List of Screener Questions (Renters)

OMB Control Number: 3170-0024

Expires: XX/XX/XXXX

Paperwork Reduction Act Notice

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this collection is 3170-0024. It expires on XX/XX/XXXX. The time required to complete this information collection is estimated to average approximately 10 minutes per response. Comments regarding this collection of information, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to [email protected].

Privacy Act Statement

5 U.S.C. 552a(e)(3)

Your information will be used by the Consumer Financial Protection Bureau (Bureau) for recruitment to participate in an interview as well as conduct usability testing of an emergency rental assistance tool.

If you choose to participate, the Bureau will collect demographic information, such as your race, income, and housing situation to determine your eligibility to participate in the study.

Information collected will be treated in accordance with the System of Records Notice (SORN), CFPB.021 – CFPB Consumer Education and Engagement Records. Although the Bureau does not anticipate further disclosing the information provided, it may be disclosed as indicated in the Routine Uses described in the SORN. Direct identifying information will be kept private except as required by law.

This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified at 12 U.S.C. §§ 5493 and 5512.

Participation is voluntary.

Renters Study: Bank of Screener Questions

1. Are you renting the home where you currently reside?

   1. Yes [May select]

   2. No [Disqualify]

2. Please select any of the statements below that describe your situation

   1. I have fallen behind on 1 or more rent payments in the last year [May select]

   2. I made 2 or more late rent payments in the last 18 months [May select]

   3. I needed to sell belongings, borrow from family/friends, or use a credit [May select] card in order to pay rent during the last 18 months [May select]

   4. I am in a rent repayment plan with my landlord [May select]

   5. I skipped needed items (examples: groceries, paying utilities, doctor visits, etc.) in order to pay my rent during the last 18 months [May select]

   6. None of these statements apply to me [Disqualify]

3. In the last [X] months, I have:

   1. Borrowed for an emergency

   2. Borrowed from a friend or family member

   3. Dealt with a debt collector

   4. Lost a job or jobs in my household

   5. Took out a payday loan

4. Are you Hispanic, Latino, or Spanish origin?

   1. No, not of Hispanic, Latino, or Spanish origin

   2. Yes, Hispanic, Latino, or Spanish origin

5. Please select all of the following that best describes your race:

   1. White

   2. Black or African American

   3. American Indian or Alaska Native

   4. Asian

   5. Native Hawaiian or Other Pacific Islander

6. Please select all languages that you’re fluent (can speak, read, and write) in

   1. English

   2. Spanish

   3. Chinese Mandarin

   4. Japanese

   5. Vietnamese

   6. Korean

   7. Tagalog

   8. Russian

   9. Arabic

   10. Haitian Creole

   11. Other

7. What is your native language?

   1. English

   2. Spanish

   3. Chinese Mandarin

   4. Japanese

   5. Vietnamese

   6. Korean

   7. Tagalog

   8. Russian

   9. Arabic

   10. Haitian Creole

   11. Other

8. Which of the following phrases best describes how you communicate at home?

   1. I always speak English

   2. I speak more English than my native language

   3. I speak English as often as I speak my native language

   4. I speak more of my native language than English

   5. I always speak my native language

9. Do you prefer to read in your native language or English?

   1. Native language

   2. Either/No preference

   3. English

10. What city and state do you live in?

    1. [Type in text box]

11. How would you describe the area where you live? (single select)

    1. An urban area in a large or medium sized city

    2. A suburban area around a large or medium sized city

    3. A rural area within a one hour drive of a large or medium sized city

    4. A small town or city more that’s more than a one hour drive from a large or medium sized city

    5. A rural area that’s more than a one hour drive from a large or medium sized city

    6. My area doesn’t fit any of these descriptions

12. Are you currently living on tribal land or are a tribal member?

    1. Yes

    2. No

13. What best describes your current occupation? [Check boxes, select all that apply]

    1. Going to high school

    2. Going to community college, 2-year degree program, or trade school (either full-time or part-time)

    3. Going to a 4-year college/university (either full-time or part-time)

    4. Working full-time

    5. Working part-time

    6. Homemaker

    7. Retired

    8. Not employed

14. What is the highest educational degree that you have earned? [Radio buttons, select only one]

    1. Less than high school degree or equivalent

    2. High school graduate (grade 12, diploma, or GED)

    3. Trade school certificate

    4. Some college courses completed

    5. Graduated with a 2 year degree (Associates)

    6. Graduated with a 4 year degree (Bachelors)

    7. Some graduate school courses completed

    8. Graduated with a post-graduate degree

15. What devices do you usually use for work and personal use: [Select all that apply]

    1. Desktop Mac

    2. Desktop PC

    3. Laptop Mac

    4. Laptop PC

    5. Tablet

    6. Mobile phone

16. What is your annual household income? [Radio buttons, select only one]

    1. Less than $30K

    2. $30K - $50K

    3. $50K - $100K

    4. $100 - $150K

    5. More than $150K