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pdfDEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
OMB Control Number: 1660-0105
Expiration Date: 09/30/2017
Public reporting burden for this survey is estimated to average 15 minutes per response. The
burden estimate includes the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and submitting the survey. This
collection of information is required to voluntary. You are not required to respond to this collection
of information unless it displays a valid OMB control number is displayed in the upper right corner
of this form. Send comments regarding the accuracy of the burden estimate and any
suggestions for reducing the burden to: Information Collections Management, Department of
Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington
VA 20598-3005, Paperwork Reduction Project (1660-0105) NOTE: Do not send your
completed form to this address.
SECTION I. INTRODUCTION
Hello, this is ______ calling for the Research Company on behalf of the Federal Emergency
Management Agency (FEMA). We are doing a special poll about preparation for disasters and
would like to include your opinions. This survey will take about 15 minutes and is completely
voluntary.
These questions comply with the Privacy Act of 1974 and have been approved by the Office of
Management and Budget under number 1660-0105.If you have any questions about the
survey, you can reach a FEMA contact by calling 1-202 646-2500) and indicating you want
to talk with a contact for the FEMA Survey.
(If landline , read:) In order to keep our poll random, please think about everyone living in
your household age 18 or older. May I please speak with the person who will celebrate the
next birthday?
(Interviewer: If necessary, probe with:) May I speak to the person who will
celebrate the next birthday?)
(Interviewer: If necessary, probe with:) Is that person available?)
(Interviewer: If necessary, read:) Asking for the person with the next birthday is
how we randomly choose our survey respondents, which makes our research
more representative of the U.S.)
(Interviewer: If respondent has difficulty figuring out next birthday, read:) I
need to speak to the person in your household who will be celebrating the next
birthday. Please think about everyone who lives in your household, 18 years of
age or older, and their birthdays. Is the person who will have the next birthday
available?)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
1
4
7
8
9
Respondent available - (Continue)
Next birthday respondent not available (Continue)
Respondent not available/Not a good
time/Wants to be called later - (Set time
to call back)
(Soft Refusal)
(Hard Refusal) - (Thank and
Terminate)
(Interviewer: All interviews are recorded. The recording begins when the
respondent answers the phone. This statement is read after the "Continue"
response is entered after the Introduction and before the first question.)
A. RECORDING NOTICE
This interview will be recorded for internal quality assurance.
1
2
(Continue)
(Refused) - (Thank and Terminate)
Skip: (If code 1 “Respondent available” in INTRO, Skip to “Interview Start”;
Otherwise, Continue)
B. Call Back
(Interviewer: This case will now be suspended - please type in
the name or age/gender of the respondent who has been selected so that the
callback can be directed to the appropriate person.)
Follow up for call-back to selected respondent
Interviewer: If necessary, read:) So that we can reach this person more easily when
we call back, can you please tell me this person's first name or initials?
(Interviewer: If necessary, read:) If you prefer to not give me their first name,
could you tell me their age and gender so we know who to ask for when we call
back?)
(Interviewer: IF NO INFORMATION PROVIDED, ENTER: "18 + NB")
(Programmer: Suspend Survey)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
(Interviewer: When suspended survey resumes, read:)
Hello, this is _________ with the Research Company’s Poll calling on behalf of Federal
Emergency Management Agency (FEMA). Can I please speak with (______________)? We
are doing a special poll and you have been randomly selected to respond to this survey. This
survey will take about 15 minutes and is completely voluntary.
These questions comply with the Privacy Act of 1974 and have been approved by the Office of
Management and Budget under number 1660-0105.If you have any questions about the
survey, you can reach a FEMA contact by calling 1-202 646-2500) and indicating you want a
contact for the FEMA Survey.
1
2
7
8
Yes, male respondent available
Yes, female respondent available
Respondent not available/Not a good
time
(Refused)
Skip: (If code 1 in above, Autocode as 1;
If code 2 in above, Autocode as 2;
If code 7 in above, Reset to “Call Back” script;
If code 8 in above, Thank and Terminate)
RECORDING NOTICE
(Interviewer: All interviews are recorded. The recording begins when
the respondent answers the phone. This statement is read after the
"Continue" response is entered after the Introduction and before the first
question.)
This interview will be recorded for internal quality assurance.
1
2
(Continue)
(Refused) - (Thank and Terminate)
SECTION II. INTERVIEW START
GENDER:
(Interviewer: Code only; Do NOT ask)
1
2
Male
Female
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
A. LANDLINE/CELL
Have I reached you on a landline phone or on a cell phone?
(Interviewer: If respondent says ‘home phone,’ ‘VOIP/Internet phone,’ or
any type of phone other than a cell phone, code as ‘1.’)
1
2
3
4
5
Landline
Cell Phone
(DK)
(Refused)
(Business Line-Landline or Cell)
[VOLUNTEERED]
Skip: (If code 5 in is the response code above, Thank and Terminate; Otherwise,
Continue)
B. AGE
Please tell me your age.
