☻OMB Control No. xxxx
Expiration Date xxxxxx
☻☻
☻DHAP Incremental Rent Transition Study
Baseline Questionnaire
[NOTE: THIS SURVEY WILL BE PRINTED AS A PAMPHLET AND DISTRIBUTED TO FAMILIES TO COMPLETE WHEN THEY VISIT THE PHA OR CASE MANAGEMENT AGENCY.]
The U.S. Department of Housing and Urban Development (HUD) is conducting a study of how well DHAP has met your housing and case management needs and how to improve services provided to you and future recipients of disaster housing assistance. We’d like to ask you some questions about yourself and any people you might be renting, buying a house, or living with. Your answers to all questions will be confidential and will not affect any housing assistance, case management, or other services you receive. Answering the questions will take about 20 minutes. If you have any questions as you complete the questionnaire, please ask the PHA or case management agency staff helping to oversee this survey.
DHAP IRT Study Confidential ID Number: ___________________
__________________________________________________________________
This first set of questions is about where you lived before Hurricane Katrina or Rita, how many different apartments or houses you have rented since then, and your current housing.
1. Think back to the time just before Hurricane Katrina or Rita, that is in August or September 2005. Where were you living at that time?
Address: _____________________________
City: ________________________________
State: ________________________________
Zip Code: ____________________________
2. Since
you were displaced by Hurricane Katrina or Rita in 2005, how many
different apartments, houses, or travel trailers have you lived in?
(CHECK ONE.)
q 0 |
q 2 |
q 4
|
q 1 |
q 3 |
q 5 or more
|
3. Have you ever owned your own home?
q Yes |
|
q No |
|
The next set of questions is about where you plan to live after your DHAP assistance ends.
4. Where
do you expect to live after DHAP ends in February 2009? (CHECK ONE
BOX ONLY)
q The apartment building /single family home / duplex /manufactured home I am in living in now
q Different apartment building /single family home / duplex /manufactured home
q Move in with relatives
q Move in with friends
q Homeless shelter
q Other (specify):_______________________________
5. After DHAP assistance ends, if you will be living in the same or different apartment building/single family home / duplex /manufactured home, do you expect to own or rent the place where you will live?
q Own |
|
q Rent |
|
q Don’t Know q Not Applicable |
|
6. After DHAP ends, do you plan to stay in this same city you are living in now or do you plan to move to another city?
q Same City
q Different City:
Please Specify: City________________, State: _________
7. One year from now, do you plan to live in the same city you are living in now or do you plan to move to another city?
q Same City
q Different City:
Please Specify: City________________, State: _________
8. How do you expect to pay your rent or mortgage payments after DHAP ends?
q Income from employment
q Child support payments, alimony, or maintenance payments
q Voucher or Housing Assistance Payment (HAP) from PHA or from HUD
q Social Security retirement or disability benefits
q Other pensions or retirement income
q Unemployment benefits
q Veterans’ benefits
q Interest, dividend, or other investment income
q Other income
q Do not expect to have income to pay rent
The next set of questions is about you personally, they help us better understand how DHAP has helped people from different backgrounds.
9. What is your marital status? (CHECK ONE.)
q Now married
q Widowed
q Divorced
q Separated
q Never married
q Other (please describe) ______________
10. What is the highest degree or level of school you have completed? (CHECK ONE.)
q Less than 12th grade
q 12th grade, no diploma
q High school diploma or equivalent (e.g., GED)
q 1 or more years of college, no degree
q Associate degree
q Bachelor’s degree
q Master’s degree, professional degree, or doctorate degree
11. What is your current work status? (CHECK ONE.)
q Employed full-time
q Employed part-time
q Homemaker or student
q Unemployed, looking for work
q Unemployed, not looking for work
q Temporarily laid off or on leave
q Retired or disabled
12. How
many dependents (under the age of 18) do you currently have living
with you?
(CHECK ONE.)
q 0 |
q 2 |
q More than 3 |
q 1 |
q 3 |
|
13. What is your gender?
q Male
q Female
14. What is your date of birth? _____/______/______ (month/date/year)
15. Which describes your ethnicity? (Select only one.)
q Hispanic or Latino
q Not Hispanic or Latino
16. Which describes your race? (Select one or more.)
q American Indian or Alaska Native
q Asian
q Black or African American
q Native Hawaiian or Other Pacific Islander
q White
The following questions ask about the amount of income and other assets you have to pay rent, pay a mortgage, or purchase a house. Answer the questions for yourself plus anyone you plan to rent, purchase, or live with.
17. What is your gross monthly income? Gross monthly income is the amount of money you receive from all sources. It is calculated before taxes and other deductions are taken out. (Include all sources of income you have. You should also include the income of any one else who lives with you or will live with you.)
$______________________
a. Does this total income include…? (CHECK ALL THAT APPLY.)
q Income from employment
q Interest, dividend, or other investment income
q Child support payments, alimony, or maintenance payments
q Social Security retirement or disability benefits
q Other pensions or retirement income
q Unemployment benefits
q Veterans’ benefits
q Other income
18. How much money do you have in savings? (“Savings” includes money in checking accounts, savings accounts, money market accounts, certificates of deposit, mutual funds, brokerage accounts, savings at home, savings with others who are keeping it safe, and any other kinds of savings. Include your savings as well as the savings of anyone living with you.)
$______________________
q Don’t know
19. How much money do you have in retirement accounts, such as 401(k) accounts, 403(b) accounts, or IRAs? (Include your retirement accounts as well as those of anyone living with you.)
$______________________
q Don’t know
20. Have you received a report on your credit recently?
q Yes |
|
q No |
|
q Don’t Know |
|
21. Given your credit, how easy or hard do you think it will be for you (and any co-borrowers) to get a loan to purchase a house, a car, or get a college/student loan?
q Very easy
q Somewhat easy
q Somewhat hard
q Very hard
q Don’t know
22. What did you hope the DHAP case management services would help you with? (CHECK ALL THAT APPLY.)
q Determining how much rent I can afford
q Searching for the right apartment for me
q Improving my credit or getting out of debt
q Financial education or money management
q Helping me obtain a permanent housing voucher
q Helping me obtain other assistance such as TANF, Food Stamps/SNAP, and SSI/SSDI
q Buying a house
q Medical needs
q Legal issues
q Other reason (specify):______________________________________________
23. Did the DHAP case management provide the help you wanted or needed?
q Yes |
|
q No |
|
24. Do you have any other comments you would like to make about the DHAP case management services or program overall?
Those are all the questions we have.
Thank you for participating in this survey!
Please return this questionnaire to the case management staff person overseeing this survey.
| File Type | application/CDFV2-corrupt |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |