2019 Tx CDBG Survey Questionnaire
For the purposes of this questionnaire, the term "unit" means
your home
.
Street Address
Your Zip Code
Your Phone Number
Including yourself, how many people usually live in the unit?
# Of People In Unit?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Including yourself, how many people in your family usually live in the unit?
# Of Family In Unit?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Do any other families live in the unit?
Yes
No
Family Size?
Family Size?
1
2
3
4
5
6
7
8
9
10
11
12
Number Of Males?
Number of Males In Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number Of Females?
Number of Females In Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Income
Income
Less Than $36,550
More Than $36,550 But Less Than $41,750
More Than $41,750 But Less Than $46,950
More Than $46,950 But Less Than $52,150
More Than $52,150 But Less Than $56,350
More Than $56,350 But Less Than $60,500
More Than $60,500 But Less Than $64,700
More Than $64,700 But Less Than $68,850
More Than $68,850 But Less Than $73,010
More Than $73,010 But Less Than $77,182
More Than $77,182 But Less Than $81,354
More Than $81,354 But Less Than $85,526
More Than $85,526
Please Check All That Apply To Your Family
White Non-Hispanic
White Hispanic
Black African American Non-Hispanic
Black African American Hispanic
Black African American and White Non-Hispanic
Black African American and White Hispanic
Asian Non-Hispanic
Asian Hispanic
Asian And White Non-Hispanic
Asian And White Hispanic
Native Hawaiian/Other Pacific Islander Non-Hispanic
Native Hawaiian/Other Pacific Islander Hispanic
American Indian/Alaskan Native Non-Hispanic
American Indian/Alaskan Native Hispanic
American Indian/Alaskan Native and Black African American Non-Hispanic
American Indian/Alaskan Native and Black African American Hispanic
American Indian/Alaskan Native and White Non-Hispanic
American Indian/Alaskan Native and White Hispanic
Other Multi-Racial Non-Hispanic
Other Multi-Racial Hispanic
Number of White Non-Hispanics in Family
Number of White Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of White Hispanics in Family
Number of White Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Black African American Hispanics in Family
Number of Black African American Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Black African American Non-Hispanics in Family
Number of Black African American Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Black African American and White Hispanics in Family
Number of Black African American and White Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Black African American and White Non-Hispanics in Family
Number of Black African American and White Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Asian Hispanics in Family
Number of Asian Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Asian Non-Hispanics in Family
Number of Asian Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Asian and White Hispanics in Family
Number of Asian and White Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Asian and White Non-Hispanics in Family
Number of Asian and White Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Native Hawaiian/Other Pacific Islander Hispanics in Family
Number of Native Hawaiian/Other Pacific Islander Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Native Hawaiian/Other Pacific Islander Non-Hispanics in Family
Number of Native Hawaiian/Other Pacific Islander Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native Hispanics in Family
Number of American Indian/Alaskan Native Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native Non-Hispanics in Family
Number of American Indian/Alaskan Native Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native and Black African American Hispanics in Family
Number of American Indian/Alaskan Native and Black African American Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native and Black African American Non-Hispanics in Family
Number of American Indian/Alaskan Native and Black African American Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native and White Hispanics in Family
Number of American Indian/Alaskan Native and White Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of American Indian/Alaskan Native and White Non-Hispanics in Family
Number of American Indian/Alaskan Native and White Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Other Multi-Racial Hispanics in Family
Number of Other Multi-Racial Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Number of Other Multi-Racial Non-Hispanics in Family
Number of Other Multi-Racial Non-Hispanics in Family
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Submit