Part A, Attachment A_HTOPS Jul Sep Nov Questionnaires

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Survey Questionnaire Front/Roster/End Instrument Content



Q1 You have been invited to the Household Trends and Outlook Pulse Survey, a large, national survey that will collect information on topics such as food and nutrition, transportation, employment, and education. You should have received a letter explaining this 20-minute survey.
 




Q203 This survey is available in English and Spanish. If you would like to change the language of the survey, please use the link in the upper right corner of each page to select the language in which you prefer to complete the survey.

Esta encuesta está disponible en inglés y en español. Si le gustaría cambiar la selección del idioma más tarde, utilice el menú desplegable en la esquina superior derecha de cada página para seleccionar el idioma en el que usted prefiere completar la encuesta.



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Continue Click the “NEXT” button below to begin. 



PRA      The authority for the collection of this information for the Household Trends and Outlook Pulse Survey (0607-1029) is provided under Title 13, Sections 141, 182, and 193. Disclosure of the information provided to us with other Census Bureau staff for work-related purposes is permitted under the Privacy Act of 1974 (5 U.S.C. § 552a). Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/Census-3 Demographic Survey Collection (Census Bureau Sampling Frame).    

Staff (employees and contractors) received training on privacy and confidentiality policies and practices; access to PII is restricted to authorized personnel only. Personally identifiable information collected includes name, address, telephone/cell phone number, DOB or age, email address, race or ethnicity. Furnishing this information is voluntary. Failure to do so will result in no consequences to you. 

We estimate that completing the baseline survey will take no more than 20 minutes. 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, 0607-1029, confirms this approval and expires on 9/30/2028. If this number were not displayed, we could not conduct this survey. To learn more about this survey go to: https://www.census.gov/programs-surveys/htops.html.    

** U.S. Census Bureau Notice and Consent Warning ** 

You are accessing a United States Government computer network. Any information you enter into this system is confidential. It may be used by the Census Bureau for statistical purposes and to improve the website. If you want to know more about the use of this system, and how your privacy is protected, visit our online privacy webpage at https://www.census.gov/about/policies/privacy/privacy-policy.html.
Use of this system indicates your consent to collection, monitoring, recording, and use of the information that you provide for any lawful government purpose. So that our website remains safe and available for its intended use, network traffic is monitored to identify unauthorized attempts to access, upload, change information, or otherwise cause damage to the web service. Use of the government computer network for unauthorized purposes is a violation of Federal law and can be punished with fines or imprisonment (PUBLIC LAW 99-474).


R1 What year were you born? 
________________________________________________________________


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Display This Question:
If If What year were you born? Please enter a number.   Text Response Is Less Than or Equal to  2008


R3 The address we have on file appears below. Is this the address where you currently live?    ${e://Field/ADDRESS1} ${e://Field/ADDRESS2}  ${e://Field/CITY}, ${e://Field/STATE} ${e://Field/ZIP}
    • Yes  (1) 
    • No  (2) 

End of Block: Eligibility

Start of Block: Ineligible
Display This Question:
If If What year were you born? Please enter a number.   Text Response Is Greater Than  2008
Or The address we have on file appears below. Is this the address where you currently live? ... = No

INELIG You are not eligible to complete this survey. Thank you for your time.

End of Block: End Screener Not Selected

Start of Block: Roster

R2_new What is your full name?
    • First name (1) __________________________________________________
    • Last name (2) __________________________________________________


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R4 How many total people – adults and children – currently live in your household, including yourself? Please DON’T count anyone who lives most of their time somewhere else, even if they are currently staying here. Please enter a number.
________________________________________________________________


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Display This Question:
If If How many total people – adults and children – currently live in your household, including yourself? Please don’t count anyone who lives most of their time somewhere else, even if they are currently... Text Response Is Not Equal to  1


R4a How many people under 18 years-old currently live in your household? Please DON’T count anyone who lives most of their time somewhere else, even if they are currently staying here. Please enter a number.
________________________________________________________________


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R_introA Next are a few questions about you.





DOB_AGE_S What is your date of birth?  
	mm  (1) __________________________________________________
    • dd  (4) __________________________________________________
    • yy  (5) __________________________________________________
AGE_VERIFY Please verify or enter correct age.
    • age (years)  (7) __________________________________________________


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SEX_S Are you male or female?
    • Male  (1) 
    • Female  (2) 


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DEM2_S 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) 


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DEM3 Are you of Hispanic, Latino, or Spanish origin? 
    ▢ No, not of Hispanic, Latino, or Spanish origin  (1) 
    ▢ Yes, of Hispanic, Latino, or Spanish origin  (2) 

DEM4 What is your race?  Select all that apply.
    • White  (1) 
    • Black or African American  (2) 
    • American Indian or Alaska Native  (3) 
    • Native Hawaiian or Other Pacific Islander  (4) 
    • Asian  (5) 


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DEM13_S What is your marital status? 
    • Married  (1) 
    • Widowed  (2) 
    • Divorced  (3) 
    • Separated  (4) 
    • Never married  (5) 


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DEM5_S What is the highest degree or level of school you have completed? If currently enrolled, select the previous grade or highest degree received.
NO SCHOOLING COMPLETED
    • No schooling completed  (1) 
LESS THAN GRADE 1
    • Nursery school   (2) 
    • Kindergarten   (3) 
GRADE 1 THROUGH GRADE 12
    • Grade 1 through 11 – Specify:   (4) __________________________________________________
    • 12th grade – NO DIPLOMA  (5) 
HIGH SCHOOL GRADUATE
    • Regular high school diploma  (6) 
    • GED or alternative credential   (7) 
COLLEGE OR SOME COLLEGE
    • Some college credit, but less than 1 year of college credit   (8) 
    • 1 or more years of college credit, no degree  (9) 
    • Associate’s degree (for example: AA, AS)  (10) 
    • Bachelor’s degree (for example: BA, BS)  (11) 
    • Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)  (12) 
    • Professional degree beyond a bachelor’s degree (for example: MD, DDS, DVM, LLB, JD)  (13) 
    • Doctorate degree (for example: PhD, EdD)  (14) 

End of Block: Demographics

Start of Block: Armed Forces




DEM14 Are you or your spouse currently serving in the U.S. Armed Forces (Active Duty, Reserve, or National Guard)? Reserve and Guard members or 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) 


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DEM15 Are you or your spouse currently serving in the U.S. Armed Forces (Active Duty, Reserve, or National Guard)? Reserve and Guard members or 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 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)



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Start of Block: Language 




LANG Including you and the adults regularly living with you, does anyone primarily speak a language other than ${e://Field/Lang_fill} at home?
    • Yes  (1) 
    • No  (2) 


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Display This Question:
If Including you and the adults regularly living with you, does anyone primarily speak a language ot... = Yes


LANG2 What language is regularly spoken at home?  If more than one, select the language spoken most often.  
Display This Choice:
If Q_Language != ES
And Q_Language != ES-ES
    • Spanish or Spanish Creole  (1) 
Display This Choice:
If Q_Language != EN
    • English   (2) 
    • Chinese     (3) 
    • French (including Patois, Cajun)   (4) 
    • French Creole   (5) 
    • Tagalog or Filipino   (6) 
    • Vietnamese     (7) 
    • German     (8) 
    • Korean     (9) 
    • Russian     (10) 
    • Italian     (11) 
    • Hindi or Urdu    (12) 
    • Arabic     (13) 
    • Portuguese or Portuguese Creole    (14) 
    • Polish    (15) 
    • Persian    (16) 
    • Gujarati   (17) 
    • Other - Specify:  (18) __________________________________________________


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Display This Question:
If Including you and the adults regularly living with you, does anyone primarily speak a language ot... = Yes
And Q_Language = EN
Or If
Q_Language = ES-ES
Or Q_Language = ES


LANG3 How well do you speak English?
    • Very well  (1) 
    • Well  (2) 
    • Not well  (3) 
    • Not at all  (4) 

End of Block: Language 




[SURVEY QUESTIONNAIRE CONTENT HERE]


Back End of Instrument


Start of Block: Back End


CON6 We may wish to ask follow up questions about this survey. Please provide a cell phone number, email address, or landline phone number where we can reach you:
    • Cell phone number  (1) __________________________________________________
    • Email address  (2) __________________________________________________
    • Landline phone number  (3) __________________________________________________

(Display only if CON6_1 not empty) 
CON3b We send survey follow up messages via text message. Message and data rates may apply, depending on your mobile phone service plan. Message frequency varies. You can opt out of these messages at any time by replying STOP or reply HELP for more assistance.   Would you like us to contact you by text message?
    • Yes  (1) 
    • No  (2) 


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RIP We may recontact this household in the future to update information. We would like to use some of the information you have provided today to make that interview shorter and more efficient. When we speak to you or to someone else you are living with, is it OK if we use some of your answers as a starting point?
    • Yes  (1) 
    • No  (2) 

Start of Block: Submit

OUTRO Those are all the questions we have for you today. Thank you for participating in the Household Trends and Outlook Pulse Survey. You can find more information about the survey at this website: https://www.census.gov/programs-surveys/htops.html. 

Once your survey is submitted, you will not be able to access your information or change any of your responses. After you submit your responses and are shown the confirmation page, you may close the web browser.
 
If you are ready to submit your responses, please click the Submit button below.

End of Block: Submit




July 2026 Questionnaire Content



Start of Block: Satisfaction


OECD Overall how satisfied are you with life as a whole these days?
    • 0 (Not satisfied at all)  (1) 
    • 1  (2) 
    • 2  (3) 
    • 3  (4) 
    • 4  (5) 
    • 5  (6) 
    • 6  (7) 
    • 7  (8) 
    • 8  (9) 
    • 9  (10) 
    • 10 (Completely satisfied)  (11) 

End of Block: Satisfaction

Start of Block: Household



Display this question:
If How many people under 18 years-old currently live in your household? Text Response Is Greater Than  0


D12 In your household, are there…   Select all that apply.
    • Children under 1 year old?  (1) 
    • Children 1 through 4 years old?  (2) 
    • Children 5 through 11 years old?  (3) 
    • Children 12 through 17 years old?  (4) 


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Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?




D13 During the school year that began in [SCHOOL YEAR], 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) 


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Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


EMP7 Next, we are going to ask about the child care 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 child care 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 child care that were unavailable.
    • Yes  (1) 
    • No  (2) 
    • Not applicable  (3) 


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Display this question:
If EMP7 = Yes


EMP8 Which if any of the following occurred in the LAST 4 WEEKS as a result of child care 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) 


Display this question:
If D12 = Children under 1 year old?


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) 


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Display this question:
If D12 = Children under 1 year old?


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) 


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Display this question:
If INF5 = Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula
Or INF5 = Infant formula only


INF6 In the LAST 4 WEEKS, did you have difficulty getting infant formula?
    • Yes, in the last 7 days  (1) 
    • Yes, more than 7 days ago but within the LAST 4 WEEKS  (2) 
    • No, did not have trouble getting infant formula in the LAST 4 WEEKS  (3) 


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Start of Block: Employment




EMP_Intro Now we are going to ask about your employment.