(Interviewer: Open ended and code actual age using coding table)
(Programmer: Note #1)
Skip: (If “AGE” code 01-17 in above response, Thank and Terminate;
Otherwise, Continue)
(Programmer: Note #2)
Skip: (If BLANK in “GENDER” coding above, Continue;
Otherwise, Skip to Note before “STATE” )
C. GENDER:
(Interviewer: Code only; Do NOT ask)
1
2
Male
Female
Skip: (If part of a “HAZARD OVERSAMPLE” , Continue;
Otherwise, Skip to Read before Awareness1)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
D. HAZARD OVERSAMPLE VERIFICATION
1) STATE validation
What is the name of the state you live in?
(Interviewer: Open ended and code using State coding table
(Programmer: Note #1:)
Skip: If code 98 (DK) or 99 (Refused) in above, Thank and Terminate;
Otherwise, Continue
(Programmer: Note #2:)
Skip: (If code 03 or 04 in for Oversample #1 in “SAMPLE TYPE”, Continue;
Otherwise, Skip to Note before “COUNTY Oversample #2”)
HOLD
List Other: Y
2) COUNTY validation – coded by interviewer for each of the eight Oversamples using a
skip pattern to proceed through the oversamples.
What is the name of the county you live in?
(Interviewer: Open ended and code using OVERSAMPLE coding table)
3) ZIPCODE VALIDATION
What is your ZIP Code?
(Interviewer: Open ended and code all five digits of ZIP Code)
(Programmer:
The ONLY valid ZIP Codes are the following (by Oversample):
ZIPMATCH
[DO NOT ASK; AUTOCODED:] Valid County, FIPS CODE, and ZIP
Code Provided.
1
2
Yes
No
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
Skip: (If code 2 in ZIPMATCH, Thank and Terminate;
Otherwise, Continue)
4) OVERSAMPLE HAZARD AND GEO PROFILES
HAZARD PROFILE 1:
(Programmer:
If code 01-45 in QNSD13_1, Autocode as 1;
If code 01-44 in QNSD13_2, Autocode as 2;
If code 001-165 in QNSD13_3, Autocode as 3;
If code 001-078 in QNSD13_7, Autocode as 4;
If code 01-92 in QNSD13_4, Autocode as 5;
If code 001-116 in QNSD13_5, Autocode as 6;
If code 001-345 in QNSD13_6, Autocode as 7;
If Valid ZIP Code in QNSD13_8, Autocode as 8;
Otherwise, Thank and Terminate)
HAZARD PROFILE SELECTIONS USED FOR 2017 SURVEY
1
Tornado Section
2
Flood Section
3
Hurricane Section
4
Extreme Heat Section
5
Wildfire
6
Earthquake
7
Winter storm
8
Urban Area
HAZARD PROFILE ALTERNATIVE HAZARD SELECTIONS
The following are alternative Oversample Profiles for selection. Hazard profiles will be selected
to maintain the maximum 15 minute survey administration and selection of questions provided
in the PRA such that the approved burden hours and questions are maintained.
Hazards: Power Outages, pandemic flu, hazardous material, nuclear, and terrorism
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
13-8 Demographic: HOME OWNERSHIP
Do you rent or own your home?
1
Rent
2
Own
3
(Other)
4
(DK)
5
(Refused)
(Interviewer: READ:)
Your responses will not be shared with anyone in a way that could personally identify you.
III. Question topics
1. AWARENESS
1a.
Read, seen, heard. In the past six months, have you read, seen, or heard any
information about how to get better prepared for a disaster? By disaster, I mean events
that could threaten lives, disrupt public or emergency services like water and power, or
damage property.
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in A1, Continue; Otherwise, Skip to A2)
1b.
What. What was it that you read, saw, or heard about how to get better prepared
for a disaster?
(Interviewer: Open ended)
(Programmer: Allow up to two responses)
01
02
03
04
05
Other (list)
(DK)
(Refused)
HOLD
HOLD
# of Responses: 2
List Other: Y
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
1c.
Action. After receiving the information about how to get better prepared, did you
take any steps to prepare for a disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
2. STAGES
2.a In thinking about preparing yourself for a major disaster, which best represents
your preparedness?
(Interviewer: Read 1-5)
1
2
3
4
5
8
9
I have not yet prepared, but I intend to in
the next six months
I have not yet prepared, but I intend to in
the next month
I just recently began preparing
I have been prepared for at least the
past six months
I am not planning to do anything about
preparing
(DK)
(Refused)
3. BEHAVIORS
3a. Drills. In the past year, have you practiced what to do in a disaster by participating
in a disaster preparedness exercise or drill __________?
(Interviewer: read and rotate B3a-1 through B3a-4)
1
2
3
4
Yes
No
(DK)
(Refused)
3a-1-4 Drill locations.
3a-1
3a-2
3a-3
3a-4
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At home
At work
At school
At another community location
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
Skip: (If code 1 in 3a, Continue; Otherwise, Skip to 3b)
3a 6In what other drill have you participated?
(Interviewer: Open ended)
01
02
03
04
05
Other (list)
(DK)
(Refused)
HOLD
HOLD
List Other: Y
Skip: (If code 1 in ANY in 3a 1-4, Continue; Otherwise, Skip to 3b)
3 a-7 Drills Types. In which of the following drills have you participated?
