0693-0078_Household_Survey_Instrument_24Nov2020

W4 Survey (original sample) – Housing Recovery in Lumberton, NC (edits 24Nov2020)

Survey Flow

Block: Default Question Block (40 Questions)

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Q1
OMB # 0693-0078  (Expiration 07/31/2022)                
 
We understand that the COVID-19 pandemic is disrupting your household. We are gathering information to learn how households like yours are adapting to the circumstances and how this situation may or may not be connected to broader weather-related stressors your household may face of have faced.  
 
We realize your time is at a minimum with the current situation. We sincerely appreciate your participation and our efforts will be greatly enhanced if you can spend a few minutes filling out this survey. We ask for no sensitive information and we will not identify you or your household at any time. 
 
We would like to know how your household is being impacted by COVID-19 and how it has affected your household's recovery from Hurricane Matthew and Hurricane Florence. We are also interested in learning more about practices taken that have helped reduce the impact of future hazard events.
 
If you feel uncomfortable answering any of the questions, you can skip them, or exit the survey at any time. This survey should take less than 10 minutes to complete. Thank you for your time and participation.
 
If you would like to download an information sheet on the project, please click here.

Q2


 
Please confirm you are a Lumberton resident above 18 years of age, and consent to participate in this survey.

• I am above 18 years of age and consent to this survey. (1)

Q3
 
If you received a postcard, please insert the ID number found on your postcard:

________________________________________________________________

Q4 Please enter your current home address:

________________________________________________________________

Q5 These first set of questions are about your household in general.


How many adults (18 years or older) live in your household?

0

2

3

5

6

8

9

11

12

14

15

Adults (≥ 18) ()

Q6 How many children (younger than 18 years) live in your household?

0

2

3

5

6

8

9

11

12

14

15

Children (< 18) ()

Q7 How many years have you lived in Lumberton? (if less than one year, insert 1)

________________________________________________________________

Q8 When month and year did you move into your current home? (MM/YY)

________________________________________________________________

Q9 Was your home damaged by either Hurricane Matthew or Florence?

• Yes, by Matthew (1)

• Yes, by Florence (2)

• Yes, both Matthew and Florence (6)

• No, neither hurricane damaged my home (3)

• Don't Know (4)

Q10 Next, the questions are going to ask about your household's perceived preparedness now.


Do you rent or own your home?

• Rent (1)

• Own (2)

• Other, please specify (3) ________________________________________________

Display This Question:

If Q10 = Rent

Q11 Do you have renter's insurance?

• Yes (1)

• No (2)

• Don't Know (3)

Display This Question:

If Q10 = Own

Q12 Do you have flood insurance?

• Yes (1)

• No (2)

• Don't Know (3)

Display This Question:

If Q10 = Own

Q13 Do you have homeowner's insurance?

• Yes (1)

• No (2)

• Don't Know (3)

Display This Question:

If Q11 = Yes

Or Q12 = Yes

Or Q13 = Yes

Q14 Do you believe you have adequate insurance coverage for another flood event?

• Yes (1)

• No (2)

• Don't Know (3)

Display This Question:

If Q10 = Own

Q15 Do you have a mortgage?

• Yes (1)

• No (2)

• Don't Know (3)

Q16 How has your participation with neighborhood and/or community groups changed since the COVID-19 pandemic?

• Decreased (1)

• Stayed the same (2)

• Increased (3)

• Don't know (4)

Q17 How has your contact with neighbors and/or extended family and friends changed since the COVID-19 pandemic? 

• Decreased (1)

• Stayed the same (6)

• Increased (7)

• Don't know (8)

Q18 How many major floods or hurricanes have you experienced first-hand (in your lifetime)? 

________________________________________________________________

Q19 How likely do you think your home is to be damaged during a major flood event, similar to Hurricane Matthew or Florence?

• Extremely unlikely (1)

• Unlikely (5)

• Neutral (6)

• Likely (7)

• Extremely likely (8)

Q20 If given evacuation orders, how likely is your household to evacuate your home during a future major flood event, similar to Hurricane Matthew or Florence?

• Extremely unlikely (1)

• Unlikely (6)

• Neutral (7)

• Likely (8)

• Extremely likely (9)

Q21 Please explain your evacuation decision:

________________________________________________________________

Q22 The next set of questions look at mitigation and preparedness strategies used by your household now or that you plan to put in place in the next six months.


