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1. How much do you contribute per month toward your retirement plan(s) and social security?
2. Please specify your gender.
Male
Female
3. What is the health insurance premium you pay for a single person per month?
Less than $100
$100 - $150
$150 - $200
$200 - $250
$250 - $300
$300 - $350
$350 - $400
$400 - $450
$450 - $500
More than $500
4. In what type of an accommodation do you currently live?
One bedroom accommodation
Two bedroom accommodation
Three bedroom accommodation
Four bedroom accommodation
Five bedroom accommodation
Other
5. What is the average monthly cost you pay for utilities such as gas,electricity,water,cable and internet?
Less than $100
$100 - $150
$150 - $200
$200 - $250
$250 - $300
$300 - $350
$350 - $400
$400 - $500
More than $500
6. What is the average monthly rent you pay for housing/accommodation?
$500 - $1000
$1100 - $1500
$1600 - $2000
$2100 - $2500
$2600 - $3000
$3100 - $3500
Other
7. How much do you spend per month on groceries?
Less than 200
$200 - $250
$250 - $300
$300 - $350
$350 - $400
$400 - $450
$450 - $500
More than $500
8. How much do you spend per month on transportation which includes gasoline, maintenance, repairs and auto insurance?
Less than $200
$200 - $250
$250 - $300
$300 - $350
$350 - $400
$400 - $500
More than $500
9. Please mention the name of your city and state.
10. In what industry do you work?
Manufacturing
Leisure and Hospitality
Education
Healthcare
Financial/Professional
Social Service
Government
Trade
Technology
Agriculture
Real Estate/Construction
Transportation
Other
11. In which age-group do you fall?
16 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 and above.
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