EMP1 Have you, or has anyone in your household, experienced a loss of employment income in the LAST 4 WEEKS? 
    • Yes  (1) 
    • No  (2) 




EMP2 
In the LAST 7 DAYS, did you do ANY work for either pay or profit?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If EMP2 = Yes


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?
    • Government  (1) 
    • Private company  (2) 
    • Non-profit organization including tax-exempt and charitable organizations  (3) 
    • Self-employed  (4) 
    • Working in a family business  (5) 


Display this question:
If EMP2 = No


EMP4 What is your main reason for not working for pay or profit? 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) 
    • I am/was unable to find work  (10) 
    • Other reason – Specify:  (9) __________________________________________________


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Display this question:
If EMP2 = Yes


SPN5_DAYSTW_2 In the LAST 7 DAYS, have you teleworked or worked from home?
    • Yes, for 1-2 days  (1) 
    • Yes, for 3-4 days  (2) 
    • Yes, for 5 or more days  (3) 
    • No  (4) 


End of Block: Employment


Start of Block: AI Use in Households

AIP1. Artificial intelligence (AI) refers to software tools or built-in digital features that can generate text or images, answer questions, or make suggestions. This includes standalone tools like ChatGPT or Gemini, as well as AI features built into apps, devices, search engines, or software, such as search summaries or writing suggestions.

In the last 2 months, have YOU used an AI tool for any of the following activities?
Select all that apply.
☐ I have not used an AI tool in the last 2 months 
☐ Finding factual information
☐ Brainstorming or generating ideas
☐ Writing, editing, or translating text
☐ Assisting with schoolwork or learning
☐ Assisting with creative tasks (such as creating images, music, or writing)
☐ Searching for jobs or work opportunities
☐ Looking for housing or apartments
☐ Understanding government benefits or public services
☐ Getting health or medical information
☐  Mental health or emotional support
☐ Comparing financial products or services
☐ Other - Specify: __________

[Display if AIP1 ≠ “I have not personally used an AI tool”]

AIP2. Outside of work or school, how often did you personally use AI tools in the last 2 months?
o Every day or almost every day
o Several times a week
o Several times a month
o Once or twice in the last 2 months

[Display if AIP1 ≠ “I have not personally used an AI tool”]

AIP3. Please indicate whether you agree or disagree with the following statements.
Statement
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree





Content generated by AI is useful for the kinds of tasks I want to complete
I feel prepared to use AI in daily life
o
o
o
o
I trust information generated by AI systems
o
o
o
o
AI tools help me complete tasks more quickly
o
o
o
o
I am concerned about AI’s impact on jobs and careers
o
o
o
o
I am concerned about how AI systems use personal data
o
o
o
o

AIP4. In the last 2 months, have you actively avoided or opted out of using AI ?
Examples may include disabling AI-generated summaries, turning off an AI assistant or feature, or avoiding use of an AI-based application.
o Yes
o No
o Not sure

AI-JOB1. Job Search Screener
In the last 2 months, have you searched for jobs or explored new work opportunities?
o Yes
o No

[Display if AI-JOB1 = Yes]

AI-JOB2. In the last 2 months, did you use AI tools for any of the following job search activities?
Select all that apply.
☐ Finding or evaluating job opportunities 
☐ Preparing application materials 
☐ Preparing for interviews 
☐ Assistance during a live interview or assessment 
☐ Learning or practicing job-related skills 
☐ None of the above 
☐ Other - Specify: __________



[Display if AI-JOB2 ≠ “None of the above”]

AI-JOB3. Overall, how much did AI tools help with your job search activities?
o Helped a lot
o Helped somewhat
o Did not make much difference
o Made it somewhat more difficult
o Made it much more difficult

[Display if AI-JOB1 = Yes]

AI-JOB4. Did you receive a job offer in the last 2 months?
o Yes
o No

End of Block: AI Use in Households



Start of Block: Mental Health and Health Status




display_HLTH Next, we will ask about health.




DIS1 Do you have difficulty seeing, even when wearing glasses?
    • 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?
    • 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?
    • 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?
    • 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?
    • 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?
    • No - no difficulty  (1) 
    • Yes - some difficulty  (2) 
    • Yes - a lot of difficulty  (3) 
    • Cannot do at all  (4) 


Page Break



HLTH_intro Over the LAST 2 WEEKS, how often have you been bothered by...




HLTH1 Feeling nervous, anxious, or on edge?
    • 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?
    • 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?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 




HLTH4 Feeling down, depressed, or hopeless?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 


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Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


Page Break


Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Display this question:
If MH2 = Yes, all children who needed treatment received it
Or MH2 = Yes, but only some children who needed treatment received it


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) 


Page Break


Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Page Break




HLTH8 Are you CURRENTLY covered by any of the following types of health insurance or health coverage plans?  Do NOT include plans that cover only one type of service, such as dental, drug, or vision plans.

YES, INSURED
Select all that apply.

    • Insurance through a current or former employer or union (through yourself or another family member) (1)
    • Medicare, for people 65 and older, or people with certain disabilities (3)
    • Medicaid, Children’s Health Insurance Program (CHIP), or any kind of government-assistance plan for those with low incomes or a disability (4)
    • Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) (2)
    • Veteran’s health care (enrolled for VA) (6)
    • TRICARE or other military health care (5)
    • Indian health Service (7)
    • Any other type of health insurance or health coverage plan. (8) - Specify:_____________

NO, UNINSURED

    • No health insurance or health coverage plan (9)


End of Block: Mental Health and Health Status

Start of Block: Socialization


SOC2_first How often do you feel lonely?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 




SOC1_first How often do you get the social and emotional support you need?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 


Page Break




SOC3 In a typical week, and not including people you live with, how many times do you get together with people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC4 In a typical week, and not including people you live with, how many times do you talk on the telephone or by video with the people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC5 During the PAST 12 MONTHS, how many times did you attend religious services?   Do not include special occasions such as weddings, funerals, or other special events.
    • Zero  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 




SOC6 During the PAST 12 MONTHS, how many times did you attend meetings of clubs or organizations you belong to?   Examples include community groups, unions, athletic groups, or school groups.
    • Zero / do not belong to a group  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 

End of Block: Socialization



NARCAN Naloxone (Narcan) is a medication which can be used to reverse an opioid overdose. Have you ever carried naloxone in case of an emergency?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NARCAN = Yes

NARCAN2 Have you ever used naloxone to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NARCAN2 = Yes

NARCAN3 Have you used naloxone in the PAST 30 DAYS to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


Page Break




SHORTAGE1 In the LAST 4 WEEKS, 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) 
    • Medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.  (3) 
    • Other critical medical products – Specify:  (4) __________________________________________________
    • ⊗My household has not been affected by any of these shortages  (5) 


Page Break


Display this question:
If SHORTAGE1 = A medicine or medication that requires a prescription or is given by provider, pharmacist, or hospital
Or SHORTAGE1 = A medicine or medication that is sold over the counter (without a prescription)
Or SHORTAGE1 = A medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.
Or SHORTAGE1 = Other critical medical products, please specify


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) __________________________________________________

End of Block: Medical

Start of Block: Food Security




FD1 Getting enough food can be a problem for some people. In the LAST 7 DAYS, which of these statements best describes the food eaten in your household? 
    • 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) 


Page Break



Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat
And If
If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat


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) 
    • ⊗None of the above  (4) 




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?
    • Yes  (1) 
    • No  (2) 


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FD6_rev 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) 
    • Free or reduced-price meals at school through NSLP (National School Lunch Program)  (3) 
    • Summer EBT (Electronic Benefits Transfer)  (4) 
    • ⊗None of these  (5) 


Page Break


Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?


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) 
    • Not Applicable/don’t have to pay for food at school  (3) 


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SPN4 In the LAST 2 MONTHS, 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? 
    • Not at all difficult  (1) 
    • A little difficult  (2) 
    • Somewhat difficult  (3) 
    • Very difficult  (4) 




INFLATE1 In the area where you live and shop, do you think prices in general have changed IN THE LAST 2 MONTHS? 
    • 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) 


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Display this question:
If INFLATE1 = I think prices have increased


INFLATE2 How stressful, if at all, has the increase in prices IN THE LAST 2 MONTHS been for you? 
    • 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? 
    • Very concerned  (1) 
    • Somewhat concerned  (2) 
    • A little concerned  (3) 
    • Not at all concerned  (4) 

End of Block: Food Security

Start of Block: Housing




HSE1 
The next questions ask about housing. 
 Is your house or apartment…? 
    • 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) 


Page Break


Display this question:
If HSE1 = Rented


HSE3 Is this household CURRENTLY caught up on rent payments?
    • Yes  (1) 
    • No  (2) 


Display this question:
If HSE1 = Owned by you or someone in this household with a mortgage or loan (including home equity loans)


HSE4 Is this household CURRENTLY caught up on mortgage payments?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If HSE3 = No
Or HSE4 = No



HSE6 How many months behind is this household in paying your rent or mortgage?
________________________________________________________________


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Display this question:
If HSE3 = No


HSE8 How likely is it that your household will have to leave this home or apartment within the NEXT 2 MONTHS because of eviction? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


Display this question:
If HSE4 = No


HSE9 How likely is it that your household will have to leave this home within the NEXT 2 MONTHS because of foreclosure? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


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Display this question:
If HSE8 = Very likely
Or HSE8 = Somewhat likely
Or HSE9 = Very likely
Or HSE9 = Somewhat likely


NEWHSE10 If you (and your household) did have to leave, where do you think you would go?
    • Get a different place of your/their own to live in  (1) 
    • Move in with friends  (2) 
    • Move in with family  (3) 
    • Household would split up and go to different places  (4) 
    • Would probably go to a homeless shelter  (5) 
    • Move into vehicle  (6) 
    • Live outside  (7) 




NEWHSE11 At any time in the LAST 12 MONTHS did you or a person that currently lives with you experience homelessness?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If NEWHSE11 = Yes


NEWHSE12 Where did you or that person live or stay when experiencing homelessness?   Select all that apply. 
    • In a homeless shelter  (1) 
    • On the streets/tent/car/abandoned building  (2) 
    • Sleeping temporarily on someone’s couch  (3) 
    • Other  (4) 
    • ⊗Don’t know  (5) 


Display this question:
If NEWHSE11 = Yes


NEWHSE13 Were you the person who experienced homelessness? If not, how is that person related to you?   Select all that apply. 
    • It was me  (1) 
    • My spouse/partner  (2) 
    • My child 18 or older  (3) 
    • My child under age 18  (4) 
    • Parent  (5) 
    • Sibling  (6) 
    • Other family member  (7) 
    • Unrelated person  (8) 


Page Break




HSE14 In the LAST 2 MONTHS, did your household reduce or forego expenses for basic household necessities, such as medicine or food, in order to pay an energy bill?
    • Yes  (1) 
    • No  (2) 




HSE15 In the LAST 2 MONTHS, did your household keep your home at a temperature that you felt was unsafe or unhealthy?
    • Yes  (1) 
    • No  (2) 




