Hurricane Pulse Survey
Welcome! Thank you for participating in the Hurricane Pulse Survey sponsored by the U.S. Census Bureau and other federal agencies.
This survey will
help measure the impact of recent natural disasters on social and
economic factors on topics like:
employment status
food security
housing security
physical and mental wellbeing.
Data from this survey will
be used to help federal agencies plan for disaster relief now and in
the future.
This survey is also available in Spanish. If you would like to change your language selection, please use the drop down menu in the upper right corner of each page to select the language in which you prefer to complete the survey.
This survey is a
cooperative effort across many government agencies to provide
critical, up-to-date information on the U.S. population. Completing
this 20-minute survey will help federal, state, and local agencies
identify emergent issues in your community.
PRA
We estimate that completing this voluntary survey will take 20 minutes on average. Send comments regarding this estimate or any other aspect of this survey to [email protected].
The U.S. Census Bureau is required by law to protect your information. The Census Bureau is not permitted to publicly release your responses in a way that could identify you. Federal law protects your privacy and keeps your answers confidential (Title 13, United States Code, Section 9 and Title 5, U.S. Code, Section 552a).
This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, 0607-0971, confirms this approval and expires on 01/31/2027.
The uses of your data are limited to those identified in the Privacy Act System of Record Notice titled, “SORN COMMERCE/Census-3, Demographic Survey Collection (Census Bureau Sampling Frame).”
To learn more about this survey go to: https://www.census.gov/householdpulsedata.
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This survey is available in English and Spanish. Please select the language in which you prefer to complete the survey.
If you would
like to change your language selection later, please use the drop
down menu in the upper right corner of each page to select the
language in which you prefer to complete the survey.
English (1)
Español (2)
These questions are for statistical purposes only.
D1 What year were you born? Please enter a number.
________________________________________________________________
D2 Are you of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin (1)
Yes, Mexican, Mexican American, Chicano (2)
Yes, Puerto Rican (3)
Yes, Cuban (4)
Yes, another Hispanic, Latino, or Spanish origin (5) __________________________________________________
D3 What is your race? Please select all that apply.
White (specify) (1) ______________________________________
Black or African American (specify) (2) ___________________________
American Indian or Alaska Native (specify) (3) ________________________
Asian Indian (4)
Chinese (5)
Filipino (6)
Japanese (7)
Korean (8)
Vietnamese (9)
Other Asian (specify) (10) _______________________________
Native Hawaiian (11)
Chamorro (12)
Samoan (13)
Other Pacific Islander (specify) (14) _________________________________
D4 What is the highest degree or level of school you have completed? Select only one answer.
Less than high school (1)
Some high school (2)
High school graduate or equivalent (for example GED) (3)
Some college, but degree not received or is in progress (4)
Associate’s degree (for example AA, AS) (5)
Bachelor's degree (for example BA, BS, AB) (6)
Graduate degree (for example master's, professional, doctorate) (7)
D5 What is your marital status? Select only one answer.
Now married (1)
Widowed (2)
Divorced (3)
Separated (4)
Never married (5)
D6 What sex were you assigned at birth, on your original birth certificate?
Male (1)
Female (2)
D7_alt How do you currently describe yourself? Select all that apply.
▢ Male (1)
▢ Female (2)
▢ Transgender (3)
▢ Nonbinary (4)
▢ I use a different term (5) ____________________________________
D8_alt Just to confirm, you were assigned "${D6/ChoiceGroup/SelectedChoices}" at birth and now you describe yourself as "${D7_alt/ChoiceGroup/SelectedChoices}". Is that correct?
Yes (1)
No (2)
D6_correction Please confirm or correct your answer to the following question: ${D6/QuestionText}
Male (1)
Female (2)
D7_altcorrection Please confirm or correct your answer to the following question: ${D7_alt/QuestionText}
▢ Male (1)
▢ Female (2)
▢ Transgender (3)
▢ Nonbinary (4)
▢ I use a different term (5) ____________________________________
D9_writein Which of the following best represents how you think of yourself?
Gay or lesbian (1)
Straight, that is not gay or lesbian (2)
Bisexual (3)
I use a different term: _________________ (4)
D10 How many total people – adults and children – currently live in your household, including yourself? Please enter a number.
