American Healthy Homes Survey II

American Healthy Homes Survey II

Appendix F Nonresponse follow-up questionnaire.HUD._21nov17

American Healthy Homes Survey II

OMB: 2539-0026

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Appendix F - AHHS II Nonresponse Follow-up Questionnaire


Q1. When was your home built?


  1. 1978 TO PRESENT

  2. BETWEEN 1960 AND 1977

  3. BETWEEN 1940 AND 1959

  4. 1939 OR BEFORE


  1. DON’T KNOW


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


  1. YES (SKIP TO Q4)

  2. NO


  1. DON’T KNOW


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


  1. 4 OR FEWER UNITS

  2. 5 UNITS OR MORE


  1. DON’T KNOW


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


  1. NUMBER OF RESIDENTS |__| |__|


  1. DON’T KNOW


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


  1. YES

  2. NO (SKIP TO Q7)


  1. DON’T KNOW


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


  1. YES

  2. NO


  1. DON’T KNOW


Q7. Do you own or rent this home?


  1. OWN (SKIP TO Q9)

  2. RENT


  1. DON’T KNOW


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


  1. HOUSING AUTHORITY

  2. PRIVATE LANDLORD


  1. DON’T KNOW


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


  1. Up to $34,999

  2. $35,000 or above


  1. DON’T KNOW


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


  1. WHITE

  2. BLACK OR AFRICAN AMERICAN

  3. ASIAN

  4. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

  5. AMERICAN INDIAN OR ALASKAN NATIVE



Q11. Do you consider yourself Hispanic or Latino?


  1. HISPANIC OR LATINO

  2. NOT HISPANIC OR LATINO

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