HSE16 In the LAST 2 MONTHS, was your household unable to pay an energy bill or unable to pay the full bill amount?
    • Yes  (1) 
    • No  (2) 


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HEAT1 Which of the following cooling devices do you have in your home?   Select all that apply.
    • Central Air Conditioning  (1) 
    • Window Air Conditioning units  (2) 
    • Fans  (3) 
    • Evaporative Coolers (swamp coolers)  (4) 
    • Other cooling devices  (5) 
    • ⊗I don’t use any cooling devices  (6) 




HEAT2 This summer, have you been able to keep your home at a safe and healthy temperature on hot days?
    • Yes  (1) 
    • Sometimes  (2) 
    • No  (3) 


Page Break


Display this question:
If Which of the following cooling devices do you have in your home? Select all that apply. = Central Air Conditioning
Or Which of the following cooling devices do you have in your home? Select all that apply. = Window Air Conditioning units
And If
This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = No
Or This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = Sometimes


HEAT3 What prevents you from keeping your home at a safe and healthy temperature?   Select all that apply.
    • My air conditioning is not strong enough to keep my home cool.  (1) 
    • My air conditioning is not working.  (2) 
    • I cannot afford to run my air conditioning at all.  (3) 
    • I cannot afford to run my air conditioning as much needed to keep my home cool enough.  (4) 
    • The power frequently goes out.  (5) 
    • Other  (6) 


Display this question:
If Which of the following cooling devices do you have in your home? Select all that apply. != Central Air Conditioning
And Which of the following cooling devices do you have in your home? Select all that apply. != Window Air Conditioning units
And If
This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = No
Or This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = Sometimes


HEAT4 What prevents you from keeping your home at a safe and healthy temperature?   Select all that apply.
    • My cooling devices are not strong enough to keep my home cool.  (1) 
    • My cooling devices are not working.  (2) 
    • I cannot afford to run my cooling devices at all.  (3) 
    • I cannot afford to run my cooling devices as much as needed to keep my home cool enough.  (4) 
    • The power frequently goes out.  (5) 
    • ⊗I don’t have air conditioning.  (6) 
    • Other  (7) 


Page Break




HEAT5 A cooling shelter is an air-conditioned or cooled location that has been designated as a place to go to cool off in extreme heat.  Do you or members of your household ever go to a cooling shelter on hot days?
    • Yes  (1) 
    • No   (2) 
    • We don’t need to go to a cooling shelter  (3) 


Page Break


Display this question:
If A cooling shelter is an air-conditioned or cooled location that has been designated as a place to... = Yes


HEAT6 Do you face any of these issues with the cooling shelter?   Select all that apply.
    • The cooling shelter is too crowded.  (1) 
    • The cooling shelter is not open when I/we want to go.  (2) 
    • The nearest cooling shelter is far away or difficult to reach.  (3) 
    • Someone in my household needs medical or mobility support that is not available at the cooling shelter.  (4) 
    • I don’t feel safe at the cooling shelter.  (5) 
    • The cooling shelter does not allow pets.  (6) 
    • Other issues.  (7) 
    • ⊗N/A. No issues with the cooling shelter.  (8) 


Display this question:
If A cooling shelter is an air-conditioned or cooled location that has been designated as a place to... = No


HEAT7 Why don’t you go to a cooling shelter on hot days?   Select all that apply.
    • The cooling shelter is too crowded.  (1) 
    • The cooling shelter is not open when I/we want to go.  (2) 
    • The nearest cooling shelter is far away or difficult to reach.  (3) 
    • Someone in my household needs medical or mobility support that is not available at the cooling shelter.  (4) 
    • I don’t feel safe at the cooling shelter.  (5) 
    • The cooling shelter does not allow pets.  (6) 
    • I don’t know where to find a cooling shelter.  (7) 
    • ⊗I don’t need a cooling shelter.  (8) 
    • Other issues.  (9) 

HEAT8 Do you have any health conditions that may increase the risk of heat-related illness? (Examples include heart disease, respiratory conditions, diabetes, or taking medications that affect body temperature regulation)
    • Yes  (1) 
    • No   (2) 
    • Not Sure  (3) 
 
 
Display this question:
If Do you have any health conditions that may increase the risk of heat-related illness = Yes
 
HEAT9 Which of the following apply? Select all that apply.
 
    • Heart disease or circulation problems  (1) 
    • Asthma or other respiratory conditions   (2) 
    • Diabetes  (3) 
    • Kidney disease  (4)
    • Medications that affect sweating or body temperature  (5)
    • Mobility limitations  (6)
    • Other – Specify:  (7)
_____________________________________________________
 
 
HEAT10 On hot days have you or members of your household done any of the following to stay cool or reduce home cooling costs? Select all that apply.
    • Used a public cooling shelter (e.g., government or non-profit facility)  (1) 
    • Visited a public facility like a community center or library for air conditioning   (2) 
    • Visited a commercial facility like a mall, movie theatre, or department store for air conditioning  (3) 
    • Spent time in a friend or family member’s air-conditioned home  (4)
    • Went to a public or private pool  (5)
    • Stayed in a hotel or short-term rental with air conditioning  (6)
    • Avoided using appliances (e.g., oven, dryer) to reduce indoor heat  (7)
    • Took no special actions  (8)
    • Other – Specify:  (9)
_____________________________________________________




TRANS1 CURRENTLY, which of the following transportation options do you have access to:  Select all that apply. 
    • Walk  (1) 
    • Bike or e-scooter  (2) 
    • Motorcycle or moped  (3) 
    • Your own personal vehicle (e.g., car, truck, SUV)  (4) 
    • A personal vehicle borrowed from a friend, family member, neighbor, coworker, or acquaintance (including carpooling)  (5) 
    • Rental car or carsharing service (e.g., Zipcar)  (6) 
    • Taxi service or rideshare (e.g., Uber, Lyft)  (7) 
    • Bus  (8) 
    • Rail transit (subway, light rail, streetcar, commuter rail)  (9) 
    • Ferryboat  (10) 
    • Paratransit (that is, specialized, door-to-door transport service for people with disabilities)  (11) 
    • Other methods – Specify:  (12) __________________________________________________


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TRANS2 Which one of the following statements best describes your access to transportation in the LAST 4 WEEKS:
    • Enough transportation to meet your needs  (1) 
    • Enough transportation, but not always the kinds you want to use  (2) 
    • Sometimes not enough transportation to meet your needs  (3) 
    • Often not enough transportation to meet your needs  (4) 
    • Always not enough transportation to meet your needs  (5) 


Page Break


Display this question:
If TRANS2 = Sometimes not enough transportation to meet your needs
Or TRANS2 = Often not enough transportation to meet your needs
Or TRANS2 = Always not enough transportation to meet your needs


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  (1) 
    • My transportation options require more travel time than I have available  (2) 
    • My transportation options are unpredictable (travel time, availability)  (3) 
    • My transportation options cost more than I can afford  (4) 
    • My transportation options feel unsafe  (5) 
    • I have a disability that limits my travel options or makes travel challenging  (6) 
    • ⊗None of the above  (7) 

TRANS4 
Last week, how many times did you drive a vehicle with a feature that can automatically control part of the driving (such as adjusting speed, steering within a lane, or braking)?
    • 0 times (I did not drive a vehicle with these features last week)  (1) 
    • 1-2 times  (2) 
    • 3-4 times  (3)
    • 5-6 times  (4)
    • 7 or more times  (5)



End of Block: Housing

Start of Block: Arts

ArtsIntro Next, we have a few questions about participation with the arts and entertainment.




ART1 During the LAST 4 WEEKS, did you attend any live music, dance, or theater performances in person?
    • Yes  (1) 
    • No  (2) 




ART2 During the LAST 4 WEEKS, did you go in person to an art exhibit, such as paintings, sculpture, textiles, graphic design, or photography?
    • Yes  (1) 
    • No  (2) 




ART3 During the LAST 4 WEEKS, did you go to the movies?
    • Yes  (1) 
    • No  (2) 


Page Break




ART4 During the LAST 4 WEEKS, did you create, practice, or perform art of your own?    This may have included music, dance, or theater; creative writing; crafts or visual arts; digital art; or film or photography done for artistic purposes.
    • Yes  (1) 
    • No  (2) 




ART5 Please indicate whether you strongly agree, agree, disagree, or strongly disagree with the next statement.   “There are plenty of opportunities for me to take part in arts and cultural activities in my neighborhood or community.” 
    • Strongly agree  (1) 
    • Agree  (2) 
    • Disagree  (3) 
    • Strongly Disagree  (4) 

End of Block: Arts


Start of Block: Dietary Guidelines and Consumer Behavior
 
DIET1 In the last 2 months, which statement best describes changes in the amount of full-fat dairy products without added sugar in your diet? Examples include whole milk and plain whole milk yogurt.
    • I ate more full-fat dairy products without added sugar.  (1) 
    • I ate about the same amount.  (2) 
    • I ate fewer full-fat dairy products without added sugar.  (3) 
    • I don’t know.  (4) 
    • I do not eat dairy products.  (5)
 
DIET2 In the last 2 months, which statement best describes changes in the amount of protein in your diet? Protein foods include animal sources of protein such as eggs, poultry, seafood and plant-sourced protein, such as beans, legumes, nuts and soy.
    • I ate more protein.  (1) 
    • I ate the same amount of protein.  (2) 
    • I ate less protein.  (3) 
    • I don’t know.  (4) 
 
DIET3 In the last 2 months, which statement best describes changes to the amount of highly processed foods in your diet? Highly processed foods include packaged snacks, sugary cereals, fast food, frozen meals, and soft drinks.
    • I ate more highly processed foods.  (1) 
    • I ate the same amount of highly processed foods.  (2) 
    • I ate fewer highly processed foods.  (3) 
    • I don’t know.  (4) 
 
DIET4 The U.S. government recently updated the Dietary Guidelines for Americans with messages such as “Eat Real Food” and changes to the Food Pyramid. Which statement best describes your response to the updated Dietary Guidelines?
    • I used the updated guidelines to make changes to my diet.  (1) 
    • I did not use the updated guidelines to make changes to my diet.  (2) 
    • I am not aware of the updated guidelines.  (3) 
 
End of Block: Dietary Guidelines and Consumer Behavior


Start of Block: Trust

Trust1 The population count, the crime rate, and the unemployment rate are examples of statistics produced by the federal government. Personally, how much trust do you have in federal statistics in the United States? Would you say that you tend to trust federal statistics or you tend not to trust them?
    • Tend to trust federal statistics  (1) 
    • Tend not to trust federal statistics  (2) 



TRUST_INTRO The next questions are about institutions in American society.
 
