Qualitative Survey

Household Economics and Decisionmaking 2017

I. SAMPLE VARIABLES
•
•
•

KP standard demographics
xsflag (1=Fresh; 2=Re-interview; 3=Oversample)
xIflag (1=$5, 2=$10)

II. QUOTA CHECK BASED ON SAMPLE VARIABLES
NA
III. INTRODUCTION

[DISPLAY01]
OMB Control Number:
Expiration Date:
Additional information is available here on the OMB public reporting requirements.
The Federal Reserve Board is interested in learning more about the financial wellbeing and economic
perceptions of the American people. The data collected in this survey will be used for research,
analysis, and policymaking on consumer finances and household financial stability. A dataset
containing anonymized responses may also be released publicly on the Federal Reserve Board’s
website. We appreciate your participation in this survey. In appreciation for your completing
this survey, you will be provided with the equivalent of [(IF XSFLAG=2 AND XIFLAG=2) INSERT:
$10 / if (xsflag=1 or 3) or (xsflag=2 and xIflag=1) insert: $5] through the GfK rewards system.
[IF “HERE” CLICKED ABOVE, DISPLAY THIS TEXT IN A NEW TAB OR WINDOW]
The Federal Reserve may not conduct or sponsor, and an organization is not required to respond to,
a collection of information unless it displays a currently valid OMB control number. Public reporting
burden for this information collection is estimated to average28 minutes, including the time to gather
data in the required form and to review instructions and complete the information collection. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Secretary, Board of Governors of the Federal
Reserve System, 20th and C Streets, NW, Washington, DC 20551, and to the Office of Management
and Budget, Paperwork Reduction Project (7100-0359), Washington, DC 20503.

IV. SCREENER
NA
V. MAIN QUESTIONNAIRE
SCRIPTER: Use default instruction text for each question type unless otherwise specified.
SCRIPTER: Do not prompt on all questions.
LIVING ARRANGEMENTS SECTION
Base: All respondents
[SHOW DISPLAY1 AND L0 ON THE SAME PAGE]
[DISPLAY1]
First, tell us a little about yourself.

Base: All respondents

FR 3077 Draft Form.docx

1/46

[GRID, S ACROSS]
[SUPPRESS DEFAULT INSTRUCTIONS, INSTEAD SHOW: Please answer yes or no to each option]
L0. Do each of the following types of people currently live with you in your household?
DOWN:
a. My spouse or partner
b. My child or children who are under age 18
c. My adult child or children who are age 18 or older
d. My parents
e. My extended family such as brothers, sisters or cousins
f. Roommate(s) who are not related to me
g. Other individuals (please specify) [text box]
ACROSS:
1. Yes
0. No
Base: L0_c = 1
[SP]
L0A. Which of the following best describes the adult children (who are age 18 or older) who live with
you?
1. All of the adult children living with me are currently enrolled in school
2. One or more of the adult children who lives with me is not currently enrolled in school
Base: (L0=d, e, f, or g) or (L0=c and L0A=2)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
L1. You indicated that you live with [IF L0_E=1, INSERT: your parents,] [IF L0_E=1, INSERT:
extended family members,] [IF L0_F=1, INSERT: a roommate,] [IF L0A=2, INSERT: adult children
who are not in school,] [IF L0 CHECKED D, E, OR F OR L0A=2, INSERT: or] someone outside of your
immediate family.
Are each of the following reasons why you live with these individuals?
Down
a. To save money
b. To provide financial assistance to those living with me
c. To care for sick, disabled, or elderly family member or friend
d. To receive assistance with child care
d. Companionship / prefer living with others
f. Other (Please specify):[TXT]________________________________
Across
1. Yes
0. No
GENERAL WELL-BEING SECTION
Base: All respondents
[GRID, S ACROSS]
B0. How well do each of these statements describe you our your situation?
DOWN
a. Because of my money situation, I feel like I will never have the things I want in life
b. I am just getting by financially

FR 3077 Draft Form.docx

2/46

c. I am concerned that the money I have or will save won’t last
ACROSS
1. Completely
2. Very well
3. Somewhat
4. Very little
5. Not at all

Base: All respondents
[GRID, S ACROSS]
B1. How often do each of these statements apply to you?
DOWN
a. I have money left over at the end of the month
b. My finances control my life
ACROSS
1. Always
2. Often
3. Somewhat
4. Rarely
5. Never
Base: All respondents
[S]
B2. Overall, which one of the following best describes how well you are managing financially these
days:
4. Living comfortably
3. Doing okay
2. Just getting by
1. Finding it difficult to get by
Base: All respondents
[S]
B3. Compared to 12 months ago, would you say that you (and your family living with you) are better
off, the same, or worse off financially?
5. Much better off
4. Somewhat better off
3. About the same
2. Somewhat worse off
1. Much worse off
Base: All respondents
[S]
B6. Think of your parents when they were your age. Would you say you (and your family living with
you) are better, the same, or worse off financially than they were?
5. Much better off
4. Somewhat better off
3. About the same
2. Somewhat worse off
1. Much worse off

FR 3077 Draft Form.docx

3/46

Base: All respondents
[TEXTBOX, 500 CHARACTERS]
PROGRAMMING NOTE: TEXTBOX IS INTENTIONALLY LARGER THAN THE STATED LIMIT SO THAT RESPONDENT IS
NOT FORCED TO REDUCE TEXT IF THEY WRITE TOO MUCH.
[O]
B10. In a couple of words (150 character max) please describe any important life event or experience
in the past year that impacted your family’s finances? If none please click the “None” box.
[TEXTBOX, 500 CHARACTERS]

999 None [S]
EMPLOYMENT SECTION
Base: All respondents
[SHOW DISPLAY2 AND D1 ON THE SAME PAGE]
[DISPLAY2]
This section will ask some questions about your recent employment.
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
D1. At any point in the past month, were you:
Down
a. Employed for someone else
b. Self-employed or working for myself
c. Temporarily laid off from a job that you have returned to or expect to return to
Across
1. Yes
0. No
Base: D1_a=1 or D1_b=1
(Employed or self-employed)
[S]
D1D. In the past month, were there any periods where you did not have a job?
1. Yes
0. No
Base: (D1_a=0 and D1_b=0) or D1D=1
(Not employed or had a period that did not have a job)
[S]
D1E. You reported that you were not employed [if D1D=1 insert: for some period in the] last month.
During this time, were you looking for a job?
1. Yes
0. No
Base: All respondents
[S]
D1F. In the past month, did you either not have a job or work part-time for pay (rather than full-time)
because you were taking care of children or maintaining your household?

FR 3077 Draft Form.docx

4/46

1. Yes
0. No
Base: All respondents
[S]
D1G. In the past month, were you enrolled as a student?
2. Yes, as a full-time student
1. Yes, as a part-time student
0. No
Base: (D1_a=0 and D1_b=0) or D1D=1
(Not employed or had a period that did not have a job)
[S]
D1H. In the past month, were you ever not working due to a disability?
1. Yes
0. No
Base: All respondents
[S]
D1I. Do you consider yourself to be retired?
1. Yes
0. No
Base: D1_a=1 or D1_b=1
[S]
D3. Think about the main job that you had in the past month. In this job, did you:
1.
2.
3.
4.
5.

Work full-time for someone else [display if D1_a=1]
Work part-time for someone else [display if D1_a=1]
Work for yourself (self-employed) or as a sole-proprietor [display if D1_b=1]
Work as a partner in a partnership (e.g. partner in law firm, medical practice) [display if
D1_b=1]
Work as a consultant/contractor [display if D1_a=1 or D1_b=1]

Base: D3=2
(Employed part-time for someone else)
[S]
D20. You indicated that you work part-time in the main job that you had in the past month. Do you
want to work full-time?
1. Yes
0. No
-2. Don’t know
Base: D3=2
(Employed part-time for someone else)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
D21. Do each of the following contribute to your working part-time rather than full-time?

FR 3077 Draft Form.docx

5/46

Down:
1. Business conditions or lack of hours needed by employer
2. Could only find part-time work
3. Child care
4. Other family or personal obligations
5. Health or medical limitations
6. School/training program
Across:
1. Yes
0. No

Base: D3 = 1, 2, or 5
(Employed for someone else or contractor in main job)
[S]
D30. Still thinking about your main job, do you normally start and end work around the same time
each day that you work or does it vary from week-to-week?
1.
2.
3.

