Download:
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pdfDemographics Questionnaire
Equitable Engagement at HUD
Demographics
HUD is collecting this demographic data to ensure that we speak to people from a
diverse range of backgrounds.
Please select the responses that best describe you. Providing this information is
voluntary and anonymous.
OMB Control Number: 2511-0001
Expiration Date: 09/30/2024
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless such collection displays a valid OMB control number. The time required to complete this information collection
is estimated to average 5 minutes. All responses to this collection of information are voluntary. If you have comments
or concerns regarding this collection, please contact Helen Nicholas of HUD’s Customer Experience team at
[email protected].
1. What gender do you identify as?
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Male
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Female
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Non-binary
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Transgender
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I prefer not to say
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Other:_______________________
2. What state do you live in?
____________________________
3. What is your age?
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18-24
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25-34
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35-44
Demographics Questionnaire
Equitable Engagement at HUD
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45-54
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55-64
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65 and above
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I prefer not to say
4. What is the highest grade or level of school you’ve completed?
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No schooling completed
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Some high school, no diploma
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High school graduate, diploma, or the equivalent (for example: GED)
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Some college credit, no degree
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Trade/technical/vocational training
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Associate degree
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Bachelor’s degree
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Master’s degree
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Doctorate degree
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I prefer not to say
5. Please specify your race/ethnicity. (Check all that apply)
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White
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Hispanic or Latino/Latina
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Black or African American
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Asian
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American Indian or Alaska Native
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Native Hawaiian or Other Pacific Islander
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I prefer not to say
6. Do children reside in your home?
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Yes
Demographics Questionnaire
Equitable Engagement at HUD
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No
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I prefer not to say
7. # of children that reside in your home?
____________________________
8. What is your total household income (including all federal assistance)?
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$5,000 - $25,000
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$25,000 - $45,000
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$65,000 - $85,000
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$85,000 - $105,000
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$105,000 - $125,000
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$125,000+
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I prefer not to say
9. Have you received financial education or housing counseling services
before?
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Yes, I learned about it in school
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Yes, I’ve received information from my friends, family, or community
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Yes, I’ve done research online
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Yes, I’ve attended sessions from a licensed or certified housing counselor
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No
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I prefer not to say
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Other: __________
10. Which best describes where you live?
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Urban/City
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Suburban/Outside a city
Demographics Questionnaire
Equitable Engagement at HUD
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Rural
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Native American tribal land
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I prefer not to say
11. Do you identify with any of the following? (Check all that apply)
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I am an active service member or veteran
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I have a disability
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I identify as LGBTQ
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None of the above
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I prefer not to say
12. Check all that apply:
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I have student loan debt
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I have significant debt from medical bills
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I have been incarcerated in the past
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I have filed for bankruptcy in the past
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I have experienced homelessness in the past
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None of the above
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I prefer not to say
| File Type | application/pdf |
| File Title | Final - Demographics Questionnaire |
| File Modified | 2021-10-13 |
| File Created | 2021-10-08 |