TRUST2_1 How much confidence do you, yourself, have in the military?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_2 How much confidence do you, yourself, have in the police?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_3 How much confidence do you, yourself, have in the U.S. Supreme Court?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 

 
TRUST2_4 How much confidence do you, yourself, have in the presidency?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_5 How much confidence do you, yourself, have in public schools?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_6 How much confidence do you, yourself, have in the criminal justice system?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 

 
TRUST2_7 How much confidence do you, yourself, have in Congress?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_8 How much confidence do you, yourself, have in the U.S. Census Bureau?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_9 How much confidence do you, yourself, have in U.S. statistical agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)






Trust3 To what extent do you agree or disagree with the following statement?  Policy makers need federal statistics to make good decisions about things like federal funding.
    • Strongly agree  (1) 
    • Somewhat agree  (2) 
    • Neither agree nor disagree  (3) 
    • Somewhat disagree  (4) 
    • Strongly disagree  (5) 
 
 
HTRUST_1 In general, how much would you trust information about health or medical topics from a doctor?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_2 In general, how much would you trust information about health or medical topics from government health agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_3 In general, how much would you trust information about health or medical topics from scientists?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)


HTRUST_4 In general, how much would you trust information about health or medical topics from Artificial intelligence (AI) tools such as ChatGPT, Google Gemini, or Claude?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)


End of Block: Trust


Start of Block: Income







INC1 In 2025 what was your total household income before taxes? 
    • 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)

End of Block: Income




September 2026 Questionnaire Content



Start of Block: Satisfaction


OECD Overall how satisfied are you with life as a whole these days?
    • 0 (Not satisfied at all)  (1) 
    • 1  (2) 
    • 2  (3) 
    • 3  (4) 
    • 4  (5) 
    • 5  (6) 
    • 6  (7) 
    • 7  (8) 
    • 8  (9) 
    • 9  (10) 
    • 10 (Completely satisfied)  (11) 

End of Block: Satisfaction

Start of Block: Household



Display this question:
If How many people under 18 years-old currently live in your household? Text Response Is Greater Than  0


D12 In your household, are there…   Select all that apply.
    • Children under 1 year old?  (1) 
    • Children 1 through 4 years old?  (2) 
    • Children 5 through 11 years old?  (3) 
    • Children 12 through 17 years old?  (4) 


Page Break


Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?




D13 During the school year that began in [SCHOOL YEAR], 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) 


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Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


EMP7 Next, we are going to ask about the child care 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 child care 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 child care that were unavailable.
    • Yes  (1) 
    • No  (2) 
    • Not applicable  (3) 


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Display this question:
If EMP7 = Yes


EMP8 Which if any of the following occurred in the LAST 4 WEEKS as a result of child care 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) 


Display this question:
If D12 = Children under 1 year old?


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) 


Page Break


Display this question:
If D12 = Children under 1 year old?


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) 


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Display this question:
If INF5 = Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula
Or INF5 = Infant formula only


INF6 In the LAST 4 WEEKS, did you have difficulty getting infant formula?
    • Yes, in the last 7 days  (1) 
    • Yes, more than 7 days ago but within the LAST 4 WEEKS  (2) 
    • No, did not have trouble getting infant formula in the LAST 4 WEEKS  (3) 


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Start of Block: Employment




EMP_Intro Now we are going to ask about your employment.




EMP1 Have you, or has anyone in your household, experienced a loss of employment income in the LAST 4 WEEKS? 
    • Yes  (1) 
    • No  (2) 




EMP2 
In the LAST 7 DAYS, did you do ANY work for either pay or profit?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If EMP2 = Yes


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?
    • Government  (1) 
    • Private company  (2) 
    • Non-profit organization including tax-exempt and charitable organizations  (3) 
    • Self-employed  (4) 
    • Working in a family business  (5) 


Display this question:
If EMP2 = No


EMP4 What is your main reason for not working for pay or profit? 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) 
    • I am/was unable to find work  (10) 
    • Other reason – Specify:  (9) __________________________________________________


Page Break


Display this question:
If EMP2 = Yes


SPN5_DAYSTW_2 In the LAST 7 DAYS, have you teleworked or worked from home?
    • Yes, for 1-2 days  (1) 
    • Yes, for 3-4 days  (2) 
    • Yes, for 5 or more days  (3) 
    • No  (4) 


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[Display AI series if EMP2=yes]
AI1: What is your occupation? Select only one answer.
    • Computer occupations (for example, computer support specialists, software developers, data scientists) (1)
    • Construction, trades, production, transportation, and material moving occupations (2)
    • Education and social services and arts, design, entertainment, and media occupations (3)
    • Engineering, architecture, and life, physical, and social sciences occupations (4)
    • Healthcare practitioners and healthcare support occupations (5)
    • Management, business operations, financial, and legal occupations (6)
    • Office and administrative support occupations (7)
    • Sales occupations (8)
    • Security, safety, food, cleaning, and personal care services occupations (9)
    • Other (10)


AI2 Artificial intelligence (AI) is the capability of computational systems to perform tasks typically associated with human intelligence, such as learning, reasoning, problem-solving, perception, and decision-making.

IN YOUR WORK, have you used AI to do any of the following tasks? Select Yes or No for each.

Yes (1)
No (2)
Administrative tasks (1) 
    • 
    • 
Coding or modeling (2) 
    • 
    • 
Data analysis and visualization (3) 
    • 
    • 
Generating ideas (4) 
    • 
    • 
Interpreting, translating, or summarizing (5) 
    • 
    • 
Managing logistics or supply chains (6) 
    • 
    • 
Medical care (7) 
    • 
    • 
Providing customer or coworker support (8) 
    • 
    • 
Searching for facts (9)
    • 
    • 
Tutoring or educational assistance (10)
    • 
    • 
Writing communications, documentation, or instructions (11)
    • 
    • 
Page Break

[Display only if AI2 = yes for at least 1 of the tasks]
AI3 AT WORK, how often did you use AI last week? Select only one answer.
    • Used every day last week  (1)
    • Used at least 1 day last week, but not every day  (2)
    • Used, but not last week  (3)


[Display only if AI3 = (1 or 2)]
AI4 If you had NOT been able to use AI at work last week, how many additional hours would you have needed to complete the same amount of work? Select only one answer.
    • Less than 1 hour  (1)
    • 1 hour  (2)
    • 2 hours  (3)
    • 3 hours  (4)
    • 4 hours  (5)
    • More than 4 hours  (6)
    • No time savings  (7)

End of Block: Employment


Start of Block: Mental Health and Health Status




display_HLTH Next, we will ask about health.




DIS1 Do you have difficulty seeing, even when wearing glasses?
    • 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?
    • 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?
    • 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?
    • 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?
    • 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?
    • No - no difficulty  (1) 
    • Yes - some difficulty  (2) 
    • Yes - a lot of difficulty  (3) 
    • Cannot do at all  (4) 


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HLTH_intro Over the LAST 2 WEEKS, how often have you been bothered by...




HLTH1 Feeling nervous, anxious, or on edge?
    • 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?
    • 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?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 




HLTH4 Feeling down, depressed, or hopeless?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 


Page Break


Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


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Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Display this question:
If MH2 = Yes, all children who needed treatment received it
Or MH2 = Yes, but only some children who needed treatment received it


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) 


Page Break


Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Page Break




HLTH8 Are you CURRENTLY covered by any of the following types of health insurance or health coverage plans?  Do NOT include plans that cover only one type of service, such as dental, drug, or vision plans.

YES, INSURED
Select all that apply.

    • Insurance through a current or former employer or union (through yourself or another family member) (1)
    • Medicare, for people 65 and older, or people with certain disabilities (3)
    • Medicaid, Children’s Health Insurance Program (CHIP), or any kind of government-assistance plan for those with low incomes or a disability (4)
    • Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) (2)
    • Veteran’s health care (enrolled for VA) (6)
    • TRICARE or other military health care (5)
    • Indian health Service (7)
    • Any other type of health insurance or health coverage plan. (8) - Specify:_____________

NO, UNINSURED

    • No health insurance or health coverage plan (9)


End of Block: Mental Health and Health Status

Start of Block: Socialization


SOC2_first How often do you feel lonely?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 




SOC1_first How often do you get the social and emotional support you need?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 


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SOC3 In a typical week, and not including people you live with, how many times do you get together with people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC4 In a typical week, and not including people you live with, how many times do you talk on the telephone or by video with the people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC5 During the PAST 12 MONTHS, how many times did you attend religious services?   Do not include special occasions such as weddings, funerals, or other special events.
    • Zero  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 




SOC6 During the PAST 12 MONTHS, how many times did you attend meetings of clubs or organizations you belong to?   Examples include community groups, unions, athletic groups, or school groups.
    • Zero / do not belong to a group  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 

End of Block: Socialization


Start of Block: Medical

FALLVAC Have you received the following vaccines THIS SEASON (that is, since August 2026)?

Yes (1)
No (2)
COVID (FALLVAC_1) 
    • 
    • 
Flu (FALLVAC_2) 
    • 
    • 




RSVVAC There is a vaccine that became available in the Fall of 2023 that helps prevent the respiratory virus called RSV.  Have you ever received a vaccine for RSV?
    • Yes  (1) 
    • No  (2) 


Page Break



NARCAN Naloxone (Narcan) is a medication which can be used to reverse an opioid overdose. Have you ever carried naloxone in case of an emergency?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If NARCAN = Yes

NARCAN2 Have you ever used naloxone to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NARCAN2 = Yes

NARCAN3 Have you used naloxone in the PAST 30 DAYS to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


Page Break




SHORTAGE1 In the LAST 4 WEEKS, 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) 
    • Medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.  (3) 
    • Other critical medical products – Specify:  (4) __________________________________________________
    • ⊗My household has not been affected by any of these shortages  (5) 


Page Break


Display this question:
If SHORTAGE1 = A medicine or medication that requires a prescription or is given by provider, pharmacist, or hospital
Or SHORTAGE1 = A medicine or medication that is sold over the counter (without a prescription)
Or SHORTAGE1 = A medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.
Or SHORTAGE1 = Other critical medical products, please specify


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) __________________________________________________

End of Block: Medical

Start of Block: Food Security




FD1 Getting enough food can be a problem for some people. In the LAST 7 DAYS, which of these statements best describes the food eaten in your household? 
    • 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) 


Page Break



Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat
And If
If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat


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) 
    • ⊗None of the above  (4) 




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?
    • Yes  (1) 
    • No  (2) 


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FD6_rev 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) 
    • Free or reduced-price meals at school through NSLP (National School Lunch Program)  (3) 
    • ⊗None of these  (5) 


Page Break


Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?