________________________________________________________________
D11 How many people under 18 years-old currently live in your household? Please enter a number.
________________________________________________________________
D12 In your household, are there… Select all that apply.
Children under 1 year old?
Children 1 through 4 years old? (1)
Children 5 through 11 years old? (2)
Children 12 through 17 years old? (3)
Hur1 The next set of questions asks about natural disasters, such as hurricanes, floods and fires.
In 2024, were you or was anyone currently living or staying with you affected by a natural disaster?
Yes (1)
No (2)
Hur2 What type of natural disaster? Select all that apply.
Hurricane (1)
Flood (2)
Fire (3)
Tornado (4)
Volcanic activity (5)_
Earthquake (6)
Landslide/mudslide/rockfall (7)
Other, specify (8) __________________________________________
For hurricane:
Considering those people who were affected by the recent hurricane:
English |
Spanish |
Notes |
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Which of the following did you do to prepare before the recent hurricane? (Select all that apply.)
|
¿Qué medidas de preparación tomaste ante el reciente huracán? (Selecciona todas las opciones que apliquen.)
|
ICPD recommends randomizing the order of rows in this list.
|
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Which of the following do you wish you had done to prepare before the recent hurricane? (Select all that apply.)
|
¿Qué medidas de preparación te hubiese gustado tomar ante el huracán más reciente? (Selecciona todas las opciones que apliquen.)
|
ICPD recommends pulling forward only those that were NOT selected.
|
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For each of the actions you reported taking, how much did the action help you during and after the hurricane?
|
¿Cómo le ayudó la preparación durante y después del huracán más reciente?
|
ICPD recommends pulling forward only the options that people said that they had done in the previous question.
|
Hur3 In 2024, were you or was anyone currently living or staying with you displaced from their home because of a natural disaster?
Yes (1)
No (2)
Hur4 How many people currently living in your home were displaced because of a natural disaster?
___ adults
___children
Hur5 How many times have you (or they) been displaced in 2024 due to a natural disaster?
1 time
2 times
3 times
4 or more times
Hur6 How long were you (or they) displaced from the home?
Less than a week (1)
More than a week but less than a month (2)
One to two months (3)
More than two months (4)
Have not yet returned to home (or don’t plan to) (5)
HUR7 (If Hur2 = 1) Would you say that you are still in transition or are you now permanently settled in a home?
In transition
In permanent home
Hur 8(If Hur2 = 1)
Did you or your family share living quarters with relatives or friends, people you did not know, or did you not share living quarters with others? Select all that apply.
Relatives or friends
People you did not know
Did not share living quarters with others
Hur9
During the past year, was your home ever completely without power for 6 hours or more because of a hurricane?
Yes
No
Hur10 Altogether, how much damage to property or possessions did you (or they) experience as a result of natural disasters in 2024?
Property has no damage (1)
Property has some damage (2)
Property is uninhabitable (3)
Property is completely destroyed (4)
ND5 For how long after the event did you (or they) experience any of the following:
ND5A A shortage of food?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> ND5AA Are you/they still experiencing a shortage of food? Yes/No
ND5B A shortage of drinkable water?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing a shortage of water? Yes/No
ND5C Loss of electricity?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing a loss of electricity? Yes/No
ND5D Unsanitary conditions, such as inadequate toilets?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing unsanitary conditions? Yes/No
ND5E Feeling isolated, down, depressed, anxious, nervous or on edge?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing feeling isolated, down, depressed, anxious nervous or on edge? Yes/No
ND5F Fear of crime?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing fear of crime? Yes/No
ND5G Offers that seemed like a scam?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing offers that seem like a scam? Yes/No
ND5G Disruption to internet?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing disruption to internet? Yes/No
Hur11For how long after the event did you (or they) experience disruption to any of the following:
Hur11a Work?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing disruption to work? Yes/No
Hur11b School/childcare?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing disruption to school/childcare? Yes/No
Hur11c Medical services?
Not affected (0)
1-3 days (1)
4-6 days (2)
1-3 weeks (3)
a month or more (4) -> Are you/they still experiencing disruption to medical services? Yes/No
Hur12 Have you had any interactions with FEMA since the disaster? Select all that apply.
