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The 'XYZ of ABC <br />to. h <br />-gath;:a nses <br />C <br />FP6- <br />group <br />b n I <br />k-A I Jurresp'd' <br />Y, <br />ii-M, <br />Otr"and -- '_ " 111' <br />'14. <br />t is survey::a cat <br />u"nWm b _.�Jja <br />%Z4' <br />17. Del you live with in the XYZ lli�mits, of the XYZ of <br />A E3 C ? <br />0 No 0 Yes <br />18. Are you currently employed? <br />0 No + Go to question #19 <br />10 Yes —> Gotoquestioln#18a <br />18a,.What oinie method Iof transportation do you <br />usually use (for the longest distance of your <br />commute), to travel to work?, <br />0 Motorized vehicle (ie,ge car, truck, van, <br />mlotorcy,clie etc...) <br />0 Bius, Rail!, Subway, or other public <br />transportation <br />0 Walk <br />01 Work at home, <br />01 Other <br />18b.,Ilf you checked the motorized vehicle (e g. <br />cary truck, vani motorcycle, etc.) box in 18a, <br />do otlher peoplie (adults or children) usually <br />i <br />ri�de, with you to or from work? <br />0 <br />No 0 Yes <br />19. How imany years have you lived in ABC? <br />0 Less than 2 year's 0 11 -I years <br />0 2-5 years 0 More than 20 years <br />Q 6-1 years <br />20. Which belsit de,scr,ibels the bluiliding you live in? <br />0 One family house, dietacheld from any other <br />h�ouises <br />01 House attached to one or more houses (e.g., a <br />duplex or townhorrie) <br />0 Building with two or more apartm ents or <br />condorniniums <br />01 Moiblile home <br />01 101her <br />21. Is this hou�s,e, apartme�nt, or mobile home... <br />10 Reinteld for cash i or occupied without cash <br />payment'? <br />0 Owned by you or someone in this house with a <br />mortgage or free and clear? <br />2Z Doi any children 12 or under live in your <br />household? <br />01 N o 0 Yes, <br />23. Do any teenagers aged Ibletween 13 and 17 live in <br />your household? <br />0 No 0 Yes <br />24. Are you or any other members of your <br />hiousehold aged 65 or oldlSer? <br />0 No 0 Yes <br />25. Does any member of your household have a <br />0 <br />physical handicap or is anyone disabled? <br />0 N o 0 Yes <br />rj <br />28. Are you Spanish/HisPanic/Latino'P-9 <br />01 No 0 Yes I <br />301. In which category is your age? <br />0 18-24 years 0 55-64 years <br />0 25-34 years 0 65-74 years <br />0 35-44 years 0 75 years or older <br />O 45-54 years <br />ed su ir �A'z't- <br />t <br />�'h <br />re urn-..,,-. vby, n-1 e�' Jt <br />Th" fi P1etih4;jj_, -. _ . 61 ­p6s.cjgq.,pajq._,e,nve op-e� <br />��i d U, d r c d rn V <br />F "ey; <br />1' A - - -'y' .' ' . , ', <br />'y <br />71� I <br />e'sear OU 80 <br />015-31 t <br />c 0, 0, 1d0r'-,C0'-. 301, <br />ty <br />J, <br />The National Citizen SurveyTM Page 5 of 5 <br />