Normally work the same hours
Schedule varies, primarily at my request
Schedule varies, primarily based on my employer’s needs

Base: D30=3
(Schedule varies based on employer needs)
[S]
D31. Approximately how far in advance does your employer usually tell you the hours that you will
need to work on any given day?
1. One day in advance or less (including on call)
2. 2 to 3 days in advance
3. 4 to 6 days in advance
4. 1 to 2 weeks in advance
5. 2 to 4 weeks in advance
6. More than a month in advance
Base: D3 = 1, 2, or 5
(Employed for someone else or contractor in main job)
CREATE [DOV_D32]:
ASSIGN 1/3 OF RESPONDENTS DOV_D32 = “10%”
ASSIGN 1/3 OF RESPONDENTS DOV_D32 = “20%”
ASSIGN 1/3 OF RESPONDENTS DOV_D32 = “30%”
[S]
D32. If you could choose between a job that pays your current income from your main job consistently
from month to month, or one where you can make [INSERT: DOV_D32] more on average but your
hours and income will vary substantially from month to month, which would you prefer?
1. Current income consistently from month to month
2. [INSERT: DOV_D32] higher average income that varies from month to month
Base: D3=1, 2, or 5
(Employed for someone else or contractor in main job)
[S]

FR 3077 Draft Form.docx

6/46

D33. Some people are in long term jobs and others are in temporary jobs that only last for a limited
time or until the completion of a project. Provided the economy does not change and your job
performance is adequate, could you stay in your main job for at least the next 6 months?
1. Yes
0. No
-2. Don’t know
Base: D3 = 1, 2, or 5
(Employed for someone else or contractor in main job)
[Suppress default instructions, instead show: Please answer yes, no, or don’t know to each
option]
[GRID, S ACROSS]
D40. Still thinking about your main job, does your employer offer you each of the following benefits
(even if you do not personally use the benefit)?
DOWN
a. Paid sick leave
b. Paid vacation/personal leave
c. Maternity or paternity leave
d. Health insurance
e. Tuition assistance for education/training
f. Life insurance
g. Retirement benefits
h. Ability to work from home
ACROSS
1. Yes
0. No
-2. Don’t know

Base: D3 = 1, 2, or 5
(Employed for someone else or contractor in main job)
[GRID, S ACROSS]
In thinking about the quality of a job and its benefits package, how important to you is it that your
employer offer each of the following benefits?
DOWN
a. Paid sick leave
b. Paid vacation/personal leave
c. Maternity or paternity leave
d. Health insurance
e. Tuition assistance for education/training
f. Life insurance
g. Retirement benefits
h. Ability to work from home
ACROSS
1. Not important
2. Somewhat important
3. Very important
Base D3=1, 2, or 5
(Employed for someone else or contractor in main job)
[S]
D42. How satisfied are you with the total salary or wages you earn from your main job?
1. Very satisfied

FR 3077 Draft Form.docx

7/46

2. Somewhat satisfied
3. Neither satisfied nor dissatisfied
4. Somewhat dissatisfied
5. Very dissatisfied
Base: D3=1, 2, or 5
(Employed for someone else or contractor in main job)
[S]
D43. How satisfied are you with the benefits you currently receive from your main job?
1. Very satisfied
2. Somewhat satisfied
3. Neither satisfied nor dissatisfied
4. Somewhat dissatisfied
5. Very dissatisfied
Base: D1I = 0 or refused
(Not retired)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
D44. In the past 12 months, have you done each of the following:
DOWN:
a. Asked for a raise or a promotion at work (display if D1_a=1)
b. Received a raise or a promotion at work (display if D1_a=1)
c. Applied for a new job
d. Started a new job
e. Voluntarily left a job
f. Gotten laid-off or fired from a job
ACROSS:
1. Yes
0. No
Base: D1I = 0 or refused
(Not retired)
[S]
D45. Would you say your expectations about future job opportunities are:
1. Optimistic
2. Pessimistic
3. Not Sure
Base: D1_a=1 or D1_b=1
(Employed or self employed)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
D4. In addition to your main job, in the past month did you have any other paid jobs?
DOWN:
a. I had another full-time job
b. I had another part-time job
ACROSS:
1. Yes
0. No

Base: PPMARIT = 1 or 6
(Married or living with partner)
[S]
FR 3077 Draft Form.docx

8/46

D5. Which one of the following best describes your [IF PPMARIT=1, INSERT: spouse’s / IF
PPMARIT=6, INSERT: partner’s] current employment status?
1.
2.
3.
4.
5.
6.
7.
8.
9.

Employed full-time
Employed part-time
Temporarily laid off
Not employed, but looking for a job
Not employed and not looking for a job
Homemaker
Student
Disabled and not working
Retired

GIG ECONOMY / INFORMAL WORK
Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
GE1. We are also interested in other activities that you may have done recently to earn money.
In the past month, have you been paid for each of the following occasional work activities or side
jobs?
Please do not include activities that you only do as part of your main job
DOWN:
a. Babysitting, child care services, dog walking, and/or house sitting
b. Disabled adult and/or elder care services
c. House cleaning, house painting, yard work, landscaping, and/or other property maintenance work
d. Providing personal services to individuals, such as picking up their dry cleaning, helping people
move, running errands, booking travel, etc.
ACROSS:
1. Yes
0. No
Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
GE2. In the past month, have you been paid for each of the following occasional work activities or
side jobs?
Please do not include activities that you only do as part of your main job
DOWN:
a. Completing online tasks through websites, such as Amazon Services, Mechanical Turk, Fiverr,
Task Rabbit, or YouTube. Such tasks might include editing documents, reviewing resumes, writing
songs, creating graphic designs, rating pictures, posting videos, blog posts, etc.
b. Renting out property, such as your car, your place of residence, or other items you own, through
websites, newspaper ads, flyers, etc.
c. Selling new/used goods, handcrafts, etc., on-line through eBay, Craigslist, or other websites
d. Other online paid activities (do not include taking GfK Surveys). Please Specify: [text box]
ACROSS:
1. Yes
0. No
Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]

FR 3077 Draft Form.docx

9/46

[GRID, S ACROSS]
GE3. In the past month, have you been paid for each of the following occasional work activities or
side jobs?
Please do not include activities that you only do as part of your main job
DOWN:
a. Selling goods (such as food, handcrafts, etc.) or services at flea markets, swap meets, garage
sales, mobile vans/trucks, stalls/kiosks or other temporary physical outlets/locations
b. Selling used goods (such as clothes, wedding dresses, handcrafts, etc.) at consignment shops or
thrift stores
c. Any other paid activities that you have not yet mentioned (do not include taking GfK Surveys).
Please specify: [text box]
ACROSS:
1. Yes
0. No
Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[M]
GE10. In the past month, what are the reasons why you have engaged in occasional paid work
activities or side jobs? Check all that apply
a. To earn money as a primary source of income
b. To earn extra money on top of pay from a current job, retirement, pension, disability, or other
regular source of income
c. To earn extra money to help family members
d. To maintain existing job-related skills
e. To acquire new job-related skills
f. To network/meet people
g. Just for fun (as a hobby)
h. Other (please specify): [TEXT]
Base: At least one answer selected to GE10
If respondent selected more than 1 answer in Ge10, insert answer options select in GE10 as
answer options for GE11
If respondent only selected one answer option in Ge10, auto punch that as the answer for
GE11 and do not ask Ge11
[S]
GE11. In the past month, what is the main reason why you have engaged in occasional paid work
activities or side jobs?
1. To earn money as a primary source of income
2. To earn extra money on top of pay from a current job, retirement, pension, disability, or other
cegular source of income
3. To earn extra money to help family members
4. To maintain existing job-related skills
5. To acquire new job-related skills
6. To network/meet people
7. Just for fun (as a hobby)
8. [If text entered in D10 then insert that as the answer option / if D10_h=1 but no text inserted,
then insert: Other]
Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[Q]
GE20. Excluding GfK surveys, considering all occasional paid work activities or side jobs in which you
participated in last month (those that are not part of your main paid job(s)):

FR 3077 Draft Form.docx

10/46

a. How much time do you usually spend per month on occasional paid work activities or side
jobs, other than your primary job?
_______________ hours per month [range: 0-720]
b. About how much of your monthly income do you [IF PPMARIT=1, INSERT: and your spouse /
IF PPMARIT=6, INSERT: and your partner] usually get from occasional paid work activities
or side jobs? For example, 10% of your income, or 60% of your income.
_________

% of overall income [range: 0-100]

Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[S]
GE21. Six months from now, do you expect to devote more, the same, or less time to occasional
paid work activities or side jobs other than your main job compared to today?
1. More
2. Less
3. About the same
Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[S]
GE30. To what extent have occasional paid work activities or side jobs helped you to offset any
negative effects of unemployment, loss of working hours, loss of benefits, or frozen wages in a formal
job in the last year?
1. Very much
2. Somewhat
3. Not at all
4. Does not apply
Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[S]
GE40. In the past 12 months, to what extent has the money earned from occasional paid work
activities or side jobs been a significant source of income for you [IF PPMARIT=1, INSERT: and your
spouse / IF PPMARIT=6, INSERT: and your partner]?
1. Very much
2. Somewhat
3. Not at all
4. Does not apply
Base: Any response in (GE1, GE2 or GE3 = yes)
(Performed gig economy work)
[S]
GE41 In the past 12 months, to what extent has the money earned from occasional paid work
activities or side jobs been a regular/consistent source of income for you [IF PPMARIT=1, INSERT:
and your spouse / IF PPMARIT=6, INSERT: and your partner]?
1. Very much
2. Somewhat
3. Not at all
4. Does not apply
Base: PPAGE<=30
[Suppress default instructions, instead show: Please answer yes or no to each option]

