________________________________________________
Display This Question:
If If 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 pur... Text Response Contains ,
Or Or 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 pur... Text Response Contains %
Or Or 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 pur... Text Response Contains +
Or Or 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 pur... Text Response Contains -
Or Or 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 pur... Text Response Contains $
Q28_warn Please do not include any special characters such as , - % + $ in your response above. Enter only numbers.
Display This Question:
If If 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 pur... Text Response Is Greater Than 1000
Q28_check You said that you spent $${Q28/ChoiceTextEntryValue}.00 on food at supermarkets, grocery stores, online, and other places during the last 7 days. This amount seems unusually high. Are you sure it is the correct amount?
Yes (1)
No, I need to correct the amount (2)
If You said that you spent $${q://QID324/ChoiceTextEntryValue}.00 on food at supermarkets, grocery s... = 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 dollar amount.
________________________________________________________________
Display This Question:
If If 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 y... Text Response Contains ,
Or Or 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 y... Text Response Contains %
Or Or 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 y... Text Response Contains +
Or Or 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 y... Text Response Contains -
Or Or 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 y... Text Response Contains $
Q28_warn2 Please do not include any special characters such as , - % + $ in your response above. Enter only numbers.
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. Enter dollar amount.
________________________________________________________________
Display This Question:
If If 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 cafeteria... Text Response Contains ,
Or Or 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 cafeteria... Text Response Contains %
Or Or 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 cafeteria... Text Response Contains +
Or Or 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 cafeteria... Text Response Contains -
Or Or 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 cafeteria... Text Response Contains $
Q29_warn Please do not include any special characters such as , - % + $ in your response above. Enter only numbers.
Display This Question:
If If 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 cafeteria... Text Response Is Greater Than 1000
Q29_check You said that you spent $${Q29/ChoiceTextEntryValue}.00 on prepared meals during the last 7 days. This amount seems unusually high. Are you sure it is the correct amount?
Yes (1)
No, I need to correct the amount (2)
Display This Question:
If You said that you spent $${q://QID329/ChoiceTextEntryValue}.00 on prepared meals during the last... = 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 the previous question. Enter dollar amount.
________________________________________________________________
Display This Question:
If If 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 ... Text Response Contains ,
Or Or 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 ... Text Response Contains %
Or Or 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 ... Text Response Contains +
Or Or 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 ... Text Response Contains -
Or Or 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 ... Text Response Contains $
Q29_warn2 Please do not include any special characters such as , - % + $ in your response above. Enter only numbers.
Display This Question:
If In your household, are there… Select all that apply. = Children under 5 years old?
INF1 Are there any babies or infants under the age of 12 months (one = year) old in your household?
Yes (1)
No (2)
Display This Question:
If Are there any babies or infants under the age of 18 months (one and a half years) old in your hou... = Yes
INF2 How many months old is the baby or infant in your household? If there is more than one, please report the age of the youngest.
Under 6 months (1)
Between 6 months and 9 months (2)
Between 9 months and 12 months (3)
Display This Question:
If Are there any babies or infants under the age of 12 months... = Yes
INF5 How is the baby in your household fed (in addition to any solid foods the baby may be consuming)? If there is more than one baby, please report on the youngest.
Breastfeeding (or pumped breastmilk) only (1)
Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula (2)
Infant formula only (3)
Baby isn’t fed breastmilk OR infant formula (4)
Display This Question:
If Are there any babies or infants under the age of 12... = Yes
And If
How is the baby in your household fed (in addition to any solid foods the baby may be consuming)?... = Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula
Or How is the baby in your household fed (in addition to any solid foods the baby may be consuming)?... = Infant formula only
INF6 In the last month, did you have difficulty getting infant formula?
Yes, in the last 7 days (1)
Yes, more than 7 days ago but within the last month (2)
No, did not have trouble getting infant formula in the last month (3)
INF4_rev: [Universe: INF6 1 or 2)] Please state how you dealt with the infant formula shortage. Select all that apply.
Increased breastfeeding or using pumped breastmilk (1)
Changed from powder to liquid (liquid concentrate or ready-to-feed (RTF)) (2)
Got Infant Formula at a different store than where I usually shop (3)
Got Infant Formula online (for example, Instacart, Amazon, Google Market, secondary market, or other) (4)
Received direct shipment of Infant Formula from the Infant Formula company (5)
Changed to a different brand of Infant Formula (any form, powder or liquid, including non-American brands) (6)
Changed from Infant Formula to something else (for example: Cow milk, Goat milk, Soy milk, Almond milk, Oat milk, or Toddler Drink/Formula) (7)
Stopped offering Infant Formula (8)
Watering down formula (9)
Making your own formula (10)
Received formula from family, friends, or others (like community groups or online networks) (11)
Other, specify: (12)
Display This Question:
If Are there any babies or infants under the age of 12... = Yes
And If
How is the baby in your household fed (in addition to any solid foods the baby may be consuming)?... = Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula
Or How is the baby in your household fed (in addition to any solid foods the baby may be consuming)?... = Infant formula only
INF7 Currently, how much infant formula do you have on hand?