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) 
    • Not Applicable/don’t have to pay for food at school  (3) 


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SPN4 In the LAST 2 MONTHS, 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? 
    • Not at all difficult  (1) 
    • A little difficult  (2) 
    • Somewhat difficult  (3) 
    • Very difficult  (4) 




INFLATE1 In the area where you live and shop, do you think prices in general have changed IN THE LAST 2 MONTHS? 
    • 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) 


Page Break


Display this question:
If INFLATE1 = I think prices have increased


INFLATE2 How stressful, if at all, has the increase in prices IN THE LAST 2 MONTHS been for you? 
    • 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? 
    • Very concerned  (1) 
    • Somewhat concerned  (2) 
    • A little concerned  (3) 
    • Not at all concerned  (4) 

End of Block: Food Security

Start of Block: Housing




HSE1 
The next questions ask about housing. 
 Is your house or apartment…? 
    • 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) 


Page Break


Display this question:
If HSE1 = Rented


HSE3 Is this household CURRENTLY caught up on rent payments?
    • Yes  (1) 
    • No  (2) 


Display this question:
If HSE1 = Owned by you or someone in this household with a mortgage or loan (including home equity loans)


HSE4 Is this household CURRENTLY caught up on mortgage payments?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If HSE3 = No
Or HSE4 = No



HSE6 How many months behind is this household in paying your rent or mortgage?
________________________________________________________________


Page Break


Display this question:
If HSE3 = No


HSE8 How likely is it that your household will have to leave this home or apartment within the NEXT 2 MONTHS because of eviction? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


Display this question:
If HSE4 = No


HSE9 How likely is it that your household will have to leave this home within the NEXT 2 MONTHS because of foreclosure? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


Page Break


Display this question:
If HSE8 = Very likely
Or HSE8 = Somewhat likely
Or HSE9 = Very likely
Or HSE9 = Somewhat likely


NEWHSE10 If you (and your household) did have to leave, where do you think you would go?
    • Get a different place of your/their own to live in  (1) 
    • Move in with friends  (2) 
    • Move in with family  (3) 
    • Household would split up and go to different places  (4) 
    • Would probably go to a homeless shelter  (5) 
    • Move into vehicle  (6) 
    • Live outside  (7) 




NEWHSE11 At any time in the LAST 12 MONTHS did you or a person that currently lives with you experience homelessness?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If NEWHSE11 = Yes


NEWHSE12 Where did you or that person live or stay when experiencing homelessness?   Select all that apply. 
    • In a homeless shelter  (1) 
    • On the streets/tent/car/abandoned building  (2) 
    • Sleeping temporarily on someone’s couch  (3) 
    • Other  (4) 
    • ⊗Don’t know  (5) 


Display this question:
If NEWHSE11 = Yes


NEWHSE13 Were you the person who experienced homelessness? If not, how is that person related to you?   Select all that apply. 
    • It was me  (1) 
    • My spouse/partner  (2) 
    • My child 18 or older  (3) 
    • My child under age 18  (4) 
    • Parent  (5) 
    • Sibling  (6) 
    • Other family member  (7) 
    • Unrelated person  (8) 


Page Break




HSE14 In the LAST 2 MONTHS, did your household reduce or forego expenses for basic household necessities, such as medicine or food, in order to pay an energy bill?
    • Yes  (1) 
    • No  (2) 




HSE15 In the LAST 2 MONTHS, did your household keep your home at a temperature that you felt was unsafe or unhealthy?
    • Yes  (1) 
    • No  (2) 




HSE16 In the LAST 2 MONTHS, was your household unable to pay an energy bill or unable to pay the full bill amount?
    • Yes  (1) 
    • No  (2) 


Page Break




HEAT1 Which of the following cooling devices do you have in your home?   Select all that apply.
    • Central Air Conditioning  (1) 
    • Window Air Conditioning units  (2) 
    • Fans  (3) 
    • Evaporative Coolers (swamp coolers)  (4) 
    • Other cooling devices  (5) 
    • ⊗I don’t use any cooling devices  (6) 




HEAT2 This summer, have you been able to keep your home at a safe and healthy temperature on hot days?
    • Yes  (1) 
    • Sometimes  (2) 
    • No  (3) 


Page Break


Display this question:
If Which of the following cooling devices do you have in your home? Select all that apply. = Central Air Conditioning
Or Which of the following cooling devices do you have in your home? Select all that apply. = Window Air Conditioning units
And If
This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = No
Or This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = Sometimes


HEAT3 What prevents you from keeping your home at a safe and healthy temperature?   Select all that apply.
    • My air conditioning is not strong enough to keep my home cool.  (1) 
    • My air conditioning is not working.  (2) 
    • I cannot afford to run my air conditioning at all.  (3) 
    • I cannot afford to run my air conditioning as much needed to keep my home cool enough.  (4) 
    • The power frequently goes out.  (5) 
    • Other  (6) 


Display this question:
If Which of the following cooling devices do you have in your home? Select all that apply. != Central Air Conditioning
And Which of the following cooling devices do you have in your home? Select all that apply. != Window Air Conditioning units
And If
This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = No
Or This summer, have you been able to keep your home at a safe and healthy temperature on hot days? = Sometimes


HEAT4 What prevents you from keeping your home safe at a and healthy temperature?   Select all that apply.
    • My cooling devices are not strong enough to keep my home cool.  (1) 
    • My cooling devices are not working.  (2) 
    • I cannot afford to run my cooling devices at all.  (3) 
    • I cannot afford to run my cooling devices as much as needed to keep my home cool enough.  (4) 
    • The power frequently goes out.  (5) 
    • ⊗I don’t have air conditioning.  (6) 
    • Other  (7) 


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HEAT5 A cooling shelter is an air-conditioned or cooled location that has been designated as a place to go to cool off in extreme heat.  Do you or members of your household ever go to a cooling shelter on hot days?
    • Yes  (1) 
    • No   (2) 
    • We don’t need to go to a cooling shelter  (3) 


Page Break


Display this question:
If A cooling shelter is an air-conditioned or cooled location that has been designated as a place to... = Yes


HEAT6 Do you face any of these issues with the cooling shelter?   Select all that apply.
    • The cooling shelter is too crowded.  (1) 
    • The cooling shelter is not open when I/we want to go.  (2) 
    • The nearest cooling shelter is far away or difficult to reach.  (3) 
    • Someone in my household needs medical or mobility support that is not available at the cooling shelter.  (4) 
    • I don’t feel safe at the cooling shelter.  (5) 
    • The cooling shelter does not allow pets.  (6) 
    • Other issues.  (7) 
    • ⊗N/A. No issues with the cooling shelter.  (8) 


Display this question:
If A cooling shelter is an air-conditioned or cooled location that has been designated as a place to... = No


HEAT7 Why don’t you go to a cooling shelter on hot days?   Select all that apply.
    • The cooling shelter is too crowded.  (1) 
    • The cooling shelter is not open when I/we want to go.  (2) 
    • The nearest cooling shelter is far away or difficult to reach.  (3) 
    • Someone in my household needs medical or mobility support that is not available at the cooling shelter.  (4) 
    • I don’t feel safe at the cooling shelter.  (5) 
    • The cooling shelter does not allow pets.  (6) 
    • I don’t know where to find a cooling shelter.  (7) 
    • ⊗I don’t need a cooling shelter.  (8) 
    • Other issues.  (9) 

HEAT8 Do you have any health conditions that may increase the risk of heat-related illness? (Examples include heart disease, respiratory conditions, diabetes, or taking medications that affect body temperature regulation)
    • Yes  (1) 
    • No   (2) 
    • Not Sure  (3) 
 
 
Display this question:
If Do you have any health conditions that may increase the risk of heat-related illness = Yes
 
HEAT9 Which of the following apply? Select all that apply.
 
    • Heart disease or circulation problems  (1) 
    • Asthma or other respiratory conditions   (2) 
    • Diabetes  (3) 
    • Kidney disease  (4)
    • Medications that affect sweating or body temperature  (5)
    • Mobility limitations  (6)
    • Other – Specify:  (7)
_____________________________________________________
 
 
HEAT10 On hot days have you or members of your household done any of the following to stay cool or reduce home cooling costs? Select all that apply.
    • Used a public cooling shelter (e.g., government or non-profit facility)  (1) 
    • Visited a public facility like a community center or library for air conditioning   (2) 
    • Visited a commercial facility like a mall, movie theatre, or department store for air conditioning  (3) 
    • Spent time in a friend or family member’s air-conditioned home  (4)
    • Went to a public or private pool  (5)
    • Stayed in a hotel or short-term rental with air conditioning  (6)
    • Avoided using appliances (e.g., oven, dryer) to reduce indoor heat  (7)
    • Took no special actions  (8)
    • Other – Specify:  (9)
_____________________________________________________





TRANS1 CURRENTLY, which of the following transportation options do you have access to:  Select all that apply. 
    • Walk  (1) 
    • Bike or e-scooter  (2) 
    • Motorcycle or moped  (3) 
    • Your own personal vehicle (e.g., car, truck, SUV)  (4) 
    • A personal vehicle borrowed from a friend, family member, neighbor, coworker, or acquaintance (including carpooling)  (5) 
    • Rental car or carsharing service (e.g., Zipcar)  (6) 
    • Taxi service or rideshare (e.g., Uber, Lyft)  (7) 
    • Bus  (8) 
    • Rail transit (subway, light rail, streetcar, commuter rail)  (9) 
    • Ferryboat  (10) 
    • Paratransit (that is, specialized, door-to-door transport service for people with disabilities)  (11) 
    • Other methods – Specify:  (12) __________________________________________________


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TRANS2 Which one of the following statements best describes your access to transportation in the LAST 4 WEEKS:
    • Enough transportation to meet your needs  (1) 
    • Enough transportation, but not always the kinds you want to use  (2) 
    • Sometimes not enough transportation to meet your needs  (3) 
    • Often not enough transportation to meet your needs  (4) 
    • Always not enough transportation to meet your needs  (5) 


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Display this question:
If TRANS2 = Sometimes not enough transportation to meet your needs
Or TRANS2 = Often not enough transportation to meet your needs
Or TRANS2 = Always not enough transportation to meet your needs


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  (1) 
    • My transportation options require more travel time than I have available  (2) 
    • My transportation options are unpredictable (travel time, availability)  (3) 
    • My transportation options cost more than I can afford  (4) 
    • My transportation options feel unsafe  (5) 
    • I have a disability that limits my travel options or makes travel challenging  (6) 
    • ⊗None of the above  (7) 

TRANS4 
Last week, how many times did you drive a vehicle with a feature that can automatically control part of the driving (such as adjusting speed, steering within a lane, or braking)?
    • 0 times (I did not drive a vehicle with these features last week)  (1) 
    • 1-2 times  (2) 
    • 3-4 times  (3)
    • 5-6 times  (4)
    • 7 or more times  (5)


End of Block: Housing

Start of Block: Arts

ArtsIntro Next, we have a few questions about participation with the arts and entertainment.