(Interviewer: Read and rotate 3a-5a-d)
1
2
3
4
Yes
No
(DK)
(Refused)
3a-5a
3a-5b
3a-5c
3a-5d
3a-5e
Building evacuation or fire drill
Sheltering from the high winds of a tornado or hurricane
An earthquake drill
Sealing a room against contaminated air
Some other drill
3b. Plans. Has your household developed and discussed an emergency plan that
includes instructions for household members about where to go and what to do in the
event of a local disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in 3b, Continue; Otherwise, Skip to 3c)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
3b-1 Plans – communications. Does your plan include a process for your household
members to get in touch with each other if you are not together when the disaster
happens?
1
2
3
4
Yes
No
(DK)
(Refused)
3b-2 Plans – evacuation. Does your plan include information about how to leave your
community for an evacuation?
1
2
3
4
Yes
No
(DK)
(Refused)
3b-3 Plans – shelter. Does your plan include information about where to shelter or a
safe place you can stay in the event of a disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
3b-4 Plans – Checking neighbors. Does your plan include checking on your
neighbors (those in your neighborhood or apartment building) to make sure they are
okay in the event of a disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
3c Transportation. In the event of a disaster that required you to leave your area,
would you need to rely on public transportation or the local authorities for
transportation in order to leave?
1
2
3
4
Yes
No
(DK)
(Refused)
3d Alerts and Warnings. Do you know how you will get real-time alerts and warnings
for disasters in your community?
1
2
3
4
Yes
No
(DK)
(Refused)
3e-1 Supplies for 3 days. Do you have enough supplies set aside in your home to
get you through three days without power or running water and without transportation?
1
2
3
4
Yes
No
(DK)
(Refused)
3e-2 Supplies ready to go. Do you have emergency supplies already packed that
you can grab easily in case you have to evacuate your home quickly?
1
2
3
4
Yes
No
(DK)
(Refused)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
Skip: (If code 1 in 3e1, Continue; Otherwise, Skip to 3f)
3e-3 Utilities. How many days do you think you could last in your home without
power, running water, or transportation?
(Interviewer: Open ended and code actual number of days)
03
96
97
98
99
0396
97+
(DK)
(Refused)
3f Critical Documents. Do you have copies of critical documents, such as
identification, insurance, and banking information, stored in a fireproof/waterproof
location or stored electronically?
1
2
3
4
Yes
No
(DK)
(Refused)
3g Seeking information
Please indicate how recently you, personally, have taken any of the following
actions to prepare for a possible disaster. How recently have you (read and
rotate 3g1-3g3, has it been (read 1-3)?
1
2
3
4
8
9
3g-1
3g-2
3g-3
Within the past six months
More than six months but less than a
year ago, or
More than a year ago
(I have not done this)
(DK)
(Refused)
Attended a meeting or training on preparedness about your local disasters
Talked with others in your community about getting prepared for a disaster
Sought information about preparedness
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
4. RISK
4a Risk - Hazard perception. All areas of the country are subject to different types
of disasters - will you please name the types of disasters that would have the
biggest impact where you live?
(Interviewer: Open ended and code)
(Programmer: Allow up to three responses)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Other (list)
(DK)
(Refused)
None
All
An earthquake
A tornado
A hurricane
A major snowstorm/ice storm/extreme
winter weather
A wildfire
A flood
Extreme heat
A storm surge
A nuclear event (explosion, accident,
terrorism)
A volcano
A tsunami
A radioactive or "dirty" bomb
A terrorist attack
A land slide
A widespread outbreak of contagious
disease
A widespread food or water
contamination
A toxic chemical gas
A toxic chemical spill
# of Responses: 3
List Other: Y
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
4b Risk – Response efficacy How much would taking steps to prepare, such as
creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a disaster in your area? Would it help (read 1-5)?
1
2
3
4
5
8
9
Not at all
Very little
Somewhat
Quite a bit
A great deal
(DK)
(Refused)
4c Risk – Self efficacy. How confident are you that you can take the steps to
prepare for a disaster in your area? Would you say you are (read 1-5)?
1
2
3
4
5
8
9
Not at all confident
Slightly confident
Somewhat confident
Moderately confident
Extremely confident
(DK)
(Refused)
Skip: (If code 1, 2, or 3 in 4c, Continue;
Otherwise, Skip to 5 Experience)
4d Risk – Barriers. Is there a reason you think you would not be able to take the
steps to prepare?
(Interviewer: Open ended)
(Programmer: Allow up to two responses)
01
02
03
04
05
Other (list)
(DK)
(Refused)
No/None
HOLD
# of Responses: 2
List Other: Y
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
5. EXPERIENCE
5a Experience. Have you or your family ever experienced the impacts of a
disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in 5, Continue; Otherwise, Skip to ST_STG1)
5b Experience Self Did you experience it yourself?
1
2
3
4
Yes
No
(DK)
(Refused)
6. STAGES
6a. STAGES Self-assess. Thinking about preparing yourself for a disaster,
have you developed and discussed an action plan with your family, that includes
information about how to leave your community or where to shelter, and have
set aside supplies such as, food, water, and other essentials that allow you to be
self-sufficient for at least three days?
Which of the following best represents your preparedness?
