Evaluation of the Credit Matters Loan: Pilot Test Survey Instrument

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
BLOCK A: DEMOGRAPHIC INFORMATION
#

Question Asked

1

What is your gender?
01 Female
02 Male

2

3

What is your ethnicity or origin?

What is your race?
01 American Indian or Alaska
Native
02 Asian
03 Black or African-American
04 Native Hawaiian or Other
Pacific Islander
05 White
06 Other

01

[ ]

Female

02

[ ]

Male

01

[ ]

Hispanic or Latino

02

[ ]

Not Hispanic or Latino

01

02

5

Asian

[ ]
Black or African
American

04

[ ]
Native Hawaiian or
Other Pacific Islander

05

[ ]
[ ]

White
Other

Are you married?

01

[ ]

Yes

[If 02, skip to 6]

02

[ ]

No

Do you share an active credit card

01

[ ]

Yes

with your spouse?
Note: This 6
doesn’t
count
temporary
visits.
Adults are
defined as
people
over 18
years old.

[ ]

03

06

4

[ ]
American Indian or
Alaska Native

How many adults live in your
household, including you?

02

[ ]

No

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
Note: This 7 How many children live in your
household?
doesn’t
count
temporary
visits.
Children
are
defined as
people
under 18
years old.
8

9

What was your annual household
income in 2013?

01

[ ]

< $10,000

02

[ ]

$10 – 20,000

01 Was it less than 10 thousand?
02 10 to 20 thousand?
03 20 to 30 thousand?
04 30 to 40 thousand?
05 40 to 50 thousand?
06 More than 50 thousand?

03

[ ]

$20 – 30,000

04

[ ]

$30 – 40,000

05

[ ]

$40 – 50,000

06

[ ]

>$50,000

07

[ ]

Don’t Know

08
01

[ ]
[ ]

Refuse to Answer
th
Less than 9 gr.

02

[ ]

Some High school

03

[ ]

High school grad.

04

[ ]

GED

05

[ ]

Trade School

06

[ ]

Some College

07

[ ]

Associates Degree

08

[ ]

Bachelors Degree

09

[ ]

Master’s Degree

10

[ ]

Professional Deg.

11

[ ]

Doctorate Degree

What is the highest level of
schooling you’ve attained?
01 Less than 9th grade
02 Some High school
03 High school Graduate
04 GED
05 Trade School
06 Some College
07 Associates Degree
08 Bachelors Degree
09 Master’s Degree
10 Professional Degree
11 Doctorate Degree

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
12

[ ]

Don’t know

13

[ ]

Refused

Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to
a collection of information unless it displays a valid OMB control number. The OMB control number for this collection is 3170-0024.
It expires on 12/31/2015. The time required to complete this information collection is estimated to average approximately 30 minutes
per response, including the time for reviewing any instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Responding to this collection of information is voluntary.
Comments regarding this collection of information, including the estimated response time, suggestions for improving the usefulness of
the information, or suggestions for reducing the burden to respond to this collection should be submitted to Bureau at the Consumer
Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to [email protected].

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey

BLOCK B: FINANCIAL INFORMATION
Note to
interviewer: if
respondent is
confused or
asks for
clarification,
state that this
is not your
credit score
but your
credit
report/record.

#

Question Asked

10

In the past 12 months, have
you obtained a copy of your
credit report?

01

[ ]

Yes

02

[ ]

No

01 Yes
02 No

03

[ ]

Don’t know

04

[ ]

Refuse to answer

In the past 12 months, have
you checked your credit score?

01

[ ]

Yes

02

[ ]

No

03

[ ]

Don’t know

04

[ ]

Refuse to answer

01

[ ]

Yes

02

[ ]

No

03

[ ]

I have not tried to get
approved for a loan.

04

[ ]

Don’t know

05

[ ]

Refuse to answer

11

01 Yes
02 No

12

Have you had difficulty getting
approved for loans?
01 Yes
02 No
03 I have not tried to get
approved for a loan.

Note to
surveyor:
Include
amount
saved
below each
that apply.

13

Are you saving in any of the
following ways?
01 Saving cash at home or in
wallet
03 Paying money into a savings
account
04 Giving money to family to
save on your behalf

01

02

[ ]
wallet

Saving cash at home/in
$|__|__|__|__|__|

[ ]
Paying into savings
account
$|__|__|__|__|__|
03
[ ]
Giving money to family
to save
$|__|__|__|__|__|
04
[ ]
Saving in informal

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
05 Saving in an informal
savings club
05
06 Buying financial investment
products, other than pension
06
funds
07 Other way (including
07
remittances, buying property)
08 I have not been actively
saving (I don’t save/I have no
08
money to save)
14

