Focus Group Questionnaire

OMB Approval No. XXX-XXXX Expires: MM-DD-YYYY

ConnectHome Focus Group Questionnaire

1. What is your age?

☐18 to 25

☐ 26 to 35

☐ 36 to 50

☐ 51 to 64

☐ 65+

2. What is your current employment status?

☐ Employed full time (35+ hours/week)

☐ Employed part time (1-34 hours/week)

☐ Not employed

3. What is your education level?

☐ Grade school or some high school

☐ High school graduate or GED
☐ Some college, technical, or vocational school

☐ Two-year degree

☐ Four-year college degree or higher

4. What is the primary language spoken at your home?

☐ English

☐ Spanish

☐ Other: _______________________________

5. Including yourself, how many people live in your household?

_______________________________________

6. How many children 18 and under live in your household?

_______________________________________

7. Do you or anyone in your household have internet access in your home (including by smart phone)?

☐ Yes ☐ No

8. How, if at all, do people living in your home access the Internet while at home? Please check all that apply.

☐ No internet at home

☐ Through a high-speed Internet subscription (for example: Comcast, Cox, AT&T, Verizon, CenturyLink, Charter)

☐ Through a smartphone data plan (for example: Sprint, Verizon, AT&T, T-Mobile)

☐ Through a dial-up connection

☐ Through WiFi based outside of your home (for example: public access or from a neighbor)

☐ Other:

9. During the last 30 days, has anyone in your home used the following devices use to access the internet while at home?

	Yes	No
Smart phone
Desktop computer
Laptop, Notebook, or Netbook (for example: Chromebook, HP Mini, Macbook, Dell Inspiron)
Tablet (for example: IPad, Samsung Galaxy Tab, Kindle Fire)
Gaming console
Smart TV or device that connects TV to the Internet
Other (specify):_______________

10. During the last 30 days, how often did anyone in your home use the internet while at home?

☐ Every day

☐ A few times a week

☐ Once a week

☐ A few times in the last 30 days

☐ I don’t have internet in my home

11. On a scale of 1 to 10, how easy or difficult is it for you to use a computer? Circle one below:

1	2	3	4	5	6	7	8	9	10
Very easy									Very difficult

12. On a scale of 1 to 10, how easy or difficult is it for you to use the Internet? Circle one below:

1	2	3	4	5	6	7	8	9	10
Very easy									Very difficult

13. If a free training were offered on how to use computers, how likely would you be to participate in the training?

☐ Very likely

☐ Somewhat likely

☐ Somewhat unlikely

☐ Very unlikely

14. If a free training were offered on how to use the Internet, how likely would you be to participate?

☐ Very likely

☐ Somewhat likely

☐ Somewhat unlikely

☐ Very unlikely

Paperwork Reduction Act Notice. Public reporting burden for this collection of information is estimated to be .083 hours (5 minutes) per PHA resident, and includes time for reviewing the instructions, and completing and reviewing the responses. Your completion of this information collection is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a current, valid OMB control number.