FR 3077 Draft Form.docx

11/46

[GRID, S ACROSS]
GE50. In the past month, did you do each of the following types of unpaid work for someone else?
DOWN
a. Apprenticeship or internship
b. Volunteer work
c. Bartering (Work done in exchange for an item or service of similar value)
d. Other (Please Specify): Text Box
ACROSS:
1. Yes
0. No
YOUNG WORKERS
Base: D1_a=1 and PPAGE<=30
(Young adults employed for someone else)
[S]
YW1. Thinking about your main job, how qualified would you say you are for performing the tasks
required in this job? Do you think you are:
1. Overqualified
2. Adequately qualified
3. In need of additional training
Base: D1_a=1 and PPAGE<=30
(Young adults employed for someone else)
[S]
YW2. Do you consider your main job to be a career, a stepping stone to a career, or just a job to get
you by?
1. Career
2. Stepping stone to a career
3. Just a job
Base: PPAGE<=30
(Young adults)
[S]
YW3. Do you believe you now have the level of education and training needed for the type of job that
you would like to hold in the next 5 years?
1. Yes
0. No
-2. Don't know
GENERAL HOUSING
Base: All respondents
[SHOW DISPLAY3 AND GH1 ON THE SAME PAGE]
[DISPLAY3]
This section will ask some questions about your housing situation.
[S]
GH1. Which one of the following best describes your housing arrangement where you currently live?
1. I [IF PPMARIT=1, INSERT: (and/or my spouse) / IF PPMARIT=6, INSERT: (and/or my partner)] own [IF
PPMARIT=1 OR 6, INSERT: our, ELSE INSERT: my] home with a mortgage or loan.
2. I [IF PPMARIT=1, INSERT: (and/or my spouse) / IF PPMARIT=6, INSERT: (and/or my partner)] own [IF
PPMARIT=1 OR 6, INSERT: our, ELSE INSERT: my] home free and clear (without a mortgage or loan).
3. I [IF PPMARIT=1, INSERT: (and/or my spouse) / IF PPMARIT=6, INSERT: (and/or my partner)] pay
rent.

FR 3077 Draft Form.docx

12/46

4. I [IF PPMARIT=1, INSERT: (and/or my spouse) / IF PPMARIT=6, INSERT: (and/or my partner)] don’t
own [IF PPMARIT=1 OR 6, INSERT: our, ELSE INSERT: my] home or pay rent.

Base: All respondents
[Q WITH S, RANGE 1900 TO 2017]
GH2. In what year did you [IF GH1=1 OR 2, INSERT: buy / IF GH1=3, INSERT: start renting / IF GH1=4,
OR REFUSED, INSERT: move into] your current home?
[NUM BOX 1900-2017]
-2. Inheritted home from parents or other relatives [S. DISPLAY IF GH1=1 or GH1=2]
Base: All respondents
[GRID, S ACROSS]
GH3. How satisfied are you with each of the following aspects of your housing situation?
DOWN:
a. Overall quality of your neighborhood
b. Quality of your local schools
c. Safety of your neighborhood
d. Quality of other amenities in your neighborhood
e. Overall quality of your house/apartment
f. [IF GH1= 1, 2, 3] Cost of your house/apartment
ACROSS:
1. Very dissatisfied
2. Somewhat dissatisfied
3. Neither satisfied nor dissatisfied
4. Somewhat satisfied
5. Very satisfied
Base: All Respondents
[GRID, S ACROSS]
GH10. In deciding where to live, how important is it to you to have convenient access to each of the
following places in your local community?
DOWN
a. Park, playground, or recreation center
b. Library
c. Bank or credit union
d. Grocery store
e. Shops, restaurants, or movie theaters
f. Church or place of worship
g. Public transportation
ACROSS
1. Not important
2. Slightly important
3. Moderately important
4. Very important
RENT SECTION
Base: (GH1 = 3 or GH1 = 4) AND (GH2 >= 2016)
(Non-homeowners who moved recently)
[S]
R4. Did you own your previous home that you moved from in [INSERT GH2 RESPONSE IN NORMAL
FONT]?
0. No

FR 3077 Draft Form.docx

13/46

1. Yes, and I still own that home
2. Yes, and I sold that home
Base: (GH2>=2016) AND (R4=0 or refused)
(Non-homeowners who moved recently and did not own previous home)
[M]
R5A. An eviction is when your landlord forces you to move when you don’t want to. Were you, or a
person you were staying with, evicted from the home you moved from in [INSERT GH2 RESPONSE
IN NORMAL FONT]?
1. Yes
0. No
Base: (GH2>=2016) AND (R4=0 or refused) AND (R5A=0 or refused)
(Non-homeowners who moved recently and did not own previous home)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
R5B. Did each of the following contribute to your moving from your previous home in [INSERT GH2
RESPONSE]?
DOWN
a. Received an eviction notice
b. Your landlord told you, or a person you were staying with, to leave
c. You, or a person you were staying with, missed a rent payment and thought that if you didn’t move
you would be evicted
d. The city condemned the property and forced you to leave
ACROSS
1. Yes
0. No

Base: (GH2>=2016) AND (R4=1 or 2)
(Non-homeowners who moved recently and owned previous home)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
R5C. Did each of the following contribute to your moving from your previous home in [INSERT GH2
RESPONSE]?
DOWN
a. Bank took possession of your home in foreclosure
b. Received a notice from the bank that they planned to foreclose
c. Missed mortgage payments and thought that if you didn’t move, the bank would foreclose on your
home
d. The city condemned the property and forced you to leave
ACROSS
1. Yes
0. No
Base: (GH1 = 3)
(Renters)
[S]
R7. In the past 12 months, have you experienced any problems with your house or apartment that
you felt needed to be fixed, such as a leak or a broken appliance?
1. Yes
0. No
Base: (GH1 = 3) and (R7=1)

FR 3077 Draft Form.docx

14/46

(Renters who had a problem with their housing unit)
[S]
R8. Did you contact your landlord about the problem with your house or apartment that that needed to
be fixed?
1. Yes
0. No

Base: (GH1 = 3) and (R8=1)
(Renters who had a problem with their housing unit that they contacted landlord about)
[S]
R8A. After you contacted your landlord about the problem with your house or apartment, how much
difficulty did you have getting them to fix the probem?
3. Substantial difficulty
2. Moderate difficulty
1. A little difficulty
0. None
Base: GH1 = 3
(Renters)
[S]
R3. About how much do you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6,
INSERT: and/or your partner] pay for rent each month?
1. less than $250
2. $250 to $499
3. $500 to $749
4. $750 to $999
5. $1,000 to $1,249
6. $1,250 to 1,499
7. $1,500 to $1,749
8. $1,750 to $1,999
9. $2,000 or above

-2. Don’t know

MORTGAGE SECTION
Base: GH1 = 1
(Homeowners with a mortgage)
[S]
M2. In the past 12 months, have you [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6,
INSERT: or your partner] missed two or more payments on your mortgage?
1. Yes
0. No
Base: GH1 = 1
(Homeowners with a mortgage)
[S]
M4. About how much is your total monthly mortgage payment (i.e. the amount you send to the bank)?
1. less than $500
2. $500 to $749
3. $750 to $999
4. $1000 to $1,249
5. $1,250 to 1,499

FR 3077 Draft Form.docx

15/46

6. $1,500 to $1,749
7. $1,750 to $1,999
8. $2,000 to $2,499
9. $2,500 or above

-2. Don’t know
BANKING SECTION
Base: All respondents
[SHOW DISPLAY4 AND BK1 ON THE SAME PAGE]
[DISPLAY4]
This section will ask some questions about your experiences with banks and credit.
[S]
BK1. Do you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6, INSERT: and/or your
partner] currently have a checking, savings or money market account?
1. Yes
0. No
Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
BK2. In the past 12 months, have you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6,
INSERT: and/or your partner]:
DOWN
a. used a money order
b. used a check-cashing service
c. used a tax refund anticipation loan
d. used a pawn shop loan, a payday loan, an auto title loan, or a paycheck advance/deposit advance
ACROSS
1. Yes
0. No
Base: BK1 = 1
(Has a bank account)
[S]
BK10. In the past 12 months, have you or your spouse/partner used your mobile phone to check a
bank account balance or recent transaction, either through the bank’s mobile website or the bank’s
mobile app?
1. Yes
0. No
CREDIT APPLICATION SECTION
Base: all respondents
[S]
A6. If you were to apply for a credit card today, how confident are you that your application would be
approved?
3. Not confident
2. Somewhat confident
1. Very confident
-2. Don’t know

FR 3077 Draft Form.docx

16/46

Base: all respondents
[S]
A0. In the last 12 months, have you [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6,
INSERT: or your partner] applied for any credit (such as a credit card, higher credit card limit,
mortgage, refinance, student loan, personal loan, or other loan)?
1. Yes
0. No

Base: A0=1
(Those who applied for credit)
[M]
A0A. Please select all of the types of credit below that you [IF PPMARIT=1, INSERT: or your spouse /
IF PPMARIT=6, INSERT: or your partner] have applied for in the past 12 months.
a. Mortgage to buy a new home
b. Refinance of a home mortgage
c. Home equity loan or line of credit
d. Credit card
e. Car/auto loan
f. Student loan
g. Personal general-purpose loan from a bank
h. Personal loan from friends or family
i. Other (Please Specify): [TEXTBOX]
Base: A0=0
(Those who did not apply for credit)
[S]
A0B. Was there a time in the past 12 months that you [IF PPMARIT=1, INSERT: or your spouse / IF
PPMARIT=6, INSERT: or your partner] desired credit but chose not to submit a credit application?
1. Yes
0. No
Base: A0=1 OR -1 (Refused)
(Those who applied for credit)
[GRID, S ACROSS]
A1. In the past 12 months, please tell us if each of the following has or has not happened to you [IF
PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6, INSERT: or your partner]:
DOWN
a. You [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6, INSERT: or your partner] were
turned down for credit
b. You [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6, INSERT: or your partner] were
approved for credit, but were not given as much credit as you applied for
c. You [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6, INSERT: or your partner] put off
applying for credit because you thought you might be turned down
ACROSS
1. Yes
0. No
Base: A0B=1
(Those who did not apply for credit but desired credit)
[S]

