Revised Baseline Survey with Tracked Changes

OMB Control Number: 3170-0044

Initials

Surveyor
: Complete
Incomplete

Respondent ID:
«Unique Identifier»

|__|__|

O
O

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
DATE SURVEY (MMDDYY):

TIME STARTED SURVEY (HHMM):

1

BLOCK A: PERSONAL INFORMATION
Question Asked
Enter Surveyor ID

2

Branch

3

Enter Member Name

01
02
03
04
05
First

O
O
O
O
O

Chippewa
Dellwood
Forest Park
Graham Rd.
University City

|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|

Middle Initial
Last

|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|

Generational Suffix (eg, Sr., Jr., III, etc.)

|__|__|

1

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
4

What is the best phone number to reach you at?
What type of phone is this –
Mobile? House? Work?

5

What is the second best phone number to reach
you at?
What type of phone is this –
Mobile? House? Work?

6

01
02
03

O
O
O

Mobile
House
Work

01
02
03

O
O
O

Mobile
House
Work

|__|__|__||__|__|__||__|__|__|__|

What is your current mailing address?
Street
Street 2
City
State
Zip Code

7

|__|__|__||__|__|__||__|__|__|__|

Do you live at this address?
01 Yes

|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|
|__|__|__|__|__|__|__|__|__|
01
02

O
O

Yes
No

02 No
[If 01, skip to 9]

2

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
8

What is the address where you currently live?
Street
Street 2
City
State
Zip Code

9

Have you moved addresses in the past 5 years?
01 Yes

|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|
|__|__|__|__|__|__|__|__|__|
01
02

O
O

Yes
No

02 No
10

[If 02, skip to 11]
What is your most recent previous address?
Street
Street 2
City
State
Zip Code

|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|__|__|__|__|__|__|__|
|__|__|
|__|__|__|__|__|__|__|__|__|

|__|__|__|__|__|__|__|__|__|
11 What is your SLCCU Account Number?
>>SEPARATE THESE FIRST 3 PAGES FROM THE REMAINDER OF THE QUESTIONNAIRE>>

3

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

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

BLOCK B: DEMOGRAPHIC INFORMATION
What is your gender?

O
Female
O
Male
O Don’t Know
O999
O
Refused

01
02

O
O

Hispanic or Latino
Not Hispanic or
Latino

What is your race? Please select one or more.

01

[ ]

01 American Indian or Alaska Native
02 Asian
03 Black or African-American
04 Native Hawaiian or Other Pacific Islander
05 White

02
03

[ ]
[ ]

04

[ ]

05
777

[ ]
[ ]

American Indian
or Alaska
Native
Asian
Black or AfricanAmerican
Native Hawaiian
or Other Pacific
Islander
White
Other

01 Female
02 Male
13

What is your ethnicity or origin?
01 Hispanic or Latino
02 Not Hispanic or Latino

14

This means
that the adult
lives at the house
50% of the time
or more. Adults
are defined as
people over 18
years old.

Formatted Table

01
02
888
03

15

Are you married?

01
02
888
999

O
O
O
O

Yes
No
Don’t know
Refused

16

Do you share an active credit card with your
spouse or other family member?

01
02
888
999

O
O
O
O

Yes
No
Don’t know
Refused

1716 How many adults live in your household,
including you? Please only include in this number
individuals with whom you share finances –
meaning you are dependent on a shared or
pooled income -- since later survey questions will
ask about the finances of the household..

888
999

O
O

Don’t know
Refused

4

Formatted: Numbered + Level: 1 +
Numbering Style: 01, 02, 03, … + Start at: 888
+ Alignment: Left + Aligned at: 0.25" + Indent
at: 0.5"
Formatted: Numbered + Level: 1 +
Numbering Style: 01, 02, 03, … + Start at: 999
+ Alignment: Left + Aligned at: 0.25" + Indent
at: 0.5"

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
This means
that the child
lives at the house
50% of the time
or more. Children
are defined as
people under 18
years old. We
want to know
about how many
children live at
the house that
are dependent
on the income of
you and/or any
adults with
whom you share
finances.

1817 How many children live in your household?

888
999

1918 What was your annual (household) income in
2013the past twelve months?
01 Less than $10,000?
02 $10,000 - $19,999less than $20,000?
03 $20,000 - $29,999less than $30,000?
04 $30,000 - $39,999less than $40,000?
05 $40,000 - $49,999less than $50,000?
06 $50,000 or more?