I registered for FEMA assistance (via web, phone, or in-person)
I called the FEMA helpline
I went to disasterassistance.gov
I went to a FEMA disaster recovery center
Someone
from FEMA knocked on my door
Hur13 Have you received any form of temporary housing assistance since the natural disaster?
Yes
No
Hur14 What is your most immediate need right now? Select all that apply.
Food
Shelter
Medical assistance
Emotional support
Electricity
Access to Fresh
Water
Hur15 Overall, what is your impression of FEMA’s response to recent natural disasters in your area?
Very Positive – FEMA’s response has been excellent and met or exceeded expectations.
Somewhat Positive – FEMA’s response has been good, with some areas of improvement.
Neutral/No Opinion – I have no strong opinion or am unsure about FEMA’s response.
Somewhat Negative – FEMA’s response has been lacking in some areas but not entirely inadequate.
Very Negative – FEMA’s response has been poor and well below expectations.
Not Applicable – I am not aware of or directly affected by FEMA’s response to the recent natural disasters.
Hur16 Did you (or they) have flood insurance at the time of the hurricane?
Yes
No
Universe is still those affected by natural disasters:
PREG1 Have you, or has anyone in your household been pregnant since September 1?
PREG2 Have you, or has anyone in your household had a baby since September 1?
PREG3 Have you, or has anyone in your household breastfed or pumped breastmilk for a baby since September 1?
[If Yes to PREG1, PREG2 or PREG3]
PREG_CARE1 Did you (or a member of your household) receive any form of health care for the pregnancy before birth from a health care provider (doctor, nurse, midwife)? Y/N
PREG_CARE2 Have you or a member of your household experienced any of the following since September 1:
Nearest birthing facility/delivery hospital closed (Y/N)
Disruption to prenatal and/or postnatal care (Y/N)
Needed emergency obstetric services (Y/N)
Didn’t have an emergency birth plan or kit (Y/N)
If D12=1
INF2 How many months old is the baby or infant in your household? If there is more than one, please report the age of the youngest.
Under 6 months (1)
Between 6 months and 9 months (2)
Between 9 months and 12 months (3)
INF5 How is the baby in your household fed (in addition to any solid foods the baby may be consuming)? If there is more than one baby, please report on the youngest.
Breastfeeding (or pumped breastmilk) only (1)
Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula (2)
Infant formula only (3)
Baby isn’t fed breastmilk OR infant formula (4)
INF6 In the last month, did you have difficulty getting infant formula?
Yes, in the last 7 days (1)
Yes, more than 7 days ago but within the last month (2)
No, did not have trouble getting infant formula in the last month (3)
INF7 In the last month, did you or someone in your household have difficulty obtaining safe water to prepare infant formula?
Yes, in the last 7 days (1)
Yes, more than 7 days ago but within the last month (2)
No, did not have trouble getting safe water to prepare infant formula in the last month (3)
D13 During the school year that began in the Summer / Fall of 2024, how many children in this household are enrolled in Kindergarten through 12th grade or grade equivalent? Enter whole numbers for all that apply.
Number enrolled in a public school (1) _______________________________
Number enrolled in a private school (2) ______________________________
Number homeschooled, that is not enrolled in public or private school (3) __________________________________________________
None (4)
D14 Are you or your
spouse currently serving in the U.S. Armed Forces (Active Duty,
Reserve, or National Guard)?
Reserve and Guard
members/spouses who are full-time active duty (AGR/FTS/AR) or
currently "activated" should select the "Reserve or
National Guard" response(s). Select all that
apply.
No (1)
Yes, I'm serving on active duty (2)
Yes, I'm serving in the Reserve or National Guard (3)
Yes, my spouse is serving on active duty (4)
Yes, my spouse is serving in the Reserve or National Guard (5)
D15 Have you or your spouse ever served in the U.S. Armed Forces (Active Duty, Reserve, or National Guard)? Select all the apply.
No (1)
Yes, I served on active duty (2)
Yes, I served in the Reserve or National Guard (3)
Yes, my spouse served on active duty (4)
Yes, my spouse served in the Reserve or National Guard (5)
Now we are going to ask about your employment.
