Subject ID Number
Are you now married, widowed, divorced, separated, never married, or living with a partner?
At this time what is the highest level of education you have completed?
How many children under 18 are you the main caregiver for?
Are you employed?
1. Do you currently have at least one financial goal?
Do you currently have a personal budget, spending plan, or financial plan?
Do you currently have an automatic deposit or electronic transfer set up to put money away for a future use (such as savings)?
Over the past month, would you say your family’s spending on living expenses was less than its total income?
Over the last 2 months, have you paid a late fee on a loan or bill?
Do you have a checking account?
Do you have a savings account?
Do you owe anyone money (please include banks, friends, family, payday lenders, etc)?
In the last 3 months, has PGW, PECO, or other company [shut off/oil company refused to deliver] the [gas/ electricity/ oil] for not paying bills?
In the last 3 months, were there any days that the home was not heated or cooled because you couldnt pay the bills?
Age at Baseline(years)
Race/Ethnicity
Food Security Raw Score
Food Security Rating
Food Security Category
depression
Housing Security Rating
Energy Security Category
Parent/Cargiver's Self-Rated Health
save/have assets
borrow/owe money
spend/can't pay bills
plan