FR 3077 Draft Form.docx

17/46

A2. You indicated that you [IF PPMARIT=1, INSERT: or your spouse / IF PPMARIT=6, INSERT: or
your partner] desired credit in the past 12 months but did not submit a credit application. Was this
because you thought that you might be turned down or denied credit?
1. Yes
0. No
Base: (A1_a=1 or A1_b=1) and at least two of (A0A_a – A0A_i) selected
If only one of A0A_a – A0A_i selected, do not ask and auto-punch response
[M]
A3. In the past 12 months, which forms of credit that you applied for were you denied or offered less
credit than requested:
[ONLY SHOW OPTIONS SELECTED IN A0A AND ANSWER OPTION I. OTHER]
a. Mortgage to buy a new home
b. Refinance of a home mortgage
c. Home equity loan or line of credit
d. Credit card
e. Car/auto loan
f. Student loan
g. Personal general-purpose loan from a bank
h. Personal loan from friends or family
i. Other [INSERT A0A RESPONSE]

CREDIT CONDITION SECTION
Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
FM10. People use a variety of methods to manage their finances. Do you do any of the following to
guide how your money gets spent each month?
DOWN
a.
b.
c.
d.
e.
f.

Follow a budget or spending plan
Track spending
Review paper bank statements and/or bills
Pay with cash or a prepaid card to avoid overdrafts
Get account alerts (e.g., via email, text message, or push notification)
Automatically set aside long-term savings (e.g., in a college, retirement, or investment
account)
g. Plan and save for periodic expenses (e.g., insurance, vacation, car repair)
h. Sign up for a budget payment plan to make utility or other payments more regular/predictable
i. Pay some bills automatically (so they won’t be late or missed)
j. Other (Please specify): [TXT]___________________________

ACROSS
1. Yes
0. No

Base: FM1_a = 1 or FM1_b = 1
(Use a budget or track spending)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
FM20. Do you use any of the following methods to budget or track your spending?

FR 3077 Draft Form.docx

18/46

DOWN
a.
b.
c.
d.
e.

Electronic program through my bank
Non-bank program – e.g., online service (Mint), software (Quicken), or mobile app
Spreadsheet
Paper-based system (e.g., notebook, checkbook register)
Other (Please specify): [TXT]___________________________

ACROSS
1. Yes
0. No
CREDIT CONDITION SECTION
Base: all respondents
[S]
C2A. Do you have at least one credit card?
1. Yes
0. No

Base: C2A=1 or refused
(Has a credit card)
[S]
C3. Do you currently have any outstanding unpaid credit card debt?
1. Yes
0. No

Base: C3=1 or refused
(Has outstanding credit card debt)
[S]
C3A. Do you [IF PPMARIT=1, INSERT: and your spouse / IF PPMARIT=6, INSERT: and your partner]
currently have more, less, or about the same amount of credit card debt than you had 12 months ago?
3. More debt now
2. About the same
1. Less debt now
Base: C3=0
(Does not have outstanding credit card debt)
[S]
C3B. 12 months ago, did you have any credit card debt that you have since paid off?
1. Yes
0. No

Base: C2A=1 or refused
(Has a credit card)
[S]
C4A. In the past 12 months, how frequently have you carried an unpaid balance on one or more of your
credit cards?
0. Never carried an unpaid balance (always pay in full)
1. Once
2. Some of the time

FR 3077 Draft Form.docx

19/46

3. Most or all of the time

Base: C4A=1, 2, 3 or refused
(Has a credit card, carried unpaid balance in the past year)
[S]
C4B. In the past 12 months, how frequently have you paid only the minimum payment on one or more
of your credit cards?
0. Never
1. Once
2. Some of the time
3. Most or all of the time
EDUCATION SECTION
Base: all respondents
[SHOW DISPLAY5 AND ED0 ON THE SAME PAGE]
[DISPLAY5]
This section will ask some questions about your education and experiences with student loans.
[S]
ED0: What is the highest level of school you have completed or the highest degree you have received?
1. Less than High School degree
2. High school degree or GED
3. Some college but no degree (including currently enrolled in college)
4. Certificate or technical degree
5. Associate degree
6. Bachelor’s degree
7. Master’s degree
8. Professional degree (e.g. MBA, MD, JD)
9. Doctoral Degree
CREATE [DOV_ED]:
IF ED0 = 5 DOV_ED = “Associate Degree”
IF ED0 >= 6 DOV_ED = “Bachelor’s Degree”
Base: D1G=1 or 2
(Current student)
(Note: response numbers intentionally do not start at 1 in order to align with ED0)
[S]
ED0B: You previously indicated that you were enrolled as a student in the past month. What type of
program are you enrolled in?
2. High school or GED program
3. Non-degree training program
4. Certificate or technical degree
5. Associate degree
6. Bachelor’s degree
7. Master’s degree
8. Professional degree (e.g. MBA, MD, JD)
9. Doctoral Degree
Base: (ED0=2 or ED0=4 or ED0=5) and (D1G=0)
(High school only and not enrolled in college OR certificate or associate degree and not
currently enrolled)

FR 3077 Draft Form.docx

20/46

[S]
ED0D: Are there any educational programs beyond high school that you started, but did not complete
or transfer to another school and are no longer enrolled in?
1. Yes
0. No
Base: ED0 = (3, 4, 5, 6, 7, 8, OR 9) OR (D1G=1 or 2) OR ED0D=1
(All who attended college, are enrolled in college, or started but did not finish an educational
program)
[S]
ED1. Which one of the following broad categories best describes your [IF ED0A=1, INSERT: current /
IF ED0A=0 OR ED0A=REFUSED, INSERT: most recent] educational program?
1. Humanities
2. Social/behavioral sciences
3. Life sciences
4. Physical sciences/math
5. Computer/information sciences
6. Engineering
7. Education
8. Business/management
9. Health
10. Law
11. Vocational/technical training
12. Undeclared
13. Other (Please specify): [TEXTBOX]

Base: (ED0=3 or 4) or (ED0=2 and (D1G=1 or 2)) or (ED0=2 and ED0D=1)
([Some college or certificate] OR [high school degree and either enrolled in college or dropped
out])
[DROPDOWN]
ED2A. In what state is the school that you [IF ED0A=1, INSERT: currently attend / IF ED0A=0 OR
ED0A=REFUSED, INSERT: attended for your most recent educational program] located? If the
school is not located in the United States, please select “International” from the bottom of the list.
[DROPDOWN BOX with 50 states + DC + the term “international”]
ED2B. What is the name of the school you [IF ED0A=1, INSERT: currently attend / IF ED0A=0 OR
ED0A=REFUSED, INSERT: attended for your most recent educational program]?
School name: [State-specific drop-down list]
If you do not see the school you attended in the list above, please type it into the text box provided.
Other school not listed: [Text Box]
Base: ((ED0=3 or 4) and (D1G=0)) or (ED0=2 and ED0D=1)
([Some college or certificate] OR [high school degree and either enrolled in college or dropped
out])
[Q]
ED4. In what year did you last attend this educational program?
_____ [NUM BOX, RANGE 1900 – 2016]
Base: PPAGE<=30 and (ED0=5) and (ED0D=1)
(Started educational program but did not complete; Associate degree only since other levels
asked above)
[S]

FR 3077 Draft Form.docx

21/46

ED4A. In what year did you last attend the educational program that you started but did not
complete?
_____ [NUM BOX, RANGE 1900 – 2016]

Base: (PPAGE<=30) AND (ED0D=1 OR ED0=3) AND D1G=0
(Started an educational program but did not complete it and not currently enrolled)
[S]
ED4B: How likely is it that you will return to school and complete the program that you started but did
not complete?
1. Definitely will return and complete program
2. Probably will return and complete program
3. Not sure
4. Probably will not return and complete program
5. Definitely will not return and complete program

Base: (ED0 =3 or 4) or (ED0=2 and (D1G=1 or 2)) or (ED0=2 and ED0D=1)
(Started educational program, but less than associate degree)
[S]
ED5. Overall, how would you say the lifetime financial benefits of your [IF ED0A=1, INSERT: current /
IF ED0A=0 OR ED0A=REFUSED, INSERT: most recent] educational program compare to its financial
costs?
1. Financial benefits are much larger
2. Financial benefits are somewhat larger
3. About the same financial benefits and financial costs
4. Financial costs are somewhat larger
5. Financial costs are much larger

Base: ((ED0=3 or 4) and (D1G=0)) or (ED0=2 and ED0D=1)
([Some college or certificate] OR [high school degree and either enrolled in college or dropped
out])
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
ED6. Knowing what you know now about the benefits and costs of your education, if you could go
back and make your education decisions again would you have done each of these things:
DOWN
a.
b.
c.
d.
e.