Formula for more than one month (1)
Formula for about two or three weeks (2)
Formula for about a week (3)
Formula for less than a week (4)
None (5)
ND1 The next set of questions asks
about natural disasters, such as hurricanes, floods and fires.
In
the past year, were you displaced from your home because of a natural
disaster?
Yes (1)
No (2)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND2 What type of natural disaster? Select all that apply.
Hurricane (1)
Flood (2)
Fire (3)
Tornado (4)
Other, specify (5) __________________________________________________
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND3 How long were you displaced from your home?
Less than a week (1)
More than a week but less than a month (2)
One to six months (3)
More than six months (4)
Never returned to home (5)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND4 Altogether, how much damage to your property or possessions did you experience as a result of natural disasters in the last year? Would you say no damage, some damage, a moderate amount of damage, or a lot of damage?
No damage (1)
Some damage (2)
Moderate amount of damage (3)
A lot of damage (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5 In the first month after the natural disaster, to what extent did you experience any of the following:
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5A A shortage of food?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5B A shortage of drinkable water?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5C Loss of electricity?
Not at all (1)
A little (2)
Some (3)
A lot (4)
ND5H. Difficulty accessing medical care or medicines?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5D Unsanitary conditions, such as inadequate toilets?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5E Feeling isolated, down, depressed, anxious, nervous or on edge?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5F Fear of crime?
Not at all (1)
A little (2)
Some (3)
A lot (4)
Display This Question:
If The next set of questions asks about natural disasters, such as hurricanes, floods and fires. In... = Yes
ND5G Offers that seemed like a scam?
Not at all (1)
A little (2)
Some (3)
A lot (4)
display_HLTH Next, we will ask about health and medical care.
HLTH_intro Over the last 2 weeks, how often have you been bothered by...
HLTH1 Feeling nervous, anxious, or on edge? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH2 Not being able to stop or control worrying? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH3 Having little interest or pleasure in doing things? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH4 Feeling down, depressed, or hopeless? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
Display This Question:
If If How many people under 18 years-old currently live in your household? Please enter a number. Text Response Is Greater Than 0
MH1 During the last 4 weeks, did any children in your household need mental health treatment? Mental health treatment includes health services like counseling or medication.
Yes, all children needed mental health treatment (1)
Yes, some but not all children needed mental health treatment (2)
No, none of the children needed mental health treatment (3)
Display This Question:
If During the last 4 weeks, did any children in your household need mental health treatment? Mental... = Yes, all children needed mental health treatment
Or During the last 4 weeks, did any children in your household need mental health treatment? Mental... = Yes, some but not all children needed mental health treatment
MH2 Did the children who needed mental health treatment receive it?
Yes, all children who needed treatment received it (1)
Yes, but only some children who needed treatment received it (2)
No, none of the children who needed treatment received it (3)
Display This Question:
If Did the children who needed mental health treatment receive it? = Yes, all children who needed treatment received it
Or Did the children who needed mental health treatment receive it? = Yes, but only some children who needed treatment received it
MH3 Were you satisfied with the type, quality, and quantity of mental health treatment the children received?
Satisfied with all of the mental health treatment the children received (1)
Satisfied with some but not all of the mental health treatment the children received (2)
Not satisfied with the mental health treatment the children received (3)
Display This Question:
If During the last 4 weeks, did any children in your household need mental health treatment? Mental... = Yes, all children needed mental health treatment
Or During the last 4 weeks, did any children in your household need mental health treatment? Mental... = Yes, some but not all children needed mental health treatment
MH4 How difficult was it to get mental health treatment for the children?
Not difficult (1)
Somewhat difficult (2)
Very difficult (3)
Unable to get treatment due to difficulty (4)
Did not try to get treatment (5)
HLTH14 Think about all of the children
living in your household. In the past 4 weeks, did any of
these children seem to:
Select all that apply.
Feel anxious or clingy?
Feel very sad or depressed?
Show changes in eating behaviors, such as eating more or less than normal, or became extremely picky?
Show changes in their ability to stay focused, such as becoming easily distracted?
Show unusual anger or outbursts?
Engage in problematic behaviors such as lying, cheating, stealing, or bullying?
Behave in ways that they’ve previously outgrown, such as thumb sucking or wetting the bed?