(Interviewer: Read 1-5)
1
2
3
4
5
8
9
I have NOT prepared, and I do not intend to prepare in the next
year
I have NOT prepared, but I intend to prepare in the next year
I have NOT prepared, but I intend to prepare in the next six
months
I have been prepared for the last year
I have been preparing for MORE than a year
(DK)
(Refused)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
Programmer Note: (If code 01,02 for Sample# 0 (national) or code 17 or 18
for Sample #8 (urban) in “SAMPLE TYPE” Skip to STAGES 6 motivation,
Otherwise Continue
6b. STAGES - Hazard Thinking about preparing yourself for __________, have
you developed and discussed an action plan with your family, that includes
information about how to leave your community or where to shelter, and have set
aside supplies such as, food, water, and other essentials that allow you to be
self-sufficient for at least three days?
Which of the following best represent your preparedness? (Read 1-5)
(Interviewer: (oversample hazards)
1
2
3
4
5
8
9
I have NOT prepared, and I do not intend to prepare in the next year
I have NOT prepared, but I intend to prepare in the next year
I have NOT prepared, but I intend to prepare in the next six months
I have been prepared for the last year
I have been preparing for MORE than a year
(DK)
(Refused)
6b.
(If code 06 in ANY Response in B1, and HAZPROF1=6 ask:)
(Earthquake) Otherwise ask First Response in B1
If code 07 in ANY Response in B1, and HAZPROF1=1 ask:)
(Tornado) Otherwise ask First Response in B1
If code 08 in ANY Response in B1, and HAZPROF1=3 ask:)
(Hurricane) Otherwise ask First Response in B1
If code 09 in ANY Response in B1, and HAZPROF1=7 ask:)
(Winter Storm) Otherwise ask First Response in B1
If code 10 in ANY Response in B1, and HAZPROF1=5 ask:)
(Winter Storm) Otherwise ask First Response in B1
If code 11 in ANY Response in B1, and HAZPROF1=2 ask:)
(Flood) Otherwise ask First Response in B1
If code 12 in ANY Response in B1, and HAZPROF1=4 ask:)
(Extreme Heat) Otherwise ask First Response in B1
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
6c. STAGES motivation DC_BAL1
How important are the following in your decision to prepare for disaster? Would
you say it is (read 1-5)?
(Interviewer: Read and rotate Motivation 1A to 1E)
1
2
3
4
5
8
9
Motivation 1A
Motivation 1B
Motivation 1C
Motivation 1D
Motivation 1E
Not at all important
Not very important
Somewhat important
Very important, or
Extremely important
(DK)
(Refused)
I would feel good about being prepared
I would reduce the risk of disrupting my life during and after a disaster
It would be a hassle to make the plans, discuss them, and set aside supplies
Doing what it takes to be prepared would take time away from other activities
Doing what it takes to be prepared cost too much money
Skip: (If code 01 or 02 for Sample# 0 (national) “SAMPLE TYPE”, Skip to Read
before the Note before D1;
Otherwise, Continue)
IV Disaster Questions for all hazard samples
7. DISASTERS
(Interviewer: READ:)
Now I want us to talk specifically about disasters that may affect the area in
which you live.
7a. Risk of Hazard.
(If code 1 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for a TORNADO to happen?
(If code 2 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for a FLOOD to happen?
(If code 3 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for a HURRICANE to happen?
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
(If code 4 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for EXTREME HEAT to happen?
(If code 5 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for a WILDFIRE to happen?
(If code 6 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for an EARTHQUAKE to happen?
(If code 7 in HAZPROF, read:) Thinking about the area you live in, how likely or
unlikely would it be for a WINTER STORM to happen?
1
2
8
9
Likely
Unlikely
(DK/Not sure)
(Refused)
7b. Awareness read, seen, heard
(If code 1 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for a TORNADO?
(If code 2 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for a FLOOD?
(If code 3 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for a HURRICANE?
(If code 4 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for EXTREME HEAT?
(If code 5 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for a WILDFIRE?
(If code 6 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for an EARTHQUAKE?
(If code 7 in HAZPROF1, read:) In the past six months, have you read, seen, or
heard any information about how to get better prepared for a WINTER STORM?
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in Awareness 7b, Continue;
Otherwise, Skip to 7f Efficacy)
7c. Awareness - What
(If code 1 in HAZPROF1, read:) What was it that you read, saw, or heard
about how to get better prepared for a TORNADO?
(If code 2 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for a FLOOD?
(If code 3 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for a HURRICANE?
(If code 4 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for EXTREME HEAT?
(If code 5 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for a WILDFIRE?
(If code 6 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for an EARTHQUAKE?
(If code 7 in HAZPROF1, read:) What was it that you read, saw, or heard about
how to get better prepared for a WINTER STORM?
(Interviewer: Open ended)
(Programmer: Allow up to two responses)
01
02
03
04
05
Other (list)
(DK)
(Refused)
HOLD
HOLD
# of Responses: 2
List Other:Y
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7d. Awareness Action
(If code 1 in HAZPROF1, read:) After receiving the information about how
to get better prepared, did you take any steps to prepare for a TORNADO?
(If code 2 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for a FLOOD?
(If code 3 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for a HURRICANE?
(If code 4 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for EXTREME HEAT?
(If code 5 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for a WILDFIRE?
(If code 6 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for an EARTHQUAKE?