ART1 During the LAST 4 WEEKS, did you attend any live music, dance, or theater performances in person?
    • Yes  (1) 
    • No  (2) 




ART2 During the LAST 4 WEEKS, did you go in person to an art exhibit, such as paintings, sculpture, textiles, graphic design, or photography?
    • Yes  (1) 
    • No  (2) 




ART3 During the LAST 4 WEEKS, did you go to the movies?
    • Yes  (1) 
    • No  (2) 


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ART4 During the LAST 4 WEEKS, did you create, practice, or perform art of your own?    This may have included music, dance, or theater; creative writing; crafts or visual arts; digital art; or film or photography done for artistic purposes.
    • Yes  (1) 
    • No  (2) 




ART5 Please indicate whether you strongly agree, agree, disagree, or strongly disagree with the next statement.   “There are plenty of opportunities for me to take part in arts and cultural activities in my neighborhood or community.” 
    • Strongly agree  (1) 
    • Agree  (2) 
    • Disagree  (3) 
    • Strongly Disagree  (4) 

End of Block: Arts


Start of Block: Dietary Guidelines and Consumer Behavior
 
DIET1 In the last 2 months, which statement best describes changes in the amount of full-fat dairy products without added sugar in your diet? Examples include whole milk and plain whole milk yogurt.
    • I ate more full-fat dairy products without added sugar.  (1) 
    • I ate about the same amount.  (2) 
    • I ate fewer full-fat dairy products without added sugar.  (3) 
    • I don’t know.  (4) 
    • I do not eat dairy products.  (5)
 
DIET2 In the last 2 months, which statement best describes changes in the amount of protein in your diet? Protein foods include animal sources of protein such as eggs, poultry, seafood and plant-sourced protein, such as beans, legumes, nuts and soy.
    • I ate more protein.  (1) 
    • I ate the same amount of protein.  (2) 
    • I ate less protein.  (3) 
    • I don’t know.  (4) 
 
DIET3 In the last 2 months, which statement best describes changes to the amount of highly processed foods in your diet? Highly processed foods include packaged snacks, sugary cereals, fast food, frozen meals, and soft drinks.
    • I ate more highly processed foods.  (1) 
    • I ate the same amount of highly processed foods.  (2) 
    • I ate fewer highly processed foods.  (3) 
    • I don’t know.  (4) 
 
DIET4 The U.S. government recently updated the Dietary Guidelines for Americans with messages such as “Eat Real Food” and changes to the Food Pyramid. Which statement best describes your response to the updated Dietary Guidelines?
    • I used the updated guidelines to make changes to my diet.  (1) 
    • I did not use the updated guidelines to make changes to my diet.  (2) 
    • I am not aware of the updated guidelines.  (3) 
 
End of Block: Dietary Guidelines and Consumer Behavior


Start of Block: Trust

Trust1 The population count, the crime rate, and the unemployment rate are examples of statistics produced by the federal government. Personally, how much trust do you have in federal statistics in the United States? Would you say that you tend to trust federal statistics or you tend not to trust them?
    • Tend to trust federal statistics  (1) 
    • Tend not to trust federal statistics  (2) 



TRUST_INTRO The next questions are about institutions in American society.
 
TRUST2_1 How much confidence do you, yourself, have in the military?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_2 How much confidence do you, yourself, have in the police?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_3 How much confidence do you, yourself, have in the U.S. Supreme Court?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_4 How much confidence do you, yourself, have in the presidency?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_5 How much confidence do you, yourself, have in public schools?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_6 How much confidence do you, yourself, have in the criminal justice system?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 

 
TRUST2_7 How much confidence do you, yourself, have in Congress?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_8 How much confidence do you, yourself, have in the U.S. Census Bureau?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_9 How much confidence do you, yourself, have in U.S. statistical agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)





Trust3 To what extent do you agree or disagree with the following statement?  Policy makers need federal statistics to make good decisions about things like federal funding.
    • Strongly agree  (1) 
    • Somewhat agree  (2) 
    • Neither agree nor disagree  (3) 
    • Somewhat disagree  (4) 
    • Strongly disagree  (5) 

HTRUST_1 In general, how much would you trust information about health or medical topics from a doctor?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_2 In general, how much would you trust information about health or medical topics from government health agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_3 In general, how much would you trust information about health or medical topics from scientists?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)


HTRUST_4 In general, how much would you trust information about health or medical topics from Artificial intelligence (AI) tools such as ChatGPT, Google Gemini, or Claude?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)


End of Block: Trust


Start of Block: Income







INC1 In 2025 what was your total household income before taxes? 
    • 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)

End of Block: Income

Start of Block: Suicide

INTRO We understand that the next questions may be personal and difficult to answer. You don’t have to answer any question you do not wish to. If, at any time, you feel distressed you can exit the survey by closing your browser and return later if desired. If you would like to speak with a trained professional, please refer to the resources provided below. National Suicide Prevention Lifeline: Call or text 988 or Chat at 988lifeline.org 



SUICIDE1 At any time in the PAST 12 MONTHS, did you seriously think about trying to kill yourself?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If SUICIDE1 = Yes

SUICIDE1a Did any of the following situations contribute to your thoughts about suicide?  Select all that apply. 
    • Financial problem(s)  (1) 
    • Job loss  (2) 
    • Other job/school problem(s)  (3) 
    • Relationship problem(s) (e.g., family, friends)  (4) 
    • Mental health conditions (e.g., depression/anxiety)  (5) 
    • Substance use (e.g., alcohol, other drugs)  (6) 
    • Physical health problem(s)  (7) 
    • Loneliness or social isolation  (8) 
    • Experiences of discrimination  (9) 
    • Death of family member or loved one  (10) 
    • Criminal/legal problem(s)  (11) 
    • Exposure to violence or other trauma  (12) 
    • Concerns over current events/news  (13) 
    • ⊗None of above  (14) 
    • Other – Specify:  (15) __________________________________________________


Display this question:
If SUICIDE1 = Yes

SUICIDE1b Do any of the following help you cope with your thoughts about suicide?  Select all that apply. 
    • Talking with friends, family  (1) 
    • Participating in support group  (2) 
    • Participating in group activities (e.g.,   exercise, volunteering)  (3) 
    • Engaging in religious, cultural or spiritual activities  (4) 
    • Talking with mental health professional  (5) 
    • Engaging with social media/digital technology (e.g., mobile apps, gaming, or online resources/ website)  (6) 
    • Engaging with Artificial Intelligence (AI) tools  (7)
    • 988 Suicide & Crisis Lifeline  (8) 
    • Other – Specify:  (9) __________________________________________________


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Display this question:
If SUICIDE1 = Yes

SUICIDE1c To whom did you tell about these thoughts about suicide?  Select all that apply. 
    • ⊗I didn’t tell anyone  (1) 
    • Family member  (2) 
    • Friend  (3) 
    • Mental health provider  (4) 
    • Healthcare provider  (5) 
    • Coworker or teacher  (6) 
    • Religious or spiritual advisor  (7) 
    • Other – Specify:  (8) __________________________________________________


Page Break



SUICIDE2 At any time in the PAST 12 MONTHS, did you try to kill yourself?
    • Yes  (1) 
    • No  (2) 



SUICIDE3 At any time in the PAST 12 MONTHS, did you purposefully hurt yourself without wanting to die, such as cutting or burning yourself on purpose?
    • Yes  (1) 
    • No  (2) 

End of Block: Suicide





November 2026 Questionnaire Content



Start of Block: Satisfaction


OECD Overall how satisfied are you with life as a whole these days?
    • 0 (Not satisfied at all)  (1) 
    • 1  (2) 
    • 2  (3) 
    • 3  (4) 
    • 4  (5) 
    • 5  (6) 
    • 6  (7) 
    • 7  (8) 
    • 8  (9) 
    • 9  (10) 
    • 10 (Completely satisfied)  (11) 

End of Block: Satisfaction

Start of Block: Household



Display this question:
If How many people under 18 years-old currently live in your household? Text Response Is Greater Than  0


D12 In your household, are there…   Select all that apply.
    • Children under 1 year old?  (1) 
    • Children 1 through 4 years old?  (2) 
    • Children 5 through 11 years old?  (3) 
    • Children 12 through 17 years old?  (4) 


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Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?




D13 During the school year that began in [SCHOOL YEAR], 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) 


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Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


EMP7 Next, we are going to ask about the child care 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 child care 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 child care that were unavailable.
    • Yes  (1) 
    • No  (2) 
    • Not applicable  (3) 


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Display this question:
If EMP7 = Yes


EMP8 Which if any of the following occurred in the LAST 4 WEEKS as a result of child care 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) 


Display this question:
If D12 = Children under 1 year old?


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) 


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Display this question:
If D12 = Children under 1 year old?


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) 


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Display this question:
If INF5 = Sometimes breastfeeding (or pumped breastmilk) and sometimes infant formula
Or INF5 = Infant formula only


INF6 In the LAST 4 WEEKS, did you have difficulty getting infant formula?
    • Yes, in the last 7 days  (1) 
    • Yes, more than 7 days ago but within the LAST 4 WEEKS  (2) 
    • No, did not have trouble getting infant formula in the LAST 4 WEEKS  (3) 


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Start of Block: Employment




EMP_Intro Now we are going to ask about your employment.




EMP1 Have you, or has anyone in your household, experienced a loss of employment income in the LAST 4 WEEKS? 
    • Yes  (1) 
    • No  (2) 




EMP2 
In the LAST 7 DAYS, did you do ANY work for either pay or profit?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If EMP2 = Yes


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?
    • Government  (1) 
    • Private company  (2) 
    • Non-profit organization including tax-exempt and charitable organizations  (3) 
    • Self-employed  (4) 
    • Working in a family business  (5) 


Display this question:
If EMP2 = No


EMP4 What is your main reason for not working for pay or profit? 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) 
    • I am/was unable to find work  (10) 
    • Other reason – Specify:  (9) __________________________________________________


Page Break


Display this question:
If EMP2 = Yes


SPN5_DAYSTW_2 In the LAST 7 DAYS, have you teleworked or worked from home?
    • Yes, for 1-2 days  (1) 
    • Yes, for 3-4 days  (2) 
    • Yes, for 5 or more days  (3) 
    • No  (4) 


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EMPUI1 Since JANUARY 1, 2026, have you applied for Unemployment Insurance (UI) benefits?
    • Yes  (1) 
    • No  (2) 


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EMPUI2 Since JANUARY 1, 2026, have you received Unemployment Insurance (UI) benefits?
    • Yes  (1) 
    • No  (2) 


Display this question:
If EMPUI1 = Yes
And EMPUI2 = No

EMPUI3_NEW Why haven’t you received Unemployment Insurance (UI) benefits?
    • Application denied  (1) 
    • Waiting for decision  (2) 
    • Approved but waiting for payment  (4) 

End of Block: Employment


Start of Block: AI Use in Households

AIP1. Artificial intelligence (AI) refers to software tools or built-in digital features that can generate text or images, answer questions, or make suggestions. This includes standalone tools like ChatGPT or Gemini, as well as AI features built into apps, devices, search engines, or software, such as search summaries or writing suggestions.