EMP1 Have you, or has anyone in your household experienced a loss of employment income since September 1, 2024? Select only one answer.
Yes (1)
No (2)
EMP2
In the
last 7 days, did you do ANY work for either pay or
profit? Select only one answer.
Yes (1)
No (2)
EMP3 Are you employed by the government, by a private company, a nonprofit organization or are you self-employed or working in a family business? Select only one answer.
Government (1)
Private company (2)
Non-profit organization including tax exempt and charitable organizations (3)
Self-employed (4)
Working in a family business (5)
EMP4 What is your
main reason for not working for pay or profit? Select only one
answer.
I did not work because:
I did not want to be employed at this time (1)
I am/was caring for children not in school or daycare (2)
I am/was caring for an elderly person (3)
I am/was sick or disabled (4)
I am retired (5)
I am/was laid off or furloughed (6)
My employer closed temporarily or went out of business (7)
I do/did not have transportation to work (8)
A natural disaster affected my ability to work (9)
Other reason, please specify (10) __________________________________________________
Next, we will ask about health.
DIS1 Do you have difficulty seeing, even when wearing glasses? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS2 Do you have difficulty hearing, even when using a hearing aid? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS4 Do you have difficulty walking or climbing stairs? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS3 Do you have difficulty remembering or concentrating? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS5 Do you have difficulty with self-care, such as washing all over or dressing? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
DIS6 Using your usual language, do you have difficulty communicating, for example understanding or being understood? Select only one answer.
No - no difficulty (1)
Yes - some difficulty (2)
Yes - a lot of difficulty (3)
Cannot do at all (4)
Over the last 2 weeks, how often have you been bothered by...
HLTH1 Feeling nervous, anxious, or on edge? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH2 Not being able to stop or control worrying? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH3 Having little interest or pleasure in doing things? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
HLTH4 Feeling down, depressed, or hopeless? Select only one answer.
Not at all (1)
Several days (2)
More than half the days (3)
Nearly every day (4)
MH1 During the last 4 weeks, did any children in your household need mental health treatment? Mental health treatment includes health services like counseling or medication.
Yes, all children needed mental health treatment (1)
Yes, some but not all children needed mental health treatment (2)
No, none of the children needed mental health treatment (3)
MH2 Did the children who needed mental health treatment receive it?
Yes, all children who needed treatment received it (1)
Yes, but only some children who needed treatment received it (2)
No, none of the children who needed treatment received it (3)
MH3 Were you satisfied with the type, quality, and quantity of mental health treatment the children received?
Satisfied with all of the mental health treatment the children received (1)
Satisfied with some but not all of the mental health treatment the children received (2)
Not satisfied with the mental health treatment the children received (3)
MH4 How difficult was it to get mental health treatment for the children?
Not difficult (1)
Somewhat difficult (2)
Very difficult (3)
Unable to get treatment due to difficulty (4)
Did not try to get treatment (5)
SOClonely How often do you feel lonely?
Always (1)
Usually (2)
Sometimes (3)
Rarely (4)
Never (5)
SOCsupport How often do you get the social and emotional support you need?
Always (1)
Usually (2)
Sometimes (3)
Rarely (4)
Never (5)
SHORTAGE1 In the past month, have you or a member of your household been directly affected by a shortage of the following? Select all that apply.
A medicine or medication that requires a prescription or is given by provider, pharmacist, or hospital (1)
A medicine or medication that is sold over the counter (without a prescription) (2)
A medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc. (3)
Other critical medical products, please specify ____ (4)
My household has not been affected by any of these shortages (5)
SHORTAGE2A How did you or a member of your household respond to the shortage? Select all that apply.
Changed to a substitute or alternative medication, equipment, or medical product (1)
Spent more money or time to find the medication, equipment, or medical products (2)
Delayed, stopped, rationed or re-used medication, equipment, or medical products (3)
Delayed or canceled a medical procedure or treatment because medication, equipment or products needed for care were not available to me or a provider (4)
Consulted a medical professional or other sources to help me get medication, equipment, or medical products (5)
Experienced negative physical health impacts (6)
Experienced negative mental health impacts (7)
I don’t know (8)
Other, specify _____ (9)
EMP7 Next, we are
going to ask about the childcare arrangements for children in the
household.