What is the size of your
household’s overall debt (eg
credit card debt, student debt,
payday loans (small, shortterm unsecured loans))?
01 Below $5,000
02 Between $5000 and
$10,000
03 Between $10,000 and
$20,000
04 Above $20,000

15

What is the size of your
household’s monthly
payments toward debt?
01
02
03
04
05
06

16

Below $100
Between $100 and $200
Between $200 and $300
Above $300
Don’t Know
Refused
How often do you buy
lottery tickets?
Would you say
01 “Multiple tickets per
week”

savings club
$|__|__|__|__|__|
[ ]
Buying fin investment
products
$|__|__|__|__|__|
[ ]
Other way
$|__|__|__|__|__|
[ ]
I have not been actively
saving
$|__|__|__|__|__|
[ ]
Don’t know

09

[ ]

Refuse to answer

01

[ ]

Below $5,000

02

[ ]
Between $5,000 and
$10,000

03

[ ]
Between $10,000 and
$20,000

04

[ ]

Above $20,000

05

[ ]

Don’t Know

06

[ ]

Refused

01

[ ]

Below $100

02

[ ]

Between $100 and $200

03

[ ]

Between $200 and $300

04

[ ]

Above $300

05

[ ]

Don’t Know

06

[ ]

Refused

01

[ ]

Multiple per week

02

[ ]

about one per week

03

[ ]

A few times a year

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
04
02 “About one ticket per
week”
05
03 “A few times a year”
04 “Less than 1 ticket per
06
year average my adult life”
05 “Never purchased a
07
lottery ticket”
17

How often do you go to
the casino?
Would you say
01 “At least once a week”
02 “At least once a month”
03 “At least once a year”
04 “I’ve never been to the
casino”

18

Do you bring an ATM card
to the casino?
01 No, I bring a fixed
amount of cash.
02 Yes, I bring an ATM card
and take out more cash if I
need it.

19

If you want to buy
something that you desire
but is not a necessity and
you don’t currently have
enough cash, which of the
following do you do:
01 “Save up for it”
02 “Take out a loan”
03 “Put it on layaway”
04 “Borrow money from a
friend or relative”
05 “Sell some possessions”
06 “Other”



[ ]

Less than once per year

[ ]

Never

[ ]

Don’t know

[ ]

Refused

01

[ ]

At least once a week

02

[ ]

At least once a month

03

[ ]

At least once a year

04

[ ]
casino

05

[ ]

Don’t know

06
01

[ ]
[ ]

Refused
No

02

[ ]

Yes

03

[ ]

Don’t know

04

[ ]

Refused

05

[ ]

Multiple per week

06

[ ]

about one per week

07

[ ]

A few times a year

08

[ ]

Less than once per year

09

[ ]

Never

10

[ ]

Don’t know

11

[ ]

Refused

I’ve never been to the

Read Aloud: I am going to read out some attitude and behavior statements.
I would like to know how much you agree or disagree that each of the
statements applies to you, personally. Please again use a scale of 1 to 5,
where 1 tells me that you completely agree that the statement describes

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
you and 5 shows that you completely disagree:

20

Before I buy something I
carefully consider whether I
can afford it
01
02
03
04
05

21

I tend to live for today and let
tomorrow take care of itself
01
02
03
04
05

22

Completely agree
2
3
4
Completely disagree

Completely agree
2
3
4
Completely disagree

I find it more satisfying to
spend money than to save it
for the long term
01
02
03
04
05

Completely agree
2
3
4
Completely disagree

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey

23

I pay my bills on time
01
02
03
04
05

24

I am prepared to risk some of
my own money when making
an investment

01
02
03
04
05

25

Completely agree
2
3
4
Completely disagree

Completely agree
2
3
4
Completely disagree

I keep a close personal watch
on my financial affairs
01
02
03
04
05

Completely agree
2
3
4
Completely disagree

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey

26

I set long term financial goals
and strive to achieve them
01
02
03
04
05

27

Money is there to be spent
01
02
03
04
05

28

Completely agree
2
3
4
Completely disagree

Completely agree
2
3
4
Completely disagree

I often find that I regret
spending money. I wish that
when I had cash, I was better
disciplined and saved my
money rather than spent it.
01
02
03
04
05

Completely agree
2
3
4
Completely disagree

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey

29

I rarely jump into something
without thinking about it.
01
02
03
04
05

30

I demand the highest quality in
everything I do.
01
02
03
04
05

31

Completely agree
2
3
4
Completely disagree

Completely agree
2
3
4
Completely disagree

I have trouble finishing or
completing my tasks.
01
02
03
04
05

Completely agree
2
3
4
Completely disagree

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

01

[ ]

Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08
01

[ ]
[ ]

Refused
Completely agree

02

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08

[ ]

Refused

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
01
32
Success is a matter of hard
work; luck has little or nothing
02
to do with it.
01
02
03
04
05

33

Completely agree
2
3
4
Completely disagree

Suppose SLCCU held a raffle
and you won. You have a
choice: you can collect $50 in
cash today or $100 in cash one
month from today. Which
would you choose?