Complain of physical pain with no medical issue such as stomach aches or pains?
None of the children in my household exhibited any of these behaviors
DIS1 Do you have difficulty seeing, even when wearing glasses? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS2 Do you have difficulty hearing, even when using a hearing aid? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS4 Do you have difficulty walking or climbing stairs? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS3 Do you have difficulty remembering or concentrating? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS5 Do you have difficulty with self-care, such as washing all over or dressing? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS6 Using your usual language, do you have difficulty communicating, for example understanding or being understood? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
HLTH8 Are you currently covered by any of the following types of health insurance or health coverage plans? Mark Yes or No for each.
|
Yes (1) |
No (2) |
Insurance through a current or former employer or union (through yourself or another family member) (1) |
|
|
Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) (2) |
|
|
Medicare, for people 65 and older, or people with certain disabilities (3) |
|
|
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability (4) |
|
|
TRICARE or other military health care (5) |
|
|
VA (including those who have ever used or enrolled for VA health care) (6) |
|
|
Indian Health Service (7) |
|
|
Other (8) |
|
|
Display This Question:
If Are you currently covered by any of the following types of health insurance or health coverage pl... = Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability [ No ]
MEDICAID_1 Since January 1, 2022, have you ever had Medicaid coverage?
Yes, I had Medicaid coverage, but I no longer have it (1)
No, I have not had Medicaid since January 1, 2022 (2)
Display This Question:
If Since January 1, 2022, have you ever had Medicaid coverage? = Yes, I had Medicaid coverage, but I no longer have it
MEDICAID_2 What was the main reason you no longer have Medicaid?
I gained new coverage and chose to drop Medicaid (1)
I moved to a new state (2)
I no longer qualify for Medicaid (3)
I tried to stay in Medicaid, but I could not complete the renewal process (4)
HSE1
The next questions ask about
housing.
Is your house or apartment…? Select
only one answer.
Owned by you or someone in this household free and clear? (1)
Owned by you or someone in this household with a mortgage or loan (including home equity loans)? (2)
Rented? (3)
Occupied without payment of rent? (4)
HSE2 Which best describes this building? Include all apartments, flats, etc., even if vacant. Select only one answer.
A mobile home (1)
A one-family house detached from any other house (2)
A one-family house attached to one or more houses (3)
A building with 2 apartments (4)
A building with 3 or 4 apartments (5)
A building with 5 or more apartments (6)
Boat, RV, van, etc. (7)
Display This Question:
If The next questions ask about housing. Is your house or apartment…? Select only one answer. = Rented?
HSEnew2 Has your monthly rent changed during the last 12 months? If so, by how much?
My rent did not change (1)
My rent decreased (2)
My rent increased by less than $100 (3)
My rent increased by $100-$249 (4)
My rent increased by $250-$500 (5)
My rent increased by more than $500 (6)
Display This Question:
If The next questions ask about housing. Is your house or apartment…? Select only one answer. = Rented?
HSE3 Is this household currently caught up on rent payments? Select only one answer.
Yes (1)
No (2)
Display This Question:
If The next questions ask about housing. Is your house or apartment…? Select only one answer. = Owned by you or someone in this household with a mortgage or loan (including home equity loans)?
HSE4 Is this household currently caught up on mortgage payments? Select only one answer.
Yes (1)
No (2)
Display This Question:
If Is this household currently caught up on rent payments? Select only one answer. = No
Or Is this household currently caught up on mortgage payments? Select only one answer. = No
HSE6 How many months behind is this household in paying your rent or mortgage?
________________________________________________________________
HSE7rev Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to move due to any of the following reasons? Select all that apply.
Because the landlord raised the rent (1)
Because you missed a rent payment and you thought you would be evicted (4)
Because the landlord did not make repairs (5)
Because you were threatened with eviction or told to leave by your landlord (6)
Because your landlord changed the locks, removed your belongings, or shut off your utilities (7)
Because the neighborhood was dangerous (8)
Some other pressure (9)
Did not feel pressure to move (10)
Display This Question:
If Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because the landlord raised the rent
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because you missed a rent payment and you thought you would be evicted
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because the landlord did not make repairs
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because you were threatened with eviction or told to leave by your landlord
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because your landlord changed the locks, removed your belongings, or shut off your utilities
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Because the neighborhood was dangerous
Or Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to... = Some other pressure
HSE7b During the last six months, did you actually move from any place you were living as a result of this pressure?
Yes (1)
No (2)
Display This Question:
If Is this household currently caught up on rent payments? Select only one answer. = No
|
HSE8 How likely is it that your household will have to leave this home or apartment within the next 2 months because of eviction? Select only one answer.