At any time in the last 4 weeks,
were any children in the household unable to attend daycare or
another childcare arrangement as a result of child care being closed,
unavailable, unaffordable, or because you are concerned about your
child’s safety in care? Please include before school care,
after school care, and all other forms of childcare that were
unavailable. Select only one answer.
Yes (1)
No (2)
Not applicable (3)
EMP8 Which if any of the following occurred in the last 4 weeks as a result of childcare being closed, unavailable, unaffordable, or because you are concerned about your child’s safety in care? Select all that apply.
You (or another adult) took unpaid leave to care for the children (1)
You (or another adult) used vacation, or sick days, or other paid leave in order to care for the children (2)
You (or another adult) cut your work hours in order to care for the children (3)
You (or another adult) left a job in order to care for the children (4)
You (or another adult) lost a job because of time away to care for the children (5)
You (or another adult) did not look for a job in order to care for the children (6)
You (or another adult) supervised one or more children while working (7)
Other (specify) (8) ___________________________________________
None of the above (9)
INFLATE1 In the area where you live and shop, do you think prices in general have changed in the last 2 months? Select only one answer.
I think prices have increased (1)
I do not think prices have changed (2)
I think prices have decreased (3)
I do not know (4)
INFLATE2 How stressful, if at all, has the increase in prices in the last 2 months been for you? Select only one answer.
Very stressful (1)
Moderately stressful (2)
A little stressful (3)
Not at all stressful (4)
INFLATE4 In the area you live and shop, how concerned are you, if at all, that prices will increase in the next 6 months? Select only one answer.
Very concerned (1)
Somewhat concerned (2)
A little concerned (3)
Not at all concerned (4)
The next questions ask about your household's activities in the last 7 days. Please only include experiences that occurred in the last 7 days.
In the last 7
days, how difficult has it been for your household to pay for
usual household expenses, including but not limited to food, rent or
mortgage, car payments, medical expenses, student loans, and so on?
Select only one answer.
Not at all difficult (1)
A little difficult (2)
Somewhat difficult (3)
Very difficult (4)
FD1 Getting enough food can also be a problem for some people. In the last 7 days, which of these statements best describes the food eaten in your household? Select only one answer.
Enough of the kinds of food (I/we) wanted to eat (1)
Enough, but not always the kinds of food (I/we) wanted to eat (2)
Sometimes not enough to eat (3)
Often not enough to eat (4)
FD2
Please
indicate whether the next statement was often true, sometimes true,
or never true in the last 7 days for the children living in
your household who are under 18 years old.
"The
children were not eating enough because we just couldn't afford
enough food."
Often true (1)
Sometimes true (2)
Never true (3)
FD3 Why did you not have enough to eat (or not what you wanted to eat)? Select all that apply.
Couldn’t afford to buy more food (1)
Couldn’t get to store to buy food (for example, didn’t have transportation, have mobility or health limitations that prevent you from getting out) (2)
Couldn’t go to store due to safety concerns (3)
Stores were closed (4)
None of the above (5)
FD4 During the last 7 days, did you or anyone in your household get free groceries from a food pantry, food bank, church, or other place that provides free food? Select only one answer.
Yes (1)
No (2)
FD5 Do any of the children in this household... Select all that apply.
Receive free meals at school (1)
Pay for reduced-price meals at school (2)
Pay for full-price meals at school (3)
Pick up free meals at a school or other location (4)
Receive or use an EBT card to help buy groceries (5)
Eat free meals at a location other than school (6)
Have free meals delivered (7)
None of the above (8)
FD6_new Do you or does anyone in your household currently receive benefits from… Select all that apply.
Supplemental Nutrition Assistance Program (SNAP) or Food Stamp Program (1)
WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) (2)
Summer Electronic Benefits Transfer (Summer EBT) (3)
None of these (4)
FD6 b : In 2024, did you apply for and/or receive disaster SNAP (D-SNAP) assistance?
Yes (1)
No (2)
FD7_new Does having to pay for the food children eat at school make it difficult for your household to pay for other expenses?
Yes (1)
No (2)
HSE1
The next
questions ask about housing.
