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. 2021 Sep;80(9 Suppl 1):12–23.
Service /Benefit Applied for? If YES, was the applicationcompleted? If NO, you could not complete the application, checkall of the reasons why.
Prequalification for financial hardship relief Yes No Yes No __No internet access
__Could not figure out how to complete
__Did not have all of the documents
__Did not understand questions in English
__Tried to call on phone for help but could not get thru
Rental assistance Yes No Yes No __No internet access
__Could not figure out how to complete
__Did not have all of the documents
__Did not understand questions in English
__Tried to call on phone for help but could not get thru
Food stamps Yes No Yes No __No internet access
__Could not figure out how to complete
__Did not have all of the documents
__Did not understand questions in English
__Tried to call on phone for help but could not get thru
Health insurance Yes No Yes No __No internet access
__Could not figure out how to complete
__Did not have all of the documents
__Did not understand questions in English
__Tried to call on phone for help but could not get thru
Healthcare benefits (e.g., Quest or WIC) Yes No Yes No __No internet access
__Could not figure out how to complete
__Did not have all of the documents
__Did not understand questions in English
__Tried to call on phone for help but could not get thru