Chosen a different field of study
Attended a different school
Completed less education
Completed more education
Chosen not to attend college

ACROSS
1. Yes
0. No
Base: (ED0 = 5, 6, 7, 8, or 9)
(Associate degree or above)
[DROPDOWN]
ED7A. In what state is the school that you received your [DOV_ED] located? If the school is not
located in the United States, please select “International” from the bottom of the list.
[DROPDOWN BOX with 50 states + DC + the term “international”]

FR 3077 Draft Form.docx

22/46

[DROPDOWN]
ED7B. What is the name of the school from which you received your [DOV_ED]?
School name: [State-specific drop-down list]
If you do not see the school you attended in the list above, please type it into the text box provided.
Other school not listed: [Text Box]
Base: ED0 = 5, 6, 7, 8, or 9
(Bachelor’s degree or above)
[Q]
ED9. In what year did you receive your [DOV_ED]?
[NUM BOX, RANGE 1900 – 2016]
Base: ED0 = 5, 6, 7, 8, or 9
(Bachelor’s degree or above)
[S]
ED10. Overall, how would you say the lifetime financial benefits of your [DOV_ED] program compare
to its financial costs?
1. Financial benefits are much larger
2. Financial benefits are somewhat larger
3. About the same financial benefits and financial costs
4. Financial costs are somewhat larger
5. Financial costs are much larger
Base: ED0 = 5, 6, 7, 8, or 9
(Bachelor’s degree or above)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
ED11. Knowing what you know now about the benefits and costs of your education, if you could go
back and make decisions regarding your [DOV_ED] again, would you have done each of these
things:
DOWN
a.
b.
c.
d.
e.

Chosen a different field of study
Attended a different school
Completed less education
Completed more education
Chosen not to attend college

ACROSS
1=Yes
0=No
Base: (ED0 = 2) and (D1G=0 or refused and ED0D=0) and PPAGE<=30
(Completed high school. Did not attend college)
[M, RANDOMIZE A-F]
ED13. Which of the following are reasons why you did not attend college?
a. Too expensive
b. Child care responsibilities
c. Supported or cared for parents or siblings
d. Needed to earn money
e. Wanted to work
f. Simply was not interested in college

FR 3077 Draft Form.docx

23/46

g. Was not admitted
h. Did not think benefits of attending college were worth the cost
i. Other: [TEXTBOX]_____________________________
Base: (ED0 = 3 or (ED0=2 and ED0D=1)) and (D1G=0) and (PPAGE<=30 or ED4>=2006)
(Attended college. Did not complete)
[M, RANDOMIZE A-F]
ED14. Which of the following are reasons why you did not complete your college degree?
a. Too expensive
b. Child care responsibilities
c. Supported or cared for parents or siblings
d. Needed to earn money
e. Wanted to work
f. Simply not interested in continuing in college
g. Low grades
h. Did not think the benefits of continuing college were worth the cost
i. Other: [TEXTBOX]
STUDENT LOANS SECTION
Base: All respondents
[S]
SL1. Do you currently have student loan debt or owe any money used to pay for your own education?
Please include any loans on which you are a co-signer that were used to pay for your education beyond
high school (including student loans, home equity loans, or credit cards paid off over time).
1. Yes
0. No

Base: SL1 = 1
[GRID, S ACROSS]
SL2. Think about the money you currently owe for your own education. Is the money you owe for that
education a student loan, a home equity loan, a credit card debt, or some other type of loan? If you
have multiple loans, please select all that apply.
DOWN:
a. Student Loan
b. Home Equity Loan
c. Credit Card
d. Other Loan (Please specify): [textbox]
ACROSS:
1. Yes
0. No
Base: SL2_a=1 or SL2_b=1 or SL2_c=1 or SL2_d=1
[S]
SL3. Thinking specifically about the money that you owe for your own education, please tell us the total
amount that you currently owe on these loans.
1. Less than $5,000
2. $5,000 to $9,999
3. $10,000 to $14,999
4. $15,000 to $19,999
5. $20,000 to $24,999
6. $25,000 to $29,999

FR 3077 Draft Form.docx

24/46

7. $30,000 to $39,999
8. $40,000 to $49,999
9. $50,000 to $74,999
10. $75,000 to $99,999
11. $100,000 or above

-2. Don’t know
Base: SL1 = 1
[S]
SL4. Approximately how much is the total monthly payment that you are required to make on the loans
from your education?
Please only include the amount that you are paying, and not money that is paid by others on your behalf
1. I am currently not required to make any payments on these loans
2. $1 to $49
3. $50 to $99
4. $100 to $199
5. $200 to $299
6. $300 to $399
7. $400 to $499
8. $500 to $749
9. $750 to $999
10. $1,000 or above

-2. Don’t know
Base: SL1 = 1
[S]
SL6. Are you behind on payments or in collections for one or more of the loans from your own
education?
1. Yes
0. No
Base: SL1 = 0 or refused
[S]
SL7. Did you borrow money or take out any loans to pay for your own education that you have since
repaid?
1. Yes
0. No

Base: SL1 = 1 or SL7=1
[GRID, S ACROSS]
SL8. Still thinking about the money you borrowed to pay for your own education, did you borrow money
for each of the following educational programs (including any loans which you have completely repaid)?
DOWN:
a. Certificate or technical training
b. Associate degree
c. Bachelor’s degree
d. Professional degree (e.g. MBA, MD, JD)
e. Master’s degree or Doctoral Degree
ACROSS:
1=Yes
0=No

FR 3077 Draft Form.docx

25/46

Base: IF PPMARIT=1 OR 6
[S]
SL10. Do you currently owe any money used to pay for your [IF PPMARIT=1, INSERT: spouse’s / IF
PPMARIT=6, INSERT: partner’s] education? Please only include any loans on which you are a cosigner that were used to pay for their education beyond high school (including student loans, home
equity loans, or credit cards paid off over time).
1. Yes
0. No

Base: IF PPAGE GE 30
[S]
SL11. Do you currently owe any money used to pay for your child or grandchild’s education? Please
only include any loans on which you are a co-signer that were used to pay for their education beyond
high school (including student loans, home equity loans, or credit cards paid off over time).
1. Yes
0. No
999. Do not have children or grandchildren

Base: IF SL11=1
[GRID, S ACROSS]
SL12. Is the money you owe for your child or grandchild’s education a student loans, home equity loan,
credit card debt, or some other type of loan? If you have multiple loans, please select all that apply.
DOWN:
A. Student Loan
B. Home Equity Loan
C. Credit Card
D. Other Loan (Please specify): [textbox]
ACROSS:
1. Yes
0. No
RETIREMENT PLANNING
Base: (D1I = 0 or Refused)
(Not Retired)
[SHOW DISPLAY6 AND K0 ON THE SAME PAGE]
[FOR THOSE WHO ARE NOT DISPLAYED K0, SHOW DISPLAY6A AND K8A ON THE SAME
PAGE]
[DISPLAY6]
This section will ask some questions about your planning and savings for retirement.
Base: (D1I = 0 or Refused)
(Not Retired)
[S]
K0. Do you think that your retirement savings are currently on track?
1. Yes
0. No
-2. Don’t know

Base: (D1I = 0 or Refused)

FR 3077 Draft Form.docx

26/46

(Not Retired)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
K2. Do you currently have each of the following types of retirement savings or pension?
DOWN:
a. 401(k), 403(b), Keogh, or other defined contribution plan through an employer or former employer
(i.e., a retirement plan through work, where you contribute a percent of your salary each pay-period to
invest for retirement)
b. Pension with a defined benefit through an employer or former employer (i.e. a pension that will pay
you a fixed amount each year during retirement based on a formula, your earnings, and years of service)
c. IRA or Roth IRA
d. Savings outside a retirement account (e.g. a brokerage account, savings account, or stock holdings)
e. Real estate or land that you plan to sell or rent to generate income in retirement
f. Ownership of my business
g. Other retirement savings (Please specify): [textbox]
ACROSS:
1. Yes
0. No
Base: (K2_a, K2_c, or K2_d=1)
(Not retired, Has self-directed retirement savings)
[S]
DC4: How comfortable are you with making your own investment decisions in your retirement accounts
(including IRA, 401(k), 403(b), Thrift, or other retirement accounts where you choose the investments
for yourself)?
1. Very comfortable
2. Mostly comfortable
3. Slightly comfortable
4. Not comfortable
Base: (D1I = 0 or Refused)
(Not Retired)
[S]
K5A. In the past 12 months, have you borrowed money from or cashed out (permanently withdrawn)
money from any of your retirement savings accounts?
1.
2.
3.
0.