Is your house or
apartment…? Select only one answer.
Owned by you or someone in this household free and clear? (1)
Owned by you or someone in this household with a mortgage or loan (including home equity loans)? (2)
Rented? (3)
Occupied without payment of rent? (4)
HSE2 Which best describes this building? Include all apartments, flats, etc., even if vacant. Select only one answer.
A mobile home (1)
A one-family house detached from any other house (2)
A one-family house attached to one or more houses (3)
A building with 2 apartments (4)
A building with 3 or 4 apartments (5)
A building with 5 or more apartments (6)
Boat, RV, van, etc. (7)
HSEnew2 Has your monthly rent changed during the last 12 months? If so, by how much?
My rent did not change (1)
My rent decreased (2)
My rent increased by less than $100 (3)
My rent increased by $100-$249 (4)
My rent increased by $250-$500 (5)
My rent increased by more than $500 (6)
HSE3 Is this household currently caught up on rent payments? Select only one answer.
Yes (1)
No (2)
HSE4 Is this household currently caught up on mortgage payments? Select only one answer.
Yes (1)
No (2)
HSE6 How many months behind is this household in paying your rent or mortgage?
________________________________________________________________
HSE7rev Thinking of all the places you’ve lived during the last six months, did you ever feel pressure to move due to any of the following reasons? Select all that apply.
Because the landlord raised the rent (1)
Because you missed a rent payment and you thought you would be evicted (2)
Because the landlord did not make repairs (3)
Because you were threatened with eviction or told to leave by your landlord (4)
Because your landlord changed the locks, removed your belongings, or shut off your utilities (5)
Because the neighborhood was dangerous (6)
Some other pressure, please specify (7) _____________________________
Did not feel pressure to move (8)
HSE7b During the last six months, did you actually move from any place you were living as a result of this pressure?
Yes (1)
No (2)
HSE8 How likely is it that your household will have to leave this home or apartment within the next 2 months because of eviction? Select only one answer.
Very likely (1)
Somewhat likely (2)
Not very likely (3)
Not likely at all (4)
HSE9 How likely is it that your household will have to leave this home within the next 2 months because of foreclosure? Select only one answer.
Very likely (1)
Somewhat likely (2)
Not very likely (3)
Not likely at all (4)
HSE10 In the last 12 months, how many months did your household reduce or forego expenses for basic household necessities, such as medicine or food, in order to pay an energy bill?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
HSE11 In the last 12 months, how many months did your household keep your home at a temperature that you felt was unsafe or unhealthy?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
HSE12 In the last 12 months, how many times was your household unable to pay an energy bill or unable to pay the full bill amount?
Almost every month (1)
Some months (2)
1 or 2 months (3)
Never (4)
TRANS1 Which of the following transportation options do you have access to: (Check all that apply)
Walk
Bike or e-scooter
Motorcycle or moped
Your own personal vehicle (e.g., car, truck, SUV)
A personal vehicle borrowed from a friend, family member, neighbor, coworker, or acquaintance (including carpooling)
Rental car or carsharing service (e.g., Zipcar)
Taxi service or rideshare (e.g., Uber, Lyft)
Bus
Rail transit (subway, light rail, streetcar, commuter rail)
Ferryboat
Paratransit (that is, specialized, door-to-door transport service for people with disabilities)
Other methods, please specify _______________
TRANS2 Which one of the following statements best describes your access to transportation in the past 30 days:
Enough transportation to meet your needs;
Enough transportation, but not always the kinds you want to use;
Sometimes not enough transportation to meet your needs;
Often not enough transportation to meet your needs, or
Always not enough transportation to meet your needs
If TRANS2=3, 4, or 5:
TRANS3 If you do not have enough transportation to meet your needs, which of the following reasons explain why (select all that apply):
My transportation options are not available when I need them
My transportation options require more travel time than I have available
My transportation options are unpredictable (travel time, availability)
My transportation options cost more than I can afford
My transportation options feel unsafe
I have a disability that limits my travel options or makes travel challenging
None of the above
GAS1 Has the cost
of gas in the last 7 days caused you to:
Select
all that apply.