(If code 7 in HAZPROF1, read:) After receiving the information about how to get
better prepared, did you take any steps to prepare for a WINTER STORM?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in 7d (above) Awareness Action , Continue;
Otherwise, Skip to 7f)
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7e Motivation. What motivated you to take these steps to become better
prepared?
(Interviewer: Open ended and code)
(Programmer: Allow up to three responses)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
Other (list)
(DK)
(Refused)
Nothing
HOLD
It is likely that a disaster will occur in my community
If a disaster occurred in my community, it would be severe
People I know have taken steps to get prepared
If a disaster occurred in my community, the police and fire department might
not be able to take care of needs
I feel like it is my responsibility to take care of my family in a disaster
I want to protect myself in a disaster
My job or school encouraged me to take steps to become better prepared
A friend or family member encouraged me to take steps to become better
prepared
A trusted leader encouraged me to take steps to become better prepared
It just seems like something I should do
Disasters I have experienced motivated me to get better prepared
Disasters in other places motivated me to take steps to become better
prepared
Preparedness activities in my community
# of Responses: 3
List Other:Y
7f Response efficacy
(If code 1 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a TORNADO? Would it help (read 1-5)?
(If code 2 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a FLOOD? Would it help (read 1-5)?
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(If code 3 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a HURRICANE? Would it help (read 1-5)?
(If code 4 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through EXTREME HEAT? Would it help (read 1-5)?
(If code 5 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a WILDFIRE? Would it help (read 1-5)?
(If code 6 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through an EARTHQUAKE? Would it help (read 1-5)?
(If code 7 in HAZPROF1, read:) How much would taking steps to prepare, such
as creating a household emergency plan, developing an evacuation and shelter
plan, signing up for alerts and warning systems, or stocking up on supplies help
you get through a WINTER STORM? Would it help (read 1-5)?
1
2
3
4
5
8
9
Not at all
Very little
Somewhat
Quite a bit
A great deal
(DK)
(Refused)
7g RISK Self Efficacy
(If code 1 in HAZPROF1, read:) How confident are you that you can take
the steps to prepare for a TORNADO? Would you say (read 1-5)?
(If code 2 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for a FLOOD? Would you say (read 1-5)?
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(If code 3 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for a HURRICANE? Would you say (read 1-5)?
(If code 4 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for EXTREME HEAT? Would you say (read 1-5)?
(If code 5 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for a WILDFIRE? Would you say (read 1-5)?
(If code 6 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for an EARTHQUAKE? Would you say (read 1-5)?
(If code 7 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for a WINTER STORM? Would you say (read 1-5)?
(If code 8 in HAZPROF1, read:) How confident are you that you can take the
steps to prepare for a NULCEAR EVENT? Would you say (read 1-5)?
1
2
3
4
5
8
9
Not at all confident
Slightly confident
Somewhat confident
Moderately confident
Extremely confident
(DK)
(Refused)
7h Experience
(If code 1 in HAZPROF1, read:) Have you or your family ever experienced
a TORNADO?
(If code 2 in HAZPROF1, read:) Have you or your family ever experienced a
FLOOD?
(If code 3 in HAZPROF1, read:) Have you or your family ever experienced a
HURRICANE?
(If code 4 in HAZPROF1, read:) Have you or your family ever experienced
EXTREME HEAT?
(If code 5 in HAZPROF1, read:) Have you or your family ever experienced a
WILDFIRE?
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(If code 6 in HAZPROF1, read:) Have you or your family ever experienced an
EARTHQUAKE?
(If code 7 in HAZPROF1, read:) Have you or your family ever experienced a
WINTER STORM?
?
(Interviewer: If necessary, read:) By experience, I mean being in an area that
was directly impacted by the effect of [(If code 1 in HAZPROF1, read:) a
TORNADO/(If code 2 in HAZPROF1, read:) a FLOOD/(If code 3 in
HAZPROF1, read:) a HURRICANE/(If code 4 in HAZPROF1, read:) EXTREME
HEAT/(If code 5 in HAZPROF1, read:) a WILDFIRE/(If code 6 in HAZPROF1,
read:) an EARTHQUAKE/(If code 7 in HAZPROF1, read:) a WINTER STORM.)
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in 7h (previous question), Continue;
Otherwise, Skip to Note after 7i Experience-self)
7i Experience – Self
Did you experience it yourself?
1
2
3
4
Yes
No
(DK)
(Refused)
ALTERNATIVE QUESTIONS
The following questions may be used to substitute for the questions asked for the
hazard samples (questions7a-7h) above provided that the total administration
time remains 15 minutes.
1. Experience. What year DID YOU OR YOUR FAMILY Experience this hazard
____________?
2. Experience. Did you have damage from this hazard?
3. Experience. Did you receive any disaster financial assistance?
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4. Experience. Did you have to re-locate?
5. Experience. If you had to relocate, did you return to the community you were in
when impacted?
6. Alerts. Are local alerts and warnings available in your local community?
7. Risk self-efficacy. What would help you feel confident in your ability to respond?
8. Awareness. If you didn’t read, see, hear information about this hazard, what/how
would be the best way to reach you?
9. Motivation. What would inspire you to do more to get ready?
Group and community activities.
School assignments and activities.
Classes/trainings on.
More information on what to do to get ready.