[ ]

Completely agree

[ ]

2

03

[ ]

3

04

[ ]

4

05

[ ]

Completely disagree

06

[ ]

Don’t know

07

[ ]

Not applicable

08
[ ]
01
[ ]

Refused
$50 today

02

[ ]

$100 in one month

03

[ ]

Don’t know

04

[ ]

Refused

01

[ ]

$50 today

02

[ ]

$150 in one month

03

[ ]

Don’t know

04

[ ]

Refused

01

[ ]

$50 today

02

[ ]

$75 in one month

03

[ ]

Don’t know

04

[ ]

Refused

01 $50 today
02 $100 in one month
[If 02, skip to 35]
34

Ok, you prefer to receive $50
today in that first scenario.
Now say you had the choice
between collecting the $50
cash today and collecting $150
in 1 month?
01 $50 today
02 $150 in one month

35

Ok, you’re willing to wait 1
month for $100 instead of $50
today. Now let’s say the choice
is between collecting a $50
cash prize today or $75 in 1
month. Which would you
choose?
01 $50 today
02 $75 in one month

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
01
36
Suppose you were choosing
between collecting $50 in cash
02
6 months from today or $100
in cash 7 months from
03
today. Which would you
choose?

[ ]

$50 in 6 months

[ ]

$100 in 7 months

[ ]

Don’t know

04

[ ]

Refused

01

[ ]

$50 in 6 months

02

[ ]

$150 in 7 months

03

[ ]

Don’t know

04

[ ]

Refused

01

[ ]

$50 in 6 months

02

[ ]

$75 in 7 months

03

[ ]

Don’t know

04

[ ]

Refused

01 $50 in 6 months
02 $100 in 7 months
[If 02, skip to 38]
37

38

Ok, you prefer to receive $50
in 6 months. Now say you had
the choice between collecting
the $50 in 6 months and
collecting $150 in 7 months?
01 $50 in 6 months
02 $150 in 7 months
Ok, you’re willing to wait 7
months for $100 instead of
getting $50 in 6 months. Now
let’s say the choice is between
collecting a $50 cash prize in 6
months or $75 in 7 months.
Which would you choose?
01 $50 in 6 months
02 $75 in 7 months

Note to
39
interviewer:
Put decimal
place in
appropriate
box.

Suppose you put $100 into
a savings account
with a guaranteed interest
rate of 2% per year. You
don’t make any further
payments into this account
and you don’t withdraw
any money. How much
would be in the account at
the end of the first year,
once the interest payment
is made?

01
02
03

$
[ ] Don’t know
[ ] Refused

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
01
40
How much would be in the
account at the end of five
02
years? Would it be:
01 More than $110
02 Exactly $110
03 Less than $110
04 It is impossible to tell from
the information given



03
04

[ ]

More than $110

[ ]

Exactly $110

[ ]

Less than $110

[ ]
It is impossible to tell
from the information given

05

[ ]

Don’t know

06

[ ]

Refused

Read Aloud: Now I’m going to read out a list of things and you will tell me
whether each of these can affect the amount of interest that you would pay
on a bank loan.
41

Your credit rating?
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

01

[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

02

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.

03

42

How much money you have in
savings?
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

[ ]

Don’t know

04
01

[ ] Refused
[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

02

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.

03

[ ]

Don’t know

04

[ ]

Refused

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
43
How much you earn?
01
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

02

03

44

Your health?
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

Your age?
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

[ ]

Don’t know

[ ] Refused
[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

02

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.
[ ]

Don’t know

04
01

[ ] Refused
[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

02

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.

03

46

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.

04
01

03

45

[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

How much you borrow?

04
01

01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect

02

[ ]

Don’t know

[ ] Refused
[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.
[ ]

No – this does NOT

OMB No. 3170-0024
Expiration Date: 12/31/2015

St. Louis Community Credit Union Credit Builder Loan – Pilot Survey
the amount of interest you
affect the amount of
would pay on a bank loan.
interest you would pay on a
bank loan.
03

47

How long you take to repay the
loan?
01 Yes – this affects the
amount of interest you would
pay on a bank loan.
02 No – this does NOT affect
the amount of interest you
would pay on a bank loan.

TIME COMPLETED SURVEY:

[ ]

Don’t know

04
01

[ ] Refused
[ ] Yes – this affects
the amount of interest you
would pay on a bank loan.

02

[ ] No – this does NOT
affect the amount of
interest you would pay on a
bank loan.

03

[ ]

Don’t know

04

[ ]

Refused