Choose not to take a trip (for example, chose not to visit a friend/restaurant/park etc., change a task from in-person to online to reduce gas use) (1)
Combine trips (2)
Take alternative modes of transportation (for example, public transit, ridesharing, bike, etc.) (3)
None of these - the cost of gas has not affected my driving behavior (4)
HLTH8 Are you currently covered by any of the following types of health insurance or health coverage plans? Mark Yes or No for each.
|
Yes (1) |
No (2) |
Insurance through a current or former employer or union (through yourself or another family member) (1) |
|
|
Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) (2) |
|
|
Medicare, for people 65 and older, or people with certain disabilities (3) |
|
|
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability (4) |
|
|
TRICARE or other military health care (5) |
|
|
VA (including those who have ever used or enrolled for VA health care) (6) |
|
|
Indian Health Service (7) |
|
|
Other (8) |
|
|
EMPUI1 Since September 1, 2024, have you applied for Unemployment Insurance (UI) benefits? Select only one answer.
Yes
No
EMPUI2 Since September 1, 2024, have you received Unemployment Insurance (UI) benefits? Select only one answer.
Yes
No
INC1 In 2023 what was your total household income before taxes? Select only one answer.
Less than $25,000 (1)
$25,000 - $34,999 (2)
$35,000 - $49,999 (3)
$50,000 - $74,999 (4)
$75,000 - $99,999 (5)
$100,000 - $149,999 (6)
$150,000 - $199,999 (7)
$200,000 and above (8)
The U.S. Census Bureau is interested in understanding geographic differences in experiences. To help us analyze survey responses across the entire United States, please provide your complete current street address below. Your address information will only be used for statistical analyses conducted by the U.S. Census Bureau and will not be used for any other purpose or shared with any other parties.
Address Number (1) __________________________________________________
Street Name (2) __________________________________________________
Apt Unit (3) __________________________________________________
City (4) __________________________________________________
State (5) __________________________________________________
Zip (6) __________________________________________________
Do you have a Rural Route address?
Yes (1)
No (2)
Please provide the
Rural Route address where you currently reside.
Also,
provide a description of the physical location in the space provided.
RR Descriptor (1) __________________________________________________
Rural Route No (2) __________________________________________________
RR Box ID (3) __________________________________________________
City (4) __________________________________________________
State (5) __________________________________________________
Zip Code (6) __________________________________________________
Please provide as
much information as possible.
For example, if you also have
a street address associated with your residence, such as one used for
emergency services (E - 911) or for you to have a package delivered
to your home, then please provide it here.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Please provide the
city and state or ZIP Code where you are currently living.
Also, describe the physical location in the space provided.
City (1) __________________________________________________
State (2) __________________________________________________
Zip (3) __________________________________________________
Please provide as
much information as possible.
For example: a
location description such as "The apartment over the gas
station" or "The brick house with the screened porch on the
northeast corner of Farm Road and HC46" or a name of a park,
street intersection or shelter, if you are experiencing homelessness,
as well as the name of the city and state. For example, "Friendship
Park, Anywhere PA."
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
To help us contact you in the future, please provide the best phone number to reach you.
________________________________________________________________
To help us contact you in the future, please provide the best email address to reach you.
________________________________________________________________
Is there anything else related to the recent natural disasters or other social and economic issues you would like to tell us?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
That concludes the survey. Please click on the “Submit” button when you are finished. Thank you for participating in the Household Pulse Survey.
If you have any questions about this survey please visit https://www.census.gov/householdpulsedata. You can validate that this survey is a legitimate federally-approved information collection using the U.S. Office of Management and Budget approval number 0607-1029, expiring on 01/31/2027.
If you need help during this time, here are some resources that may help:
General: Individual Assistance | FEMA.gov
Infant Formula: Information for Families During the Infant Formula Shortage | Nutrition | CDC
Questions & Answers for Consumers Concerning Infant Formula | FDA
Meal finder for kids: https://www.fns.usda.gov/meals4kids
Unemployment services: https://www.usa.gov/unemployment
The National Suicide Prevention Lifeline: 988lifeline.org
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Phase 4.1 Household Pulse Survey (Cycle 5) |
| Author | Qualtrics |
| File Modified | 0000-00-00 |
| File Created | 2025-03-01 |