Appendix F Nonresponse follow up Questionnaire

Appendix F - AHHS II Nonresponse Follow-up Questionnaire

Q1. When was your home built?

1. 1978 TO PRESENT 

2. BETWEEN 1960 AND 1977 

3. BETWEEN 1940 AND 1959 

4. 1939 OR BEFORE 

5. DON’T KNOW 

Q2. Is your home a single-family home (including a townhouse, row house or duplex)?

1. YES   (SKIP TO Q4)

2. NO 

3. DON’T KNOW 

Q3. Would you say that there are 4 or fewer units, or 5 units or more, in your building?

1. 4 OR FEWER UNITS 

2. 5 UNITS OR MORE 

3. DON’T KNOW 

Q4. How many people live in this home, including yourself, other adults, and any children?

1. NUMBER OF RESIDENTS |__| |__|

2. DON’T KNOW 

Q5. Do any children under the age of 18 live in this home?

4. YES 

5. NO   (SKIP TO Q7)

6. DON’T KNOW 

Q6. Do any children under the age of 6 live in this home?

1. YES 

2. NO 

3. DON’T KNOW 

Q7. Do you own or rent this home?

1. OWN   (SKIP TO Q9)

2. RENT 

3. DON’T KNOW 

Q8. Is the housing authority your landlord or is your house/apartment privately owned?

1. HOUSING AUTHORITY 

2. PRIVATE LANDLORD 

3. DON’T KNOW 

Q9. Which of the following best represents your total household income for 2017?

1. Up to $34,999 

2. $35,000 or above 

3. DON’T KNOW 

Q10. Which race or races do you consider yourself as belonging to (please check all that apply)?

1. WHITE 

2. BLACK OR AFRICAN AMERICAN 

3. ASIAN 

4. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 

5. AMERICAN INDIAN OR ALASKAN NATIVE 

Q11. Do you consider yourself Hispanic or Latino?

1. HISPANIC OR LATINO 

2. NOT HISPANIC OR LATINO 

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