In the last 2 months, have YOU used an AI tool for any of the following activities?
Select all that apply.
☐ I have not used an AI tool in the last 2 months 
☐ Finding factual information
☐ Brainstorming or generating ideas
☐ Writing, editing, or translating text
☐ Assisting with schoolwork or learning
☐ Assisting with creative tasks (such as creating images, music, or writing)
☐ Searching for jobs or work opportunities
☐ Looking for housing or apartments
☐ Understanding government benefits or public services
☐ Getting health or medical information
☐  Mental health or emotional support
☐ Comparing financial products or services
☐ Other - Specify: __________

[Display if AIP1 ≠ “I have not personally used an AI tool”]

AIP2. Outside of work or school, how often did you personally use AI tools in the last 2 months?
o Every day or almost every day
o Several times a week
o Several times a month
o Once or twice in the last 2 months

[Display if AIP1 ≠ “I have not personally used an AI tool”]

AIP3. Please indicate whether you agree or disagree with the following statements.
Statement
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree





Content generated by AI is useful for the kinds of tasks I want to complete
I feel prepared to use AI in daily life
o
o
o
o
I trust information generated by AI systems
o
o
o
o
AI tools help me complete tasks more quickly
o
o
o
o
I am concerned about AI’s impact on jobs and careers
o
o
o
o
I am concerned about how AI systems use personal data
o
o
o
o

AIP4. In the last 2 months, have you actively avoided or opted out of using AI ?
Examples may include disabling AI-generated summaries, turning off an AI assistant or feature, or avoiding use of an AI-based application.
o Yes
o No
o Not sure

AI-JOB1. Job Search Screener
In the last 2 months, have you searched for jobs or explored new work opportunities?
o Yes
o No

[Display if AI-JOB1 = Yes]

AI-JOB2. In the last 2 months, did you use AI tools for any of the following job search activities?
Select all that apply.
☐ Finding or evaluating job opportunities 
☐ Preparing application materials 
☐ Preparing for interviews 
☐ Assistance during a live interview or assessment 
☐ Learning or practicing job-related skills 
☐ None of the above 
☐ Other - Specify: __________

[Display if AI-JOB2 ≠ “None of the above”]

AI-JOB3. 
Overall, how much did AI tools help with your job search activities?
o Helped a lot
o Helped somewhat
o Did not make much difference
o Made it somewhat more difficult
o Made it much more difficult

[Display if AI-JOB1 = Yes]

AI-JOB4. Did you receive a job offer in the last 2 months?
o Yes
o No

End of Block: AI Use in Households



Start of Block: Mental Health and Health Status




display_HLTH Next, we will ask about health.




DIS1 Do you have difficulty seeing, even when wearing glasses?
    • 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?
    • 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?
    • 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?
    • 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?
    • 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?
    • No - no difficulty  (1) 
    • Yes - some difficulty  (2) 
    • Yes - a lot of difficulty  (3) 
    • Cannot do at all  (4) 


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HLTH_intro Over the LAST 2 WEEKS, how often have you been bothered by...




HLTH1 Feeling nervous, anxious, or on edge?
    • 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?
    • 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?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 




HLTH4 Feeling down, depressed, or hopeless?
    • Not at all  (1) 
    • Several days  (2) 
    • More than half the days  (3) 
    • Nearly every day   (4) 


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Display this question:
If If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


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Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Display this question:
If MH2 = Yes, all children who needed treatment received it
Or MH2 = Yes, but only some children who needed treatment received it


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) 


Page Break


Display this question:
If MH1 = Yes, all children needed mental health treatment
Or MH1 = Yes, some but not all children needed mental health treatment


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) 


Page Break




HLTH8 Are you CURRENTLY covered by any of the following types of health insurance or health coverage plans?  Do NOT include plans that cover only one type of service, such as dental, drug, or vision plans.

YES, INSURED
Select all that apply.

    • Insurance through a current or former employer or union (through yourself or another family member) (1)
    • Medicare, for people 65 and older, or people with certain disabilities (3)
    • Medicaid, Children’s Health Insurance Program (CHIP), or any kind of government-assistance plan for those with low incomes or a disability (4)
    • Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member) (2)
    • Veteran’s health care (enrolled for VA) (6)
    • TRICARE or other military health care (5)
    • Indian health Service (7)
    • Any other type of health insurance or health coverage plan. (8) - Specify:_____________

NO, UNINSURED

    • No health insurance or health coverage plan (9)


End of Block: Mental Health and Health Status

Start of Block: Socialization


SOC2_first How often do you feel lonely?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 




SOC1_first How often do you get the social and emotional support you need?
    • Always  (1) 
    • Usually  (2) 
    • Sometimes  (3) 
    • Rarely  (4) 
    • Never  (5) 


Page Break




SOC3 In a typical week, and not including people you live with, how many times do you get together with people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC4 In a typical week, and not including people you live with, how many times do you talk on the telephone or by video with the people that you care about and feel close to?
    • Never or less than once a week  (1) 
    • 1 to 2 times  (2) 
    • 3 to 4 times  (3) 
    • 5 or more times a week  (4) 




SOC5 During the PAST 12 MONTHS, how many times did you attend religious services?   Do not include special occasions such as weddings, funerals, or other special events.
    • Zero  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 




SOC6 During the PAST 12 MONTHS, how many times did you attend meetings of clubs or organizations you belong to?   Examples include community groups, unions, athletic groups, or school groups.
    • Zero / do not belong to a group  (1) 
    • 1 to 3 times  (2) 
    • 4 to 11 times  (3) 
    • 12 or more times  (4) 

End of Block: Socialization


Start of Block: Medical

FALLVAC Have you received the following vaccines THIS SEASON (that is, since August 2026)?

Yes (1)
No (2)
COVID (FALLVAC_1) 
    • 
    • 
Flu (FALLVAC_2) 
    • 
    • 




RSVVAC There is a vaccine that became available in the Fall of 2023 that helps prevent the respiratory virus called RSV.  Have you ever received a vaccine for RSV?
    • Yes  (1) 
    • No  (2) 


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NARCAN Naloxone (Narcan) is a medication which can be used to reverse an opioid overdose. Have you ever carried naloxone in case of an emergency?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NARCAN = Yes

NARCAN2 Have you ever used naloxone to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NARCAN2 = Yes

NARCAN3 Have you used naloxone in the PAST 30 DAYS to reverse an opioid overdose?
    • Yes  (1) 
    • No  (2) 


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SHORTAGE1 In the LAST 4 WEEKS, 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) 
    • Medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.  (3) 
    • Other critical medical products – Specify:  (4) __________________________________________________
    • ⊗My household has not been affected by any of these shortages  (5) 


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Display this question:
If SHORTAGE1 = A medicine or medication that requires a prescription or is given by provider, pharmacist, or hospital
Or SHORTAGE1 = A medicine or medication that is sold over the counter (without a prescription)
Or SHORTAGE1 = A medical equipment or supplies used at home such as infusion pumps, glucose monitors, home ventilators, masks, gloves, etc.
Or SHORTAGE1 = Other critical medical products, please specify


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) __________________________________________________

End of Block: Medical

Start of Block: Food Security




FD1 Getting enough food can be a problem for some people. In the LAST 7 DAYS, which of these statements best describes the food eaten in your household? 
    • 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) 


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Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat
And If
If How many people under 18 years-old CURRENTLY live in your household? Please enter a number. Text Response Is Greater Than  0


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) 


Display this question:
If FD1 = Enough, but not always the kinds of food (I/we) wanted to eat
Or FD1 = Sometimes not enough to eat
Or FD1 = Often not enough to eat


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) 
    • ⊗None of the above  (4) 




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?
    • Yes  (1) 
    • No  (2) 


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FD6_rev 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) 
    • Free or reduced-price meals at school through NSLP (National School Lunch Program)  (3) 
    • ⊗None of these  (5) 


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Display this question:
If D12 = Children 5 through 11 years old?
Or D12 = Children 12 through 17 years old?


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) 
    • Not Applicable/don’t have to pay for food at school  (3) 


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SPN4 In the LAST 2 MONTHS, 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? 
    • Not at all difficult  (1) 
    • A little difficult  (2) 
    • Somewhat difficult  (3) 
    • Very difficult  (4) 




INFLATE1 In the area where you live and shop, do you think prices in general have changed IN THE LAST 2 MONTHS? 
    • 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) 


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Display this question:
If INFLATE1 = I think prices have increased


INFLATE2 How stressful, if at all, has the increase in prices IN THE LAST 2 MONTHS been for you? 
    • 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? 
    • Very concerned  (1) 
    • Somewhat concerned  (2) 
    • A little concerned  (3) 
    • Not at all concerned  (4) 

End of Block: Food Security

Start of Block: Housing




HSE1 
The next questions ask about housing. 
 Is your house or apartment…? 
    • 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) 


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Display this question:
If HSE1 = Rented


HSE3 Is this household CURRENTLY caught up on rent payments?
    • Yes  (1) 
    • No  (2) 


Display this question:
If HSE1 = Owned by you or someone in this household with a mortgage or loan (including home equity loans)


HSE4 Is this household CURRENTLY caught up on mortgage payments?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If HSE3 = No
Or HSE4 = No



HSE6 How many months behind is this household in paying your rent or mortgage?
________________________________________________________________


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Display this question:
If HSE3 = No


HSE8 How likely is it that your household will have to leave this home or apartment within the NEXT 2 MONTHS because of eviction? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


Display this question:
If HSE4 = No


HSE9 How likely is it that your household will have to leave this home within the NEXT 2 MONTHS because of foreclosure? 
    • Very likely  (1) 
    • Somewhat likely  (2) 
    • Not very likely  (3) 
    • Not likely at all  (4) 


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Display this question:
If HSE8 = Very likely
Or HSE8 = Somewhat likely
Or HSE9 = Very likely
Or HSE9 = Somewhat likely


NEWHSE10 If you (and your household) did have to leave, where do you think you would go?
    • Get a different place of your/their own to live in  (1) 
    • Move in with friends  (2) 
    • Move in with family  (3) 
    • Household would split up and go to different places  (4) 
    • Would probably go to a homeless shelter  (5) 
    • Move into vehicle  (6) 
    • Live outside  (7) 




NEWHSE11 At any time in the LAST 12 MONTHS did you or a person that currently lives with you experience homelessness?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NEWHSE11 = Yes


NEWHSE12 Where did you or that person live or stay when experiencing homelessness?   Select all that apply. 
    • In a homeless shelter  (1) 
    • On the streets/tent/car/abandoned building  (2) 
    • Sleeping temporarily on someone’s couch  (3) 
    • Other  (4) 
    • ⊗Don’t know  (5) 


Display this question:
If NEWHSE11 = Yes


NEWHSE13 Were you the person who experienced homelessness? If not, how is that person related to you?   Select all that apply. 
    • It was me  (1) 
    • My spouse/partner  (2) 
    • My child 18 or older  (3) 
    • My child under age 18  (4) 
    • Parent  (5) 
    • Sibling  (6) 
    • Other family member  (7) 
    • Unrelated person  (8) 


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HSE14 In the LAST 2 MONTHS, did your household reduce or forego expenses for basic household necessities, such as medicine or food, in order to pay an energy bill?
    • Yes  (1) 
    • No  (2) 




HSE15 In the LAST 2 MONTHS, did your household keep your home at a temperature that you felt was unsafe or unhealthy?
    • Yes  (1) 
    • No  (2) 




HSE16 In the LAST 2 MONTHS, was your household unable to pay an energy bill or unable to pay the full bill amount?
    • Yes  (1) 
    • No  (2) 