Yes, borrowed money
Yes, cashed out
Yes, both
No

Base: (D1I = 1)
Show Display 6A and K8A on the same screen
(Retired)
[DISPLAY6A]
This section will ask some questions about your planning and savings for retirement.
[Q WITH S, RANGE 25 TO PPAGE]
[ALLOW RESPONDENT TO EITHER TYPE ANSWER IN NUMBER BOX OR CHECK DON’T KNOW,
PROMPT WITH THE FOLLOWING IF BOTH: Please enter an answer in the number box OR check Not
Sure.]
K8A. You indicated previously that you are retired. At what age did you retire?
[NUM BOX 17-PPAGE]

FR 3077 Draft Form.docx

27/46

-2 Not Sure [S]
Base: (D1I = 1)
(Retired)
[GRID, S ACROSS]
K9. How important were each of the following in your decision to retire at the age that you did?
DOWN
a. Poor health
b. Wanted to do other things
c. Didn’t like the work
d. Family responsibilities
e. Wanted to spend more time with family
f. Forced to retire or lack of available work
ACROSS
3. Very important
2. Somewhat important
1. Not important
Base: (D1I = 1)
(Retired)
[GRID, S ACROSS]
[SUPPRESS DEFAULT INSTRUCTIONS, INSTEAD SHOW: Please answer yes or no to each option]
K10. Are each of the following sources of funds for you [IF PPMARIT=1, INSERT: and your spouse / IF
PPMARIT=6, INSERT: and your partner] in retirement?
DOWN:
a. Social Security
b. I have a job
c. My spouse/partner has a job [Display if PPMARIT=1 or PPMARIT=6]
d. Pension with a defined benefit from work (i.e. pension based on a formula, your earnings, and years
of service)
e. 401(k), 403(b), Keogh, or other defined contribution plan from work (i.e., a retirement plan through
work, where you contributed a percent of your salary each pay-period to invest for retirement)
f. IRA or Roth IRA
g. Savings outside a retirement account (e.g. a brokerage account, savings account)
h. Income from real estate or the sale of real estate
i. Income from a business or the sale of a business
j. Relying on children, grandchildren, or other family
k. Other retirement savings
ACROSS:
1. Yes
0. No
INCOME AND CONSUMPTION SECTION
[SHOW DISPLAY7 AND I0 ON THE SAME PAGE]
[DISPLAY7]
This section will ask some questions about your savings, expenses, and sources of income.
Base: All respondents
[S]
I0. In the past 12 months, did you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6,
INSERT: and/or your partner] receive any income from the following sources:
DOWN:

FR 3077 Draft Form.docx

28/46

a. Wages or salaries
b. Self-employment
c. Freelance work or hobbies (do not include income from GfK)
d. Interest, dividends, or rental income
e. Social Security
f. Supplemental Security (SSI)
g. Unemployment income
h. Pension income
i. Any other income
ACROSS:
1. Yes
0. No
Base: if ALL I0_a through I0_i =0 or refused
(No income sources listed)
[S]
I0A. Did you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6, INSERT: and/or your
partner] receive any income from any source in the past 12 months?
1. Yes
0. No
Base: I0=1 for any response OR I0A=1 or refused
(Report having any income)
[S]
[IF REFUSED, PROMPT ONCE: “We ask for information about your income because it is extremely important
for our understanding of household finances in the United States. We greatly appreciate your response
and your answer will remain completely anonymous”]
I40. Which of the following categories best describes the total income that you [IF PPMARIT=1,
INSERT: and your spouse / IF PPMARIT=6, INSERT: and your partner] received from all sources,
before taxes and deductions, in the past 12 months?
1. $0 to $4,999
2. $5,000 to $14,999
3. $15,000 to $24,999
4. $25,000 to $39,999
5. $40,000 to $49,999
6. $50,000 to $74,999
7. $75,000 to $99,999
8. $100,000 to $149,999
9. $150,000 to $199,999
10. $200,000 or higher

Base: All respondents
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
I41. In the past year, have you [IF PPMARIT=1, INSERT: and/or your spouse / IF PPMARIT=6,
INSERT: and/or your partner] received any of the following?
DOWN
a. Earned Income Tax Credit
b. Food Stamps
c. Women, Infants, and Children (WIC) nutrition program benefits
d. Assistance with housing payments from a state, county, or federal program
e. Free or reduced price school lunches
f. Cash assistance from a state or county welfare program, such as TANF

FR 3077 Draft Form.docx

29/46

ACROSS
1. Yes
0. No
Base: All respondents
[S]
I9. In the past 12 months, which one of the following best describes how your [IF PPMARIT=1, INSERT:
and your spouse’s / IF PPMARIT=6, INSERT: and your partner’s] income changes from month to
month, if at all?
1. Roughly the same amount each month
2. Roughly the same most months, but some unusually high or low months during the year
3. Often varies quite a bit from one month to the next
Base: (I9 = 2 or 3)
[S]
I12. In the past 12 months, did you [IF PPMARIT=1, INSERT: and your spouse / IF PPMARIT=6,
INSERT: and your partner] have any months where you struggled to pay your bills because your income
was lower than normal?
1. Yes
0. No
Base: All respondents
[S]
I20. In the past month, would you say that your [IF PPMARIT=1, INSERT: and your spouse’s / IF
PPMARIT=6, INSERT: and your partner’s] total spending was:
3. More than your income
2. The same as your income
1. Less than your income
FINANCIAL SUPPORT FROM OUTSIDE THE HOME
Base: All respondents
[S]
FS10. Does anyone living outside of your household (such as a parent, child, or other relative)
provide you with regular financial support, or help you with any bill payments including rent, student
loans, car payments, or other bills?
1. Yes
0. No
Base: FS10=1
(Receive financial support)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
FS20. Do you receive help with each of the following expenses or receive the following types of
financial assistance from people living outside of your household?
Down
a. Rent or mortgage
b. Student loan bill
c. Car payment
d. Money on a regular basis to use for any purpose
e. Money occasionally as needed to use for any purpose
f. Other bills or expenses [Please specify]
Across

FR 3077 Draft Form.docx

30/46

1. Yes
0. No
Base: FS10=1
(Receive financial support)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
FS30. Who outside of your household provides you with regular financial support or helps you with bill
payments?
DOWN
a. Parent(s)
b. My adult child
c. Other relatives
d. Friends
e. Other [Please specify]
ACROSS
1. Yes
0. No
Base: All respondents
[S]
FS40. Do you provide to anyone living outside of your household (such as a parent, child or other
relative) regular financial support, or help them with any bill payments including student loans, rent,
car payments, cell phone, or other bills?
1. Yes
2. No

EMERGENCY FUND SECTION
[SHOW DISPLAY8 AND EF1 ON THE SAME PAGE]
[DISPLAY8]
This section will ask some questions about your emergency savings, insurance, and economic
hardships.
Base: All respondents
[S]
EF1. Have you set aside emergency or rainy day funds that would cover your expenses for 3 months
in case of sickness, job loss, economic downturn, or other emergencies?
1. Yes
0. No

Base: EF1 = 0 or refused
(Does not have 3 months emergency fund)
[S]
EF2. If you were to lose your main source of income (e.g. job, government benefits), could you cover
your expenses for 3 months by borrowing money, using savings, selling assets, or borrowing from
friends/family?
1. Yes
0. No

FR 3077 Draft Form.docx

31/46

Base: All respondents
[M]
EF3. Suppose that you have an emergency expense that costs $400. Based on your current financial
situation, how would you pay for this expense? If you would use more than one method to cover this
expense, please select all that apply.
a. Put it on my credit card and pay it off in full at the next statement
b. Put it on my credit card and pay it off over time
c. With the money currently in my checking/savings account or with cash
d. Using money from a bank loan or line of credit
e. By borrowing from a friend or family member
f. Using a payday loan, deposit advance, or overdraft
g. By selling something
h. I wouldn’t be able to pay for the expense right now
i. Other (Please specify):[TEXTBOX]
Base: All respondents
[S]
EF5A. Do you expect to be able to pay all of your bills in full this month?
1. I will be able to pay all of my bills in full
0. I cannot pay some bills or will only make a partial payment on some of them
Base: EF5A=1
[S]
EF5B. How would a $400 emergency expense that you had to pay impact your ability to pay your other
bills this month?
1. I would still be able to pay all of my other bills in full
0. I could not pay some other bills or would only make a partial payment on some of them
Base: EF5A=0 (unable to pay all bills this month)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
EF6A. Are you expecting to be unable to pay or only make a partial payment on each of the following
bills this month?
DOWN:
a. Rent or mortgage
b. Credit card
c. Water, gas, or electric bill
d. Phone or cable bill
e. Car payment
f. Student loan
g. Other [Please specify]
ACROSS:
1. Yes
0. No

Base: EF5B=0 (unable to pay all bills this month if faced with a $400 expense)
[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
EF6B. Which of the following bills would you likely skip paying, or make only a partial payment on, if
you had a $400 emergency expense that you had to pay?
DOWN:
a. Rent or mortgage
b. Credit card

FR 3077 Draft Form.docx

32/46

c. Water, gas, or electric bill
d. Phone or cable bill
e. Car payment
f. Student loan
g. Other [Please specify]
ACROSS:
1. Yes
0. No

HEALTH AND INSURANCE SECTION
Base: All respondents
[GRID, S ACROSS]
[SHOW THIS TEXT INSTEAD OF DEFAULT INSTRUCTIONS: Please answer yes or no to each option]
E1. During the past 12 months, was there a time when you needed any of the following, but didn’t get
it because you couldn’t afford it?
DOWN:
a. Prescription medicine (including taking less medication than prescribed)
b. To see a doctor
c. Mental health care or counseling
d. Dental care (including skipping check-ups or routine cleaning)
e. To see a specialist (such as an OB/GYN, dermatologist, orthopedic surgeon, etc.)
f. Follow-up care (e.g. skipping physical therapy sessions recommended by a doctor )
ACROSS:
1. Yes
0. No