Very likely (1)
Somewhat likely (2)
Not very likely (3)
Not likely at all (4)
Display This Question:
If Is this household currently caught up on mortgage payments? Select only one answer. = No
HSE9 How likely is it that your household will have to leave this home within the next 2 months because of foreclosure? Select only one answer.
Very likely (1)
Somewhat likely (2)
Not very likely (3)
Not likely at all (4)
HSE10 In the last 12 months, how many months did your household reduce or forego expenses for basic household necessities, such as medicine or food, in order to pay an energy bill?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
HSE11 In the last 12 months, how many months did your household keep your home at a temperature that you felt was unsafe or unhealthy?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
HSE12 In the last 12 months, how many times was your household unable to pay an energy bill or unable to pay the full bill amount?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
GAS1 Has the cost of gas in the last
7 days caused you to:
Select all that apply.
Choose not to take a trip (for example, chose not to visit a friend/restaurant/park etc., change a task from in-person to online to reduce gas use) (1)
Combine trips (2)
Take alternative modes of transportation (for example, public transit, ridesharing, bike, etc.) (3)
None of these - the cost of gas has not affected my driving behavior (4)
INC1 In 2022 what was your total household income before taxes? Select only one answer.
Less than $25,000 (1)
$25,000 - $34,999 (2)
$35,000 - $49,999 (3)
$50,000 - $74,999 (4)
$75,000 - $99,999 (5)
$100,000 - $149,999 (6)
$150,000 - $199,999 (7)
$200,000 and above (8)
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 (1) __________________________________________________
Street Name (2) __________________________________________________
Apt Unit (3) __________________________________________________
City (4) __________________________________________________
State (5) __________________________________________________
Zip (6) __________________________________________________
no_address
I do not have a street address (1)
Display This Question:
If If 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, pleas... Address Number Is Empty
And And 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, pleas... Street Name Is Empty
And And 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, pleas... Apt Unit Is Empty
And And 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, pleas... City Is Empty
And And 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, pleas... State Is Empty
And And 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, pleas... Zip Is Empty
Or = I do not have a street address
rural_route
Do you have a Rural
Route address?
Yes (1)
No (2)
Display This Question:
If Do you have a Rural Route address? = Yes
rural_address Please provide the Rural
Route address where you currently reside.
Also,
provide a description of the physical location in the space provided.
RR Descriptor (1) __________________________________________________
Rural Route No (2) __________________________________________________
RR Box ID (3) __________________________________________________
City (4) __________________________________________________
State (5) __________________________________________________
Zip Code (6) __________________________________________________
Display This Question:
If Do you have a Rural Route address? = Yes
rural_description Please provide as
much information as possible.
For example, if you also have
a street address associated with your residence, such as one used for
emergency services (E - 911) or for you to have a package delivered
to your home, then please provide it here.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Display This Question:
If Do you have a Rural Route address? , No Is Displayed
And Do you have a Rural Route address? != Yes
other_address Please provide the city
and state or ZIP Code where you are currently living.Also,
describe the physical location in the space provided.
City (1) __________________________________________________
State (2) __________________________________________________
Zip (3) __________________________________________________
Display This Question:
If Do you have a Rural Route address? , No Is Displayed
And Do you have a Rural Route address? != Yes
other_description Please provide as
much information as possible.
For example: a
location description such as "The apartment over the gas
station" or "The brick house with the screened porch on the
northeast corner of Farm Road and HC46" or a name of a park,
street intersection or shelter, if you are experiencing homelessness,
as well as the name of the city and state. For example, "Friendship
Park, Anywhere PA."
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
bestnumber To help us contact you in the future, please provide the best phone number to reach you.
bestemail To help us contact you in the future, please provide the best email address to reach you.
________________________________________________________________
OPTIN Are you interested in:
Answering optional surveys to help the U.S. Census Bureau? (1)
Yes No
Receiving email updates about news from the U.S. Census Bureau? (2)
Yes No
Feedback_pandemic Is there anything else related to the coronavirus pandemic or other social and end economic issues 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 10/31/2023.If you need help during this time, here are some resources that may help:
Infant Formula:
Information for Families During the Infant Formula Shortage | Nutrition | CDC Questions & Answers for Consumers Concerning Infant Formula | FDA
General: https://www.coronavirus.gov/
Meal finder for kids: https://www.fns.usda.gov/meals4kids
Unemployment services: https://www.usa.gov/unemployment
The National Suicide Prevention Lifeline: 988lifeline.org
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Phase 3.9 Household Pulse Survey |
| Author | Qualtrics |
| File Modified | 0000-00-00 |
| File Created | 2023-10-16 |
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