O
O

Don’t know
Refused

01
02

O
Less than $10,000
O
$10,000$19,999<$20,000
03
O
$20,000<$30,00029,999
04
O
$30,000<$39,99940,000
05
O
$40,000<$49,99950,000
06
O
$50,000 or more
888 O
Don’t know
999 O
Refused

5

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
Be sure to
read all
responses/
distinguish
between
graduating and
partial
completion.

This is not
their credit score
but their credit
report/ record.

2019 What is the highest level of schooling you’ve
completed?
01 Some high school or less 01 Less than 9th
grade
02 Some High school
0213 High school Graduate/GED
04 GED
05 Trade School
06 023 Some College
07 034 Associates DegreeCollege graduate
08 Bachelor’s Degree
09 Master’s Degree
10 Professional Degree
11 Doctorate Degree45 More than college

th

01

O
Less than 9 gr.HS
Grad/GEDHigh school or <
02
O
HS Grad/GED
02
O03
O
Some HS
College
03
O04
O
HS grad.
College grad
04
O05
O
GEDMor
e than college
05
O
Trade School
06
O
Some College
07
O
Associates Degree
08
O
Bachelor’s Degree
09
O
Master’s Degree
10
O
Professional Deg.
11
O
Doctorate Degree
888 O
Don’t know
999 O
Refused

BLOCK C: FINANCIAL INFORMATION
2120 In the past 12 months, have you checked your
01
credit score?
02
888
01 Yes
999
02 No
2221 In the past 12 months, have you obtained a copy
01
of your credit report?
02
888
01 Yes
999
02 No
2322 Have you had difficulty getting approved for
01
loans in the past three years?
02
03
01 Yes
02 No
03 I have not tried to get approved for a loan.
888
999

O
O
O
O

Yes
No
Don’t know
Refused

O
O
O
O

Yes
No
Don’t know
Refused

O
O
O

Yes
No
I have not tried
to get approved
for a loan.
Don’t know
Refused

O
O

6

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
Include
amount saved
below each that
apply. This
should be a
“snapshot” of
what the
respondent
currently has
saved up in each
of the options
applicable.

2423 Are you saving in any of the following ways?
How much in total do you currently have saved
in each way?
01 Saving cash at home or in wallet
02 Making deposits into a savings account at
another financial institution
03 Buying financial investment products, other
than pension funds
04 401k/Retirement Plan
05 Prepaid cards
0605
I have not been actively saving (I don’t
save/I have no money to save)Are you
actively saving in any way?
777 Other way (including remittances, buying
property)

01

Saving cash at
home/in wallet
$|__|__|__|__|__|__|
02
[ ]
Making deposits
into
savings
account
$|__|__|__|__|__|__|
03
[ ]
Buying fin
investment
products
$|__|__|__|__|__|__|
04
[ ]
401k/Retirement
Plan
$|__|__|__|__|__|__|
05
[ ]
Prepaid cards
$|__|__|__|__|__|__|
777
[ ]
Other way
06

888
999
This
includes debts in
deferment, grace
period, or not yet
in repayment.

25

Clarify that this
does not include
regular bills.
26

Not including any mortgages or auto loans, what
is the size of your household’s overall debt (eg
credit card debt, student debt, payday loans
(small, short-term unsecured loans))?
01 Less than $5,000
02 $5000 - $9,999
03 $10,000 - $20,000
04 Above $20,000
What is the size of your household’s monthly
payments toward this debt?
01
02
03
04

Below $100
$100 - $199
$200 - $300
Above $300

[ ]

$|__|__|__|__|__|__|
[ ]05
[ ]
I have
not been
actively
saving
[ ]
[ ]
01
02
03
04
888
999

O
O
O
O
O
O

Don’t know
Refused
Less than $5,000
$5000 - $9,999
$10,000-$20,000
Above $20,000
Don’t know
Refused

01
02
03
04
888
999

O
O
O
O
O
O

Below $100
$100 - $199
$200 - $300
Above $300
Don’t know
Refused

7

Formatted: Underline

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
Cosign
means to sign
onto a loan with
another person,
where you share
responsibility; if
the first
borrower does
not pay back the
loan, the person
who “cosigned”
with them is
legally required
to make
payment on their
behalf.

27

2824

Have you ever cosigned on a loan for another
person?