Knowledge of what my neighbors or family have done to get ready
Advice on cheap, low-cost methods to prepare
Knowledge of how it impacts me
What I can do to protect myself and my family
Skip: (If code 4 (Extreme Heat) or 7 (Winter Storm) in HAZPROF, Skip to Read before
the Note before Demographics section ;
Otherwise, Continue)
V. Hazard specific questions
(Interviewer: READ:)
We are almost done. I just have a few more questions for you.
Skip: (If code 1 (tornado) in HAZPROF, Continue;
Otherwise, Skip to Note before section #8 Flood Section)
8. TORNADO SECTION
8 a Tornado shelter. Does your emergency plan include the location of a safe
and effective shelter in case of a tornado or high wind event __________?
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(Interviewer: read 8a 1A-1C.
(Interviewer: If necessary, read:) By safe and effective, I mean either a safe
room meeting FEMA guidelines or a small windowless interior room in a sturdy
building.)
1
2
3
4
Yes
No
(DK)
(Refused)
8a_1A
8a_1B
8a_1C
At home
At work
At school
Alternative Tornado Question:
Do you know the location of a community or business tornado shelter that you could use?
Skip: (If code 2 (Flood) in HAZPROF, Continue;
Otherwise, Skip to Note before Hurricane)
9. FLOOD SECTION
9a. Flood Risk. When you think about possible flooding, what is the MOST likely
type of flooding you think would happen in your community? (Read and Rotate
1-5)
1. Coastal surge – (INTERVIEWER READ: This is ocean water being
pushed on shore during a storm)
2. Riverine – (INTERVIEWER READ: This is rivers overflowing their banks)
3. Urban – (INTERVIEWER READ: This is flooding from nearby water or
heavy rains that overflow drainage systems and flood the streets
4. Flash flood – (INTERVIEWER READ: This is a sudden flash flood with a
high volume of water going over dry land and roads )
5. Other (list)
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9b. Flood Protective Action. Which of the following actions are you most likely
to take in the event there was [INSERT CODE FROM 9a] flooding in your
community?
1.
2.
3.
4.
Following a planned route to evacuate by car or other transportation
Going to the highest floor in a building
Climbing to a high place outside
Other (list)
9c. Flood alerts and warnings. In the event of a flood, do you believe you will
receive timely information from local authorities that gives you specific
instructions on what to do based on your community?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 2 in Demographics 13-8 (home ownership, administered in the
Introduction), Continue;
Otherwise, Skip to Note before 10. Hurricane section)
9c. Insurance. Do you currently have flood insurance?
1
2
3
4
Yes
No
(DK)
(Refused)
Alternative Flood question: How far away is the nearest flood you’ve heard about?
1
2
3
4
5
Nearby community or neighborhood
Somewhere else in my state
In a nearby state
Outside my region
(other)
Skip: (If code 3 in HAZPROF for Hurricane sample, Continue;
Otherwise, Skip to Note before 11. Wildfire Section. )
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10. HURRICANE SECTION
10a Hurricane Wind Shelter. Does your emergency plan include the location of a safe
and effective shelter in case of a high wind event?
(Interviewer: If necessary, read:) By safe and effective, I mean either a safe
room meeting FEMA guidelines or a small windowless interior room in a sturdy
building.)
1
2
3
4
Yes
No
(DK)
(Refused)
10b. Flood Risk. When you think about possible flooding, what is the MOST
likely type of flooding you think would happen in your community? (Read and
Rotate 1-5)
1. Coastal surge – (INTERVIEWER READ: This is ocean water being
2.
3.
4.
5.
pushed on shore during a storm)
Riverine – (INTERVIEWER READ: This is rivers overflowing their banks)
Urban – (INTERVIEWER READ: This is flooding from nearby water or
heavy rains that overflow drainage systems and flood the streets
Flash flood – (INTERVIEWER READ: This is a sudden flash flood with a
high volume of water going over dry land and roads )
Other (list)
10c. Flood Protective Actions. Which of the following actions are you most
likely to take in the event there was [INSERT CODE FROM 10b] flooding in your
community?
1.
2.
3.
4.
Following a planned route to evacuate by car or other transportation
Going to the highest floor in a building
Climbing to a high place outside
Other (list)
10d. Alerts and Warnings. In the event of a flood, do you believe you will
receive timely information from local authorities that gives you specific
instructions on what to do based on your community?
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1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 5 in HAZPROFfor Wildfire Oversample, Continue;
Otherwise, Skip to Note before 12 Earthquake)
Alternative Flood question: How far away is the nearest flood you’ve heard
about?
1
2
3
4
5
Nearby community or neighborhood
Somewhere else in my state
In a nearby state
Outside my region
(other)
11. WILDFIRE SECTION
11a. Wildfire evacuation. In the event of a wildfire, do you know where to go and how
to get there should you need to evacuate or leave your home?
1
2
3
4
Yes
No
(DK)
(Refused)
11b. Wildfire Protective Action Have you taken steps to protect your home from a
wildfire by clearing and removing items around your house or other buildings that
could easily burn?
1
2
3
4
Yes
No
(DK)
(Refused)
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Alternative Wildfire question: How far away is the nearest wildfire you’ve heard about?
