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Do you own or rent where you live? Own  Rent

Are you currently employed?  Yes  No
If so, are you an hourly or salaried employee?  Hourly  Salaried
If hourly, what is your hourly rate?  $ /hour
If salaried, what is your gross annual salary?  Please Select $0 - $19,999 $20,000 - $39,999 $40,000 - $59,999 $60,000 - $79,999 $80,000 - $99,999 $100,000 or more /year

Are you married or single?  Married  Single

If Married, is your spouse currently employed?  Yes  No
If so, are they an hourly or salaried employee?  Hourly  Salaried
If hourly, what is their hourly rate?  $ /hour
If salaried, what is their gross annual salary?  Please Select $0 - $19,999 $20,000 - $39,999 $40,000 - $59,999 $60,000 - $79,999 $80,000 - $99,999 $100,000 or more /year

What is the size of your household?  Please Select 1 2 3 4 5 or more people

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