Base: All respondents
[S]
E2. During the past 12 months, have you had any unexpected major medical expenses that you had
to pay out of pocket (that were not completely paid for by insurance)?
1. Yes
0. No
Base: E2=1
(Had major medical expense)
[Q]
E2A. Approximately how much did you pay out of pocket for unexpected major medical expenses in the
past 12 months?
$[NUMBER BOX 0-9999999]
Base: E2=1
(Had major medical expense)
[S]
E2B: Do you currently have an unpaid balance or owe any debt related to the unexpected major medical
expenses that you had in the past 12 months?
1. Yes
0. No
Base: All respondents
[GRID, S ACROSS]
[SHOW THIS TEXT INSTEAD OF DEFAULT INSTRUCTIONS: Please answer yes or no to each option]

FR 3077 Draft Form.docx

33/46

E4. Are you CURRENTLY covered by any of the following types of health insurance or health
coverage plans?
DOWN
a. Insurance through a current or former employer or union (of yourself or a family member)
b. Insurance purchased directly from an insurance company (by yourself or a family member)
c. Medicare, for people 65 or older, or people with certain disabilities
d. Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low
incomes or disability
e. TRICARE or other military health care
f. VA (including those who have ever used or enrolled for VA health care)
g. Insurance purchased through a health insurance exchange
h. Any other type of health insurance or health coverage plan
ACROSS
1. Yes
0. No
FINANCIAL HARDSHIP SECTION
Base: All respondents
[GRID, S ACROSS]
[SHOW THIS TEXT INSTEAD OF DEFAULT INSTRUCTIONS: Please answer yes or no to each option]
X2. Have you and your family living with you experienced financial hardship due to each of the following
events in the past 12 months?
Down
a. I lost a job
b. I had my work hours and/or pay reduced
c. My spouse/partner lost a job [DISPLAY IF PPMARIT=1 OR PPMARIT==6]
d. My spouse/partner had their work hours and/or pay reduced [DISPLAY IF PPMARIT=1 OR
PPMARIT==6]
e. Divorce
f. Major unexpected expenses [Please specify]
g. Other [Please specify]
Across
1. Yes
0. No

Base: X2=1 for at least one answer
Only show choices a-g where respondent answered “yes” to X2
[GRID, S ACROSS]
X3. How much financial strain did each of the events that you experienced cause for you and your
family?
Down
a. I lost a job
b. I had my work hours and/or pay reduced
c. My spouse/partner lost a job
d. My spouse/partner had their work hours and/or pay reduced
e. Divorce
f. Major unexpected expenses [Please specify]
g. Other [Please specify]
Across
1. None
2. A little strain
3. Moderate strain

FR 3077 Draft Form.docx

34/46

4. Substantial strain

CHILDHOOD BACKGROUND SECTION
[SHOW DISPLAY9 AND CH0 ON THE SAME PAGE]
[DISPLAY9]
We are interested in a few characteristics of your family when you were growing up.
Base: xsflag=1 or 3
(Fresh respondents)
[TEXT BOX]
CH0. Where did you live when you started high school?
a. City and State:
b. Zip Code:

[Text box]
[Text Box]

Base: xsflag=1 or 3
(Fresh respondents)
[GRID, S ACROSS]
CH1. When you were growing up (under age 17), how frequently did you worry about each of the
following?
DOWN
a. Your family’s finances
b. Having enough food to eat
c. Crime and personal safety
d. Having a stable caregiver
ACROSS
1. Never worried
2. Rarely worried
3. Sometimes worried
4. Regularly worried
Base: PPAGE<=30 and xsflag=1 or 3
(Fresh respondents)
[GRID, S ACROSS]
[SHOW THIS TEXT INSTEAD OF DEFAULT INSTRUCTIONS: Please answer yes, no, or don’t know
to each option]
CH5. During high school, did you receive information or counseling from your school on a regular basis
about the following:
Down
a. Jobs available while in school
b. College or college admissions
c. Jobs or career paths for after graduation
Across
1. Yes
0. No
-2. Don't know
Base: xsflag=1 or 3
(Fresh respondents)
[S]
CH2. What is the highest level of education that your mother completed?

FR 3077 Draft Form.docx

35/46

1. Less than High School degree
2. High school degree or GED
3. Some college but no degree
4. Certificate or technical degree
5. Associate degree
6. Bachelor’s degree
7. Graduate degree
-2. Don’t know
Base: xsflag=1 or 3
(Fresh respondents)
[S]
CH3. What is the highest level of education that your father completed?
1. Less than High School degree
2. High school degree or GED
3. Some college but no degree
4. Certificate or technical degree
5. Associate degree
6. Bachelor’s degree
7. Graduate degree
-2. Don’t know

FINANCIAL LITERACY SECTION
[SHOW DISPLAY10 AND FL1 ON THE SAME PAGE]
[DISPLAY10]
Finally, we have a few questions about your views on finances and the economy.
Base: All respondents
[S]
FL1. Do you think the following statement is true or false?
"Housing prices in the US can never go down.”
1. True
2. False
-2. Don’t know
Base: All respondents
[S]
FL2. Do you think the following statement is true or false?
“Buying a single company’s stock usually provides a safer return than a stock mutual fund.”
1. True
2. False
-2. Don’t know
Base: All respondents
[S]
[RANDOMIZE 1-4]
FL3. Considering a long time period (for example 10 or 20 years), which asset described below
normally gives the highest returns?
1. Stocks
2. Bonds
3. Savings accounts

FR 3077 Draft Form.docx

36/46

4. Precious metals
-2. Don’t know
Base: All respondents
[S]
FL4. Imagine that the interest rate on your savings account was 1% per year and inflation was 2% per
year. After 1 year, how much would you be able to buy with the money in this account?
1. More than today
2. Exactly the same
3. Less than today
-2. Don’t know
[INSERT STANDARD CLOSE]
End of survey

FR 3077 Draft Form.docx

37/46

Additional questions that are not planned for 2017 but are likely to be asked in one or more
future survey

L2. Could you [IF PPMARIT=1, INSERT: and your spouse / IF PPMARIT=6, INSERT: and your
partner] afford to live on your own in your current neighborhood if you had to?
4. Definitely Yes
3. Probably Yes
2. Probably No
1. Definitely No

[S]
L3. Would you [IF PPMARIT=1, INSERT: and your spouse / IF PPMARIT=6, INSERT: and your
partner] prefer to live on your own if you could afford to?
1. Yes
0. No

[S]
B6A. Thinking about your family when you were growing up (under age 17), would you say your
family during that time was generally pretty well off financially, about average, poor, or did it vary?
4. Pretty well off financially
3. About average
2. Poor
1. It varied

[S]
D7. Thinking about the raise you received in the past 12 months, how did this raise compare to
changes in your living expenses over that period?
1. It failed to keep up with changing living expenses
2. It was in-line with changes in living expenses
3. It exceeded changes in living expenses

[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
D8. How much do each of the following impact your ability to work for pay or work as much as you
would like?
DOWN
a. Child-care responsibilities
b. Caretaking responsibilities for someone other than a child (such as a parent)
c. Health problems of my own
d. Difficulty arranging transportation to or from work
e. (DISPLAY IF D1_A=1) Employer’s restrictions for how many hours I work
f. (DISPLAY IF D1_A=1) Employer sets or schedules the times or shifts that I work
ACROSS
0. No impact
1. Minor impact
2. Moderate impact
FR 3077 Draft Form.docx

38/46

3. Severe impact

[M]
[RANDOMIZE a-f]
R1. Please select all the reasons below for why you rent your home rather than own your home.

a.
b.
c.
d.
e.
f.
g.
h.
i.

It’s cheaper to rent than own a home
Owning a home is a bigger financial risk
It’s more convenient to rent (for example you can move easily)
I plan on moving in the near future
I can’t qualify for a mortgage to buy a home
I can’t afford the down payment to buy a home
I simply prefer to rent
I’m currently looking to buy a home
Other (Please specify):[TXT]________________________________

[M]
R5D. Please select all of the reasons that you moved to your current home in [INSERT GH2 RESPONSE
IN NORMAL FONT]?
a. Rent increased at previous home or apartment [display if R4=0 or refused]
b. Landlord would not fix things at previous home or apartment [display if R4=0 or refused]
c. To save money
d. Better quality or larger home
e. Closer to work or school
f. Better quality neighborhood or schools
g. Relocated to a new city
h. Change in family status (e.g. marriage, divorce, children)
i. Other (Please Specify): [TEXTBOX]

[Suppress default instructions, instead show: Please answer yes, no, or don’t know to each
option]
[GRID, S ACROSS]
R6. When you rented your current home, were each of the following part of the rental application
process?
DOWN
a. Documentation of employment or income
b. Payment of a security deposit
c. Payment of an application fee
d. Request for references
e. Request to run a credit check
f. Request to run a criminal background check
ACROSS
1. Yes
0. No
-2. Don’t know

FR 3077 Draft Form.docx

39/46

[S]
R9. Do you [IF PPMARIT=1, INSERT: (and/or your spouse) / IF PPMARIT=6, INSERT: (and/or your
partner)] expect to purchase a home in the next 5 years?
4. Definitely Yes
3. Probably Yes
2. Probably No
1. Definitely No
-2. Don’t know

[Suppress default instructions, instead show: Please answer yes or no to each option]
[GRID, S ACROSS]
R10. Are each of the following reasons that you expect to buy a home in the next 5 years?
ACROSS
a. Will have saved enough for a down-payment
b. Will be more certain about job
c. Will be more certain about location or where to live
d. Will have a higher income
e. Change in family circumstances (e.g. marriage, divorce, children)
f. Other (Please specify): [TXT]________________________________
DOWN
1. Yes
0. No

[M]
[RANDOMIZE a-f]
H0. Please select all the reasons below for why you own your home rather than rent.
a.
b.
c.
d.
e.
f.
g.
h.