01
02
888
999

How often do you buy lottery tickets?

03

Would you say
01 “Multiple tickets per week”
02 “About one ticket per week”
03 “About once a month”
04 “A few times a year”
05 “Less than 1 ticket per year average my
your adult life”
06 “Never purchased a lottery ticket”

2925

How often do you go to the casino to
gamble?
Would you say
01 “At least once a week”
02 “At least once a month”
03 “At least once a year”
04 “Less than once a year”05 “I’ve never
been to the casino”
If 05, skip to 32.

O
O
O
O

Yes
No
Don’t know
Refused

O01
O
Multipl
e per
week
04
O02
O
About
one per week
05
O03
O
About
once a month
06
O04
O
A few
times a year
07
O05
O
Less
than once
per year
08
O06
O
Never
888 O
Don’t know
999 O
Refused
01
O
At least once a
week
02
O
At least once a
month
03
O
At least once a
year
04
O
Less than once a
year
05
O
I’ve never been
to the casino
888 O
Don’t know
999 O
Refused

8

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
3026

When you go to the casino to gamble, do
you set a spending limit for yourself ahead
of time?
01 Yes.
02 No.
03 Sometimes

3127

32

If 02, skip to 32.
How often do you exceed the spending limit
you set for yourself?
01 Always
02 Very Often
03 Fairly Often
04 Sometimes
05 Almost Never
06 Never
If you want to buy something that you really
want but don’t need 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 “Credit card”
07 “Rent-to-Own”
08 “Do not buy the item”
777 “Other”

3328

How would you describe your overall
financial situation? Would you say
“excellent”, “very good”, “ok”, “not very
good”, or “bad”?

01
02
03
888
999

O
O
O
O
O

01
02
03
04
05
06

[
[
[
[
[
[

]
]
]
]
]
]

Always
Very Often
Fairly Often
Sometimes
Almost Never
Never

07
08
09
10

[
[
[
[

]
]
]
]

11

[ ]

Save up for it
Take out a loan
Put it on layaway
Borrow money
from a friend or
relative
Sell some
possessions
Credit card
Rent-to-own
Do not buy the

12
13
14

Yes
No
Sometimes
Don’t know
Refused

[ ]
[ ]
[ ]
item
777
[ ]
888 [ ]
999 [ ]
01
O
02
O
03
O
04
O
05
O

Other
Don’t know
Refused
Excellent
Very good
OK
Not very good
Bad

9

OMB Control Number: 3170-0044

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



Respondent ID:
«Unique Identifier»

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 whether you completely
agreestrongly agree, agree, feel neutrally, disagree, or strongly disagree that the each
statement describes you and 5 shows that you completely disagree:.
34 My financial situation is a source of stress in
my life.
01
02
03
04
05

Completely Strongly agree
Agree2
Neutral3
Disagree4
Completely Strongly disagree

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

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

01

O
Completely
Strongly agree
02
O
2Agree
03
O
Neutral3
04
O
Disagree4
05
O
Completely
Strongly disagree
888 O
Don’t know
999 O
Refused
01
O
Strongly agree
02
O
Agree
03
O
Neutral
04
O
Disagree
05
O
Strongly
disagree
01
O
Completely
agree
02
O
2
03
O
3
04
O
4
05
O
Completely
disagree
888 O
Don’t know
999 O
Refused

10

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
36 I tend to live for today and let tomorrow take
care of itself.
01
02
03
04
05
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

37 In a typical month, it is difficult for me to cover
my expenses and pay all my bills.
01
02
03
04
05
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

01
02
03
04
05

O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999
01
02
03
04
05

O
O
O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999

O
O

Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused

11

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
38 I am confident that I could come up with
$2000 if an unexpected need arose within the
next month.
01
02
03
04
05
01
02
03
04
05

Clarify that
the chance is not
a guarantee.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

39 I am willing to take a risk financially if there is
a chance of substantial gain.

01
02
03
04
05
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

01
02
03
04
05

O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999
01
02
03
04
05

O
O
O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999

O
O

Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused

12

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
40 I set long term financial goals of five years or
more and strive to achieve them.
01
02
03
04
05
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

41 The purpose of money is for it to be spent.
01
02
03
04
05
06

Completely agree
2
3
4
Completely disagree

42 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
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