1
2
3
4
5
Nearby community or neighborhood
Somewhere else in my state
In a nearby state
Outside my region
(other)
Skip: (If code 6 in HAZPROF for Earthquake Sample, Continue;
Otherwise, Skip to Note before
12. EARTHQUAKE SECTION
12a. Protective Action During. What is the best action to take to protect
yourself if the building you are in starts to shake and you think it's an
earthquake? Is it (read and rotate 1-3)?
1
2
3
4
5
Drop, Cover, and Hold On
Run out of the building
Get in a doorway or doorframe
(DK)
(Refused)
12b. Protective Action Mitigation. Thinking about your preparations for an earthquake
__________, have you taken steps to reduce potential flying and falling items,
such as anchoring shelving, securing cabinet doors, and moving heavy objects
down from high places?
(Interviewer: read and rotate 12bA - 12bC)
1
2
3
4
Yes
No
(DK)
(Refused)
12bA
12bB
12bC
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At work
At school
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Alternative Hazard Questions
Urban hazard
• Do you have sufficient space to store 3 days of food and water for the members of your
household and any pets?
• Skip question follow up from Q (if response to 3c is code #1 (YES):
If you are dependent on the government or others for transportation for evacuation Do you
know the specific plans for how your government or other services will provide help if you
need to evacuate
•
Extreme Heat
Do you have working air conditioning where you live?
1
yes
2
no
3
It doesn’t work
4
I can’t keep it running
5
other
•
If response is 2-5, if it is very hot outdoors and indoors, do you know a place you can
get to and stay during the day that has air conditioning?
1
2
•
yes
no
Do you know the symptoms of heat stroke and the best response?
1
2
3
yes
No
DK
Winter Storm
•
If there is a severe snow or ice storm, would you consider changing plans to avoid
travel on the roads?
1
2
yes
no
•
What, if anything, would be a reason to travel on the road in a severe winter snow or
ice storm? Open question.
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Power Outage
Do you use an alternative fuel burning heat or cooking source when the power is
•
out?
•
If yes, do you use it with ventilation?
o
1) outside with ventilation
o
2) inside with ventilation system that is designed to vent to the outside
o
3) other
•
Do you have carbon monoxide monitors on every floor?
1
2
•
yes
no
Do you have any medical equipment that requires power to operate?
1
2
yes
no
•
If #1 (yes) to above, do you have a plan for back up or a plan to re-locate to a
location with power?
1
yes
2
no
Hazardous material
• Are you aware of a plan in your community to notify you whether to shelter or
evacuate if there is a chemical spill or a chemical release in the air?
1
yes
2
no
• Do you believe you know how to shelter or evacuate if there is a chemical released
nearby?
1
yes
2
no
VI DEMOGRAPHIC SECTION
13. DEMOGRAPHIC SECTION BEGIN HERE:
(Interviewer: READ:)
Finally, I have a few demographic questions for classification purposes
only.
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Skip: (If QNSC6 is BLANK, Continue;
Otherwise, Skip to D2)
VI 1 AGE
Please tell me your age.
(Interviewer: Open ended and code actual age)
VI 2 EDUCATION
What is your highest completed level of education?
(Interviewer: Read 01-06)
01
02
03
04
05
06
07
08
Less than high school diploma
High school degree or diploma
Technical/Vocational school
Some college
College graduate
Post graduate work or degree
(DK)
(Refused)
VI 3 ETHNICITY
Are you of Hispanic, Latino, or Spanish origin - such as Mexican, Puerto
Rican, Cuban, or other Spanish origin?
1
2
3
4
Yes
No
(DK)
(Refused)
VI 4 RACE
Which of the following describes your race? You may select one or more.
(Read 1-5)
(Programmer: Allow FIVE responses)
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1
2
3
4
5
8
9
0
White
Black or African-American
Asian
American Indian or Alaska Native, or
Native Hawaiian or Pacific Islander
(DK)
(Refused)
(No more responses)
# of Responses: 5
VI 5 A) CONDITION
Do you have a disability or a health condition that might affect your capacity to respond
to an emergency situation?
(Interviewer: If necessary, read:) A mobility, hearing, vision, cognitive, or intellectual
disability or physical, mental, or health condition)
1
2
3
4
Yes
No
(DK)
(Refused)
VI 5 B) CAREGIVER
Do you currently live with or have primary responsibility for assisting someone with a
disability who requires assistance?
(Interviewer: If necessary, read:) A mobility, hearing, vision, cognitive, or intellectual
disability or physical, mental, or health condition.)
1
Yes
2
No
3
(DK)
4
(Refused)
VI 6 - ADULTS
Including yourself, how many adults, 18 years of age or older, live in this household?
(Interviewer: Open ended and code actual number)
01
96
97
98
99
0196
97 or more
(DK)
(Refused)
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VI7 A - 1 CHILDREN
QID:229149
How many children, under the age of 18, are living in your household?
(Interviewer: Open ended and code actual number using coding table)
00
01
96
97
98
99
None
0196
97 or more
(DK)
(Refused)
Skip: (If code 00 in VI. A, Skip to VII;
Otherwise, Continue)
VI 7 B-2 CHILDREN
Does at least one of the children currently attend a school outside of your home,
including day-care or part-time kindergarten?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in B-2, Continue;
Otherwise, Skip to VII LANGUAGE)
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VI 7C CHILDREN
Are you aware of the details of the emergency or evacuation plan of the school or
schools, including where the school plans to evacuate and how to get information
about the child in the event of a disaster?