It’s cheaper to own than rent a home
Owning a home is a good financial investment
Certainty about monthly payments
Building equity with payments
Don’t like to move
Less rules / able to customize house
Simply prefer to own
Other (Please specify):[TXT]________________________________

[S]
H6. Prior to purchasing your current home did you [IF PPMARIT=1, INSERT: or your spouse / IF
PPMARIT=6, INSERT: or your partner] ever own another house?
1. Yes
0. No

[M]
H7. In addition to your mortgage, please select all the sources below that you used to fund the home
purchase when you bought your current home:

FR 3077 Draft Form.docx

40/46

a.
b.
c.
d.
e.
f.
g.

Proceeds from sale of previous home
Personal savings
Loan or gift from family/friends
Second mortgage
Financial assistance from a government program or non-profit organization
None [S]
Other (Please Specify): [TEXTBOX]

[S]
BK5. Suppose that you were making a $10 purchase at a local store. How would you most commonly
expect to pay for this purchase?
a. Cash
b. Check
c. Credit card
d. Debit card
e. Prepaid card
f. Money order
g. Mobile app
h. Other [text box]: _______________

[S]
A0C. The most recent time that you applied for credit, did you submit the signed application to the
bank or lender:
a. In person at a bank branch or lender’s office
b. By mail or delivery service (e.g., USPS, FedEx, UPS)
c. Over e-mail
d. Through the bank or lender’s website or app or through an electronic delivery service (e.g.
DocuSign)
e. Via fax
f. Other [Please Specify]
Base: all respondents
[S]
C1. If you had to guess, do you think your current credit score (such as a FICO score) is:
5. Excellent
4. Very good
3. Good
2. Fair
1. Poor
-2. Don’t know my score or how to rate it

[GRID, S ACROSS]
ED12. How important was the advice or opinion of each of the following types of people when you were
deciding whether to attend college [if ED0>=3 or ED0A=1 or ED0C=1, INSERT: and what school to
attend]?
DOWN
a. Parents
b. Siblings, aunts, uncles, or other relatives
c. Friends

FR 3077 Draft Form.docx

41/46

d. High school teachers or counselors
e. Faculty or representatives of a college
f. Employer
g. Religious leader
h. Other (Please Specify): [Textbox]
ACROSS
5. Very important
4. Moderately important
3. Slightly important.
2. Not important
1. No advice from person

[RANGE FOR ALL NUMBER BOXES: $0 TO $999,999]
[SHOW IN A GRID FORMAT]
SL3. Thinking specifically about the money that you owe for your own education, please tell us the total
amount that you currently owe on each of these loans. If you don’t know an exact amount, an estimate
is fine.
a. [IF SL2_A=1] Student Loan
b. [IF SL2_B=1] Home Equity Loan
c. [IF SL2_C=1] Credit Card
d. [IF SL2_D=1] Other Loan

$____ [NUMBER BOX]
$____ [NUMBER BOX]
$____ [NUMBER BOX]
$ ____[NUMBER BOX]

e. Total [SUM OF A-D]

$____ [NUMBER BOX]

[GRID, S ACROSS]
I3. In the past 12 months, did you [IF PPMARIT=1, INSERT: and your spouse / IF PPMARIT=6,
INSERT: and your partner] do each of the following to cover spending that exceeded your income?
DOWN
a. Spend out of your savings
b. Borrow / take-on debt
c. Rely on family or friends
d. Other (Please describe): [Text box] _____________
ACROSS
1. Yes
0. No

[M; RANDOMIZE; A-F]
I10. Please indicate whether each of the following is a reason that your [IF PPMARIT=1, INSERT: and
your spouse’s / IF PPMARIT=6, INSERT: and your partner’s] income changed from month to month in
the past year:
a. Bonuses
b. Commissions
c. Seasonal employment
d. Irregular work schedule (i.e. your work hours change from week to week)
e. Periods of unemployment
f. Investment Income
g. Other (Please Specify): [TEXTBOX]

FR 3077 Draft Form.docx

42/46

[GRID, S ACROSS]
[Suppress default instructions]
E6. Do you currently have serious difficulty with any of the activities listed below due to a physical,
mental, or emotional condition?
Please do not include difficulties resulting from a temporary condition such as pregnancy or a shortterm injury.
DOWN:
a. Do you have serious difficulty hearing or serious difficulty seeing even with glasses (including being
blind or deaf)?
b. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating,
remembering, or making decisions?
c. Do you have serious difficulty walking or climbing stairs?
ACROSS:
1. Yes
0. No

[GRID]
[Suppress default instructions]
E7. Do you currently have a health problem or disability which prevents you from working or which
limits the kind or amount of work that you can do?
1. Yes
0. No

[TEXTBOX, 500 CHARACTERS]
PROGRAMMING NOTE: TEXTBOX IS INTENTIONALLY LARGER THAN THE STATED LIMIT SO THAT RESPONDENT IS
NOT FORCED TO REDUCE TEXT IF THEY WRITE TOO MUCH.
[O]
X11. In a couple of words (150 character max) please describe the main financial challenges or
concerns facing you or your family? If none please click the “None” box.
[TEXTBOX, 500 CHARACTERS]

999 None [S]

[S]
K20. Approximately how much money do you currently have saved for retirement?
1. Less than $10,000
2. $10,000 to $24,999
3. $25,000 to $49,999
4. $50,000 to $99,999
5. $100,000 to $249,999
6. $250,000 to $499,999
7. $500,000 to $999,999

FR 3077 Draft Form.docx

43/46

8. Over $1,000,000
-2. Don’t know

[S]
DC1. Does your employer offer a 401(k), 403(b), Thrift, or other defined contribution retirement plan?
1. Yes
0. No
-2. Don’t know

[S]
DC3. If your employer did offer a 401(k), 403(b), Thrift, or other defined contribution retirement plan,
would you contribute to the plan?
1. Definitely No
2. Probably No
3. Probably Yes
4. Definitely Yes
-2. Don’t know

[S]
EH1. On a scale of 1 to 5, where 1 is very poor and 5 is excellent, how would you rate the health of the
economy in your local area?
1. 1 (Very poor)
2. 2
3. 3
4. 4
5. 5 (Excellent)
-2. Don’t Know

[S]
EH2. On a scale of 1 to 5, where 1 is very poor and 5 is excellent, how would you rate the health of the
economy nationwide?
1. 1 (Very poor)
2. 2
3. 3
4. 4
5. 5 (Excellent)
-2. Don’t Know

MB1. In the past 12 months, have you or your spouse/partner accessed an account in any of the
following ways?
a. Bank Teller

FR 3077 Draft Form.docx

44/46

b.
c.
d.
e.
f.

ATM or bank kiosk
Telephone banking through phone call or automated voice or touch tone
Online banking with a laptop, desktop computer, or tablet
Mobile banking with text messaging, mobile app, or Internet browser or email on a mobile
phone
Other

[Q; RANGE: 0-999]
MB10. About how long does it take you to travel to the branch you typically visit (one way)?
_____ minutes
Check this box if you don’t visit a branch [S]

[S]
MB11. Which of the following best describes the location of your bank or credit union branch where
you can speak with a teller or bank employee, if needed?

1. I have a branch close to my home, work, school, or other place I go frequently.
2. I must go out of my way or travel for a while to visit a branch.
3. I am not able to visit a branch because my bank does not have a branch in my area.
[Q; RANGE: 0-999]
MB20. About how long does it take you to travel to the ATM you typically use (one way)?
____minutes
Check this box if you don’t use an ATM.[S]

[S]
MB21. Which of the following best describes the location of the ATM you can use for banking
transactions, if needed?
1. I have an ATM close to my home, work, school, or other place I go frequently.
2. I must go out of my way or travel for a while to access the ATM.
3. I am not able to use an ATM for banking transactions because there is not an ATM in my
area.

MB30. In the past 12 months, have you or your spouse/partner:
a. used a mobile phone to check email from a bank about an account?
b. received a mobile text alert or push notification from a bank about an account?
c. used a mobile phone’s camera to deposit a check into a bank account?

MB31. In the past 12 months, have you used a bank’s mobile website or bank’s mobile app to
a. check a bank account balance or recent transactions?
b. make a bill payment?
c. send money to other people?
d. transfer money between bank accounts owned by the same person that you own?

FR 3077 Draft Form.docx

45/46

MB32. Using your mobile phone, have you done each of the following in the past 12 months? Please
include payments you made through your bank as well as through other companies that are not your
bank.
a. Paid for something in a store using your mobile phone/app instead of cash or a physical
payment card
b. Paid for parking, a taxi, car service (e.g. Uber, Lyft) or public transit
c. Purchased a physical item or digital currency remotely by using your mobile phone’s web
browser or an app
d. Made a donation or other payment using a text message

FR 3077 Draft Form.docx

46/46