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TRANS1 CURRENTLY, which of the following transportation options do you have access to:  Select all that apply. 
    • Walk  (1) 
    • Bike or e-scooter  (2) 
    • Motorcycle or moped  (3) 
    • Your own personal vehicle (e.g., car, truck, SUV)  (4) 
    • A personal vehicle borrowed from a friend, family member, neighbor, coworker, or acquaintance (including carpooling)  (5) 
    • Rental car or carsharing service (e.g., Zipcar)  (6) 
    • Taxi service or rideshare (e.g., Uber, Lyft)  (7) 
    • Bus  (8) 
    • Rail transit (subway, light rail, streetcar, commuter rail)  (9) 
    • Ferryboat  (10) 
    • Paratransit (that is, specialized, door-to-door transport service for people with disabilities)  (11) 
    • Other methods – Specify:  (12) __________________________________________________


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TRANS2 Which one of the following statements best describes your access to transportation in the LAST 4 WEEKS:
    • Enough transportation to meet your needs  (1) 
    • Enough transportation, but not always the kinds you want to use  (2) 
    • Sometimes not enough transportation to meet your needs  (3) 
    • Often not enough transportation to meet your needs  (4) 
    • Always not enough transportation to meet your needs  (5) 


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Display this question:
If TRANS2 = Sometimes not enough transportation to meet your needs
Or TRANS2 = Often not enough transportation to meet your needs
Or TRANS2 = Always not enough transportation to meet your needs


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  (1) 
    • My transportation options require more travel time than I have available  (2) 
    • My transportation options are unpredictable (travel time, availability)  (3) 
    • My transportation options cost more than I can afford  (4) 
    • My transportation options feel unsafe  (5) 
    • I have a disability that limits my travel options or makes travel challenging  (6) 
    • ⊗None of the above  (7) 

TRANS4 
Last week, how many times did you drive a vehicle with a feature that can automatically control part of the driving (such as adjusting speed, steering within a lane, or braking)?
    • 0 times (I did not drive a vehicle with these features last week)  (1) 
    • 1-2 times  (2) 
    • 3-4 times  (3)
    • 5-6 times  (4)
    • 7 or more times  (5)


End of Block: Housing

Start of Block: Arts

ArtsIntro Next, we have a few questions about participation with the arts and entertainment.




ART1 During the LAST 4 WEEKS, did you attend any live music, dance, or theater performances in person?
    • Yes  (1) 
    • No  (2) 




ART2 During the LAST 4 WEEKS, did you go in person to an art exhibit, such as paintings, sculpture, textiles, graphic design, or photography?
    • Yes  (1) 
    • No  (2) 




ART3 During the LAST 4 WEEKS, did you go to the movies?
    • Yes  (1) 
    • No  (2) 


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ART4 During the LAST 4 WEEKS, did you create, practice, or perform art of your own?    This may have included music, dance, or theater; creative writing; crafts or visual arts; digital art; or film or photography done for artistic purposes.
    • Yes  (1) 
    • No  (2) 




ART5 Please indicate whether you strongly agree, agree, disagree, or strongly disagree with the next statement.   “There are plenty of opportunities for me to take part in arts and cultural activities in my neighborhood or community.” 
    • Strongly agree  (1) 
    • Agree  (2) 
    • Disagree  (3) 
    • Strongly Disagree  (4) 

End of Block: Arts


Start of Block: Dietary Guidelines and Consumer Behavior
 
DIET1 In the last 2 months, which statement best describes changes in the amount of full-fat dairy products without added sugar in your diet? Examples include whole milk and plain whole milk yogurt.
    • I ate more full-fat dairy products without added sugar.  (1) 
    • I ate about the same amount.  (2) 
    • I ate fewer full-fat dairy products without added sugar.  (3) 
    • I don’t know.  (4) 
    • I do not eat dairy products.  (5)
 
DIET2 In the last 2 months, which statement best describes changes in the amount of protein in your diet? Protein foods include animal sources of protein such as eggs, poultry, seafood and plant-sourced protein, such as beans, legumes, nuts and soy.
    • I ate more protein.  (1) 
    • I ate the same amount of protein.  (2) 
    • I ate less protein.  (3) 
    • I don’t know.  (4) 
 
DIET3 In the last 2 months, which statement best describes changes to the amount of highly processed foods in your diet? Highly processed foods include packaged snacks, sugary cereals, fast food, frozen meals, and soft drinks.
    • I ate more highly processed foods.  (1) 
    • I ate the same amount of highly processed foods.  (2) 
    • I ate fewer highly processed foods.  (3) 
    • I don’t know.  (4) 
 
DIET4 The U.S. government recently updated the Dietary Guidelines for Americans with messages such as “Eat Real Food” and changes to the Food Pyramid. Which statement best describes your response to the updated Dietary Guidelines?
    • I used the updated guidelines to make changes to my diet.  (1) 
    • I did not use the updated guidelines to make changes to my diet.  (2) 
    • I am not aware of the updated guidelines.  (3) 
 
End of Block: Dietary Guidelines and Consumer Behavior


 
Start of Block: Trust

Trust1 The population count, the crime rate, and the unemployment rate are examples of statistics produced by the federal government. Personally, how much trust do you have in federal statistics in the United States? Would you say that you tend to trust federal statistics or you tend not to trust them?
    • Tend to trust federal statistics  (1) 
    • Tend not to trust federal statistics  (2) 



TRUST_INTRO The next questions are about institutions in American society.
 
TRUST2_1 How much confidence do you, yourself, have in the military?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_2 How much confidence do you, yourself, have in the police?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_3 How much confidence do you, yourself, have in the U.S. Supreme Court?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_4 How much confidence do you, yourself, have in the presidency?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
TRUST2_5 How much confidence do you, yourself, have in public schools?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_6 How much confidence do you, yourself, have in the criminal justice system?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 

 
TRUST2_7 How much confidence do you, yourself, have in Congress?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_8 How much confidence do you, yourself, have in the U.S. Census Bureau?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
TRUST2_9 How much confidence do you, yourself, have in U.S. statistical agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)



Trust3 To what extent do you agree or disagree with the following statement?  Policy makers need federal statistics to make good decisions about things like federal funding.
    • Strongly agree  (1) 
    • Somewhat agree  (2) 
    • Neither agree nor disagree  (3) 
    • Somewhat disagree  (4) 
    • Strongly disagree  (5) 

HTRUST_1 In general, how much would you trust information about health or medical topics from a doctor?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_2 In general, how much would you trust information about health or medical topics from government health agencies?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4) 
 
 
HTRUST_3 In general, how much would you trust information about health or medical topics from scientists?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)


HTRUST_4 In general, how much would you trust information about health or medical topics from Artificial intelligence (AI) tools such as ChatGPT, Google Gemini, or Claude?
    • A great deal  (1) 
    • Quite a lot  (2) 
    • Some (3) 
    • Very little  (4)

End of Block: Trust


Start of Block: Income







INC1 In 2025 what was your total household income before taxes? 
    • 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)

End of Block: Income
Start of Block: Natural Disaster (Revised)


NDX1 The next set of questions asks about natural disasters, such as hurricanes, floods and fires.   Since January 2025 (last year), were you or was anyone currently living or staying with you affected by a natural disaster?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NDX1 = 1


NDX2 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) __________________________________________________


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NDX3 Since January 2025 (last year), were you or was anyone currently living or staying with you displaced from their home because of a natural disaster?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NDX3 = 1

NDX4 How many people currently living in your home were displaced because of a natural disaster?
    • Adults  (1) __________________________________________________
    • Children  (2) __________________________________________________


Display this question:
If NDX3 = 1


NDX5 How many times have you (or they) been displaced in 2025 due to a natural disaster?
    • 1 time  (1) 
    • 2 times  (2) 
    • 3 times  (3) 
    • 4 or more times  (4) 


Display this question:
If NDX3 = 1


NDX6 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) 


Display this question:
If NDX3 = 1


NDX7 Would you say that you are still in transition or are you now permanently settled in a home?
    • In transition  (1) 
    • In permanent home  (2) 


Display this question:
If NDX3 = 1


NDX8 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  (1) 
    • People you did not know  (2) 
    • ⊗Did not share living quarters with others  (3) 


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Display this question:
If NDX1 = 1


NDX10 Altogether, how much damage to property or possessions did you (or they) experience as a result of natural disasters since January 2025 (last year)?
    • Property has no damage  (1) 
    • Property has some damage  (2) 
    • Property is uninhabitable  (3) 
    • Property is completely destroyed  (4) 


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Display this question:
If NDX1 = 1

ND5intro For how long after the event did you (or they) experience any of the following:


Display this question:
If NDX1 = 1


ND5A A shortage of food?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5A = 5


ND5AA Are you/they still experiencing a shortage of food?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5B A shortage of drinkable water?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5B = 5


ND5BA Are you/they still experiencing a shortage of water?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5C Loss of electricity?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5C = 5


ND5CA Are you/they still experiencing a loss of electricity?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5D Unsanitary conditions, such as inadequate toilets?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5D = 5


ND5DA Are you/they still experiencing unsanitary conditions?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5E Feeling isolated, down, depressed, anxious, nervous or on edge?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5E = 5


ND5EA Are you/they still experiencing feeling isolated, down, depressed, anxious nervous or on edge?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5F Fear of crime?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5F = 5


ND5FA Are you/they still experiencing fear of crime?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5G Offers that seemed like a scam?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5G = 5


ND5GA Are you/they still experiencing offers that seem like a scam?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


ND5H Disruption to internet?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If ND5H = 5


ND5HA Are you/they still experiencing disruption to internet?
    • Yes  (1) 
    • No  (2) 


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Display this question:
If NDX1 = 1

NDX11intro For how long after the event did you (or they) experience disruption to any of the following:


Display this question:
If NDX1 = 1


NDX11A Work?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If NDX11A = 5


NDX11AA Are you/they still experiencing disruption to work?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


NDX11B School/childcare?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If NDX11B = 5


NDX11BA Are you/they still experiencing disruption to school/childcare?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


NDX11C Medical services?
    • Not affected  (1) 
    • 1-3 days  (2) 
    • 4-6 days  (3) 
    • 1-3 weeks  (4) 
    • A month or more  (5) 


Display this question:
If NDX11C = 5


NDX11CA Are you/they still experiencing disruption to medical services?
    • Yes  (1) 
    • No  (2) 


Page Break


Display this question:
If NDX1 = 1


NDX13 Have you received any form of temporary housing assistance since the natural disaster?
    • Yes  (1) 
    • No  (2) 


Display this question:
If NDX1 = 1


NDX14 What is your most immediate need right now? Select all that apply.
    • Food  (1) 
    • Shelter  (2) 
    • Medical assistance  (3) 
    • Emotional support  (4) 
    • Electricity  (5) 
    • Access to Fresh Water  (6) 
    • ⊗No immediate assistance needed  (7) 


Display this question:
If NDX10 = 2
Or NDX10 = 3
Or NDX10 = 4


NDX16 Did you (or they) have household insurance at the time of the disaster that covered the damage/loss related to the disaster?
    • Yes  (1) 
    • No  (2) 

End of Block: Natural Disaster (Revised)