1
2
3
4
Yes
No
(DK)
(Refused)
VII LANGUAGE
Is English the primary or main language spoken among those living in your household?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 17 or 18 in Intro Sample, Skip to Note before D6_3;
Otherwise, Continue)
VIII ZIP CODE
May I have your ZIP Code?
(Interviewer: Open ended and code ALL FIVE DIGITS OF ZIP CODE)
99998 (DK)
99999 (Refused)
Skip: (If code 01 or 02 in QNSB, Continue;
Otherwise, Skip to D16)
IX STATE
What is the name of the state you live in?
(Interviewer: Open ended and code using coding table Note 98=DK;
99=Refused)
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X TIME AT LOCATION
How long have you lived in this area?
(Interviewer: Open ended and code actual number of years)
00
01
96
97
98
99
FEMA_REG
QID:578565
Less than 1 year
0196
97 years or longer
(DK)
(Refused)
FEMA REGION:
(Programmer: and Autocode
XI CAREGIVER
Do you currently help care for an elderly or disabled family member, relative, or friend, or not?
1
2
3
4
Yes
No
(DK)
(Refused)
SECTION CLOCK:
Skip: (If code 1 in QN XI, Autocode D9 as 1 and Skip to D11;
Otherwise, Continue)
XII CLOCK
XII A TELEPHONE
Do you have a regular, landline telephone in your home that you use to make and
receive personal calls?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in XIIA, Continue;
Otherwise, Skip to Note before XII C)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
XII B TELEPHONE
As far as you know, is that landline telephone number a listed or unlisted number?
(Interviewer: IF RESPONDENT HAS MORE THAN ONE LANDLINE NUMBER,
ASK ABOUT THE ONE THEY USE MOST OFTEN AT HOME)
1
2
3
4
Listed
Unlisted
(DK)
(Refused)
Skip: (If code 2 in QNS1, Autocode D11 as 1 and Continue with Note before D12;
Otherwise, Continue)
XII C CELL PHONE
Do you have a cell phone that you use to make and receive personal calls?
1
2
3
4
Yes
No
(DK)
(Refused)
Skip: (If code 1 in D9 AND code 1 in D11, Continue;
Otherwise, Skip to D13)
XII D PHONE
Of all the telephone calls your household receives (read 1-3)?
1
2
3
4
5
All or almost all calls are received on
cell phones
Some are received on cell phones and
some on regular phones, OR
Very few or none are received on cell
phones
(DK)
(Refused)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
XIII A INCOME D13
QID:172161
What is your total MONTHLY household income, before taxes? Please include
income from wages and salaries, remittances from family members living
elsewhere, farming, and all other sources.
(Interviewer: Open ended and code)
(Interviewer: [(If response is greater than $10,000, read:) Is that a
monthly or an annual amount? (If monthly, code as appropriate using coding
table; if annual, probe for monthly amount)])
01
02
03
04
05
06
07
08
09
10
11
12
98
99
Under $60
$60 to $499
$500 to $999
$1,000 to $1,999
$2,000 to $2,999
$3,000 to $3,999
$4,000 to $4,999
$5,000 to $7,499
$7,500 to $9,999
$10,000 to $14,999
$15,000 to $19,999
$20,000 and over
(DK)
(Refused)
Skip: (If code 98 (DK) or 99 (Refused) in D13, Continue;
Otherwise, Skip to Read before THANK RESPONDENT MESSAGE)
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
XIII B INCOME D14
Is your total MONTHLY household income before taxes $4,000 or more, or is it less
than $4,000?
(Interviewer:
(If under, ask:) Is it over or under $3,000?
(If under, ask:) Is it over or under $2,000?
(If under, ask:) Is it over or under $1,000?
(If under, ask:) Is it over or under $500?
(If under, ask:) Is it over or under $60?)
(Interviewer:
(If over, ask:) Is it over or under $5,000?
(If over, ask:) Is it over or under $7,500?
(If over, ask:) Is it over or under $10,000?
(If over, ask:) Is it over or under $15,000?
(If over, ask:) Is it over or under $20,000?)
01
02
03
04
05
06
07
08
09
10
11
12
98
99
Under $60
$60 to $499
$500 to $999
$1,000 to $1,999
$2,000 to $2,999
$3,000 to $3,999
$4,000 to $4,999
$5,000 to $7,499
$7,500 to $9,999
$10,000 to $14,999
$15,000 to $19,999
$20,000 and over
(DK)
(Refused)
XIV CLOSING
(Interviewer: READ:)
This completes the interview. Thank you for taking the time to answer these questions.
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DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Community Preparedness and Participation Survey
(Interviewer: THANK RESPONDENT BY SAYING:)
Again, this is (*Interviewer Name), with Research Company. On behalf of
FEMA, I would like to thank you for your time. A top priority for FEMA is to help
people know what to do and to get prepared for emergencies and disasters. Your
opinions are important in accomplishing this.
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| File Type | application/pdf |
| Author | Lloyd, Camille |
| File Modified | 2017-08-21 |
| File Created | 2017-08-21 |