01
02
03
04
05

O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999
01

O
O
O

02
03
04
05

O
O
O
O

888
999
01
02
03
04
05

O
O
O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999

O
O

Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused

13

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
43 I demand the highest quality in everything I do.
01
02
03
04
05
01
02
03
04
05

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

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

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

01
02
03
04
05

O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999
01
02
03
04
05

O
O
O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999

O
O

Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused

14

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

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

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Completely agree
2
3
4
Completely disagree

46 Suppose the credit union 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?
01 $50 today
02 $100 in one month

01
02
03
04
05

O
O
O
O
O

01

O

02
03
04
05

O
O
O
O

888
999
01
02

O
O
O
O

888
999

O
O

01
02

O
O

888
999

O
O

01
02

O
O

888
999

O
O

Strongly agree
Agree
Neutral
Disagree
Strongly
disagree
Completely
agree
2
3
4
Completely
disagree
Don’t know
Refused
$50 today
$100 in one
month
Don’t know
Refused

Formatted: Font: 10 pt

[If 02, skip to 48]
47 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? Which would you choose?
01 $50 today
02 $150 in one month

$50 today
$150 in one
month
Don’t know
Refused

Formatted: Font: 10 pt

[Skip to 49]
48 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

$50 today
$75 in one
month
Don’t know
Refused

15

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

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

01
02

O
O

$50 in 6 months
$100 in 7
months
Don’t know
Refused

888
999

O
O

01
02

O
O

888
999

O
O

$50 in 6 months
$150 in 7
months
Don’t know
Refused

01
02
888
999

O
O
O
O

$50 in 6 months
$75 in 7 months
Don’t know
Refused

01
888
999

O
O

Don’t know
Refused

01
02
03
04

O
O
O
O

888
999

O
O

More than $110
Exactly $110
Less than $110
It is impossible
to tell from the
information
given
Don’t know
Refused

[If 02, skip to 51]
50 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? Which would you choose?
01 $50 in 6 months
02 $150 in 7 months
[Skip to 52]
51 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?

Put decimal
place in
appropriate box.

01 $50 in 6 months
02 $75 in 7 months
52 Suppose you put $100 into a no fee 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?
53 How much would be in the account at the end
of five 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

$

16

Formatted: Font: 10 pt

OMB Control Number: 3170-0044

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

Respondent ID:
«Unique Identifier»

17

OMB Control Number: 3170-0044

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



Respondent ID:
«Unique Identifier»

Read Aloud: Now I’m going to read out a list of items. After I read each one, please tell me
whether you think it can affect the amount of interest that you would pay on a bank loan.
The first is..
54 Your credit rating? Would you say…
01
O Yes – this
affects the
01 Yes – this affects the amount of interest you
amount of
would pay on a bank loan.
interest.
02 No – this does NOT affect the amount of
02
O
No
– this
interest you would pay on a bank loan.
does NOT
affect the
amount of
interest.
888 O
Don’t know
999 O
Refused
55 The amount of money you have in savings?
01
O
Yes – this
affects the
01 Yes – this affects the amount of interest you
amount of
would pay on a bank loan.
interest.
02 No – this does NOT affect the amount of
02
O
No – this
interest you would pay on a bank loan.
does NOT
affect the
amount of
interest.
888
O
Don’t know
999
O
Refused
56 Your annual income?
01
O
Yes – this
affects the
01 Yes – this affects the amount of interest you
amount of
would pay on a bank loan.
interest.
02 No – this does NOT affect the amount of
02
O
No – this
interest you would pay on a bank loan.
does NOT
affect the
amount of
interest.
888
O
Don’t know
999
O
Refused

18

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
57 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.

58 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.

59 How much you borrow overall?
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

O

02

O

888
999
01

O
O
O

02

O

888
999
01

O
O
O

02

O

888
999

O
O

Yes – this
affects the
amount of
interest.
No – this
does NOT
affect the
amount of
interest.
Don’t know
Refused
Yes – this
affects the
amount of
interest.
No – this
does NOT
affect the
amount of
interest.
Don’t know
Refused
Yes – this
affects the
amount of
interest.
No – this
does NOT
affect the
amount of
interest.
Don’t know
Refused

19

OMB Control Number: 3170-0044

Respondent ID:
«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey Pilot
60 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.

01

O

02

O

888
999

O
O

Yes – this
affects the
amount of
interest.
No – this
does NOT
affect the
amount of
interest.
Don’t know
Refused

TIME COMPLETED SURVEY (HHMM):

20