Has your household:

	Yes (1)	No (2)	Don't know (3)
Elevated hot water heater and/or HVAC (1)
Re-routed ductwork from below floor to attic space (3)
Developed an emergency plan with household members (5)
Gathered supplies to last 3 or more days (7)
Sought information on mitigation or preparedness (9)
Attended a local meeting or training on preparedness (11)
Set money aside for recovery or repairs (13)
Anything else (15)

Q23 In the next 6 months, does your household plan to:

	Yes (1)	No (2)	Don't know (3)
Elevate hot water heater and/or HVAC (1)
Re-route ductwork from below floor to attic space (2)
Make an emergency plan with household members (3)
Gather supplies to last 3 or more days (4)
Seek information on mitigation or preparedness (5)
Attend a local meeting or training on preparedness (6)
Set money aside for recovery or repairs (7)
Anything else (8)

Q24 Do you have the option to provide any utility services, even if temporarily, for your household? (Please select all that apply.)

• Yes, power generator (1)

• Yes, solar panels (4)

• Yes, water storage tanks (5)

• Yes, gas tanks (6)

• Yes, community wi-fi (7)

• Yes, community information hub (8)

• Yes, other, please explain (9) ________________________________________________

• No (10)

• Don't Know (12)

Q25 The next set of questions are intended to capture the impacts of COVID-19 on your household.


How has COVID-19 impacted repairs to your home?

• No impact (1)

• Minor impact (6)

• Neutral (7)

• Moderate impact (8)

• Major impact (9)

• Don't know (10)

Q26
How has COVID-19 impacted your household's recovery from Hurricane Florence?

• No impact (1)

• Minor impact (6)

• Neutral (7)

• Moderate impact (8)

• Major impact (9)

• Don't know (10)

Q27 Were members of your household unable to work because of COVID-19?

• Yes (1)

• No (2)

• Don't know (3)

Q28 Were members of your household reduced to part-time work because of COVID-19?

• Yes (1)

• No (2)

• Don't know (3)

Display This Question:

If Q27 = Yes

Q29 How long was your household member unable to work (please enter the number of days)?

________________________________________________________________

Display This Question:

If Q28 = Yes

Q30 How long was your household member reduced to part-time work (please enter the number of days)?

________________________________________________________________

Display This Question:

If Q27 = Yes

Q31 Were you or other household members unable to work or reduced to part-time because of:

• Temporary closure of place of employment (1)

• Permanent closure of place of employment (2)

• Childcare issues (3)

• Health issues (4)

• Other (5) ________________________________________________

Display This Question:

If Q27 = Yes

Q32 Would you say the disruption to your household's income has been:

• Significant (1)

• Moderate (2)

• Minimal (3)

• None (4)

• Don't know (6)

Q33 Finally, there are six questions about your household in general.


Do you have any individuals with special electricity-dependent medical needs in your house?
(Examples include individuals who require power wheelchairs, ventilators, oxygen concentrators, CPAP and other sleep apnea devices.)

• Yes (1)

• No (2)

Q34 When considering all members in your household, what is the highest level of of schooling completed?

• Less than High school (1)

• High School diploma (2)

• Associate's degree (3)

• Bachelor's degree (4)

• Master's degree or higher (5)

Q35 While we often ask about each member of a household, in general, when considering your household, how would you describe it's ethnicity?

• Hispanic or Latino (1)

• Not Hispanic or Latino (2)

Q36 While we often ask about each member of a household, in general, when considering your household, how would you characterize its racial makeup? (Select one or more.)

• American Indian or Alaska Native (1)

• Asian (2)

• Black or African American (3)

• Native Hawaiian or Pacific Islander (4)

• White (5)

Q37 Do you consider your household a female-headed household? (This is where a household is maintained by a female with no spouse present.)  

• Yes (1)

• No (2)

• Don't know (4)

Q38 Finally, we do not want to know the exact amount but can you identify the letter associated with the category that best captures your household's combined annual income?

• $1 to $3,999 (1)

• $4,000 to $5,999 (2)

• $6,000 to $7,999 (3)

• $8,000 to $9,999 (4)

• $10,000 to $11,999 (5)

• $12,000 to $14,999 (6)

• $15,000 to $19,999 (7)

• $20,000 to $24,999 (8)

• $25,000 to $29,999 (9)

• $30,000 to $39,999 (10)

• $40,000 to $49,999 (11)

• $50,000 to $74,999 (12)

• $75,000 to $99,999 (13)

• $100,000 to $149,999 (14)

• $150,000+ (15)

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Q39 Are there any additional comments you would like to share?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Q40 Thank you for completing our survey. 
For more information about the study, please visit http://resilience.colostate.edu.
To read our first report on the initial impact and disruption from Hurricane Matthew, please visit: https://doi.org/10.6028/NIST/SP1230. 





OMB Burden Statement: A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0693-0078. Without this approval, we could not conduct this survey/information collection. Public reporting for this information collection is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Dr. Jennifer Helgeson, NIST, 100 Bureau Drive, MS 8603, Gaithersburg, MD 20899-1710, telephone 240-672-2575, or via email: [email protected].
 

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