Copyright  1999, The Enterprise Foundation, Inc. All rights reserved.

Adaptation of this
material is permitted only for noncommercial purposes.

Sample Survey
Introduction

Hello, my name is (name of interviewer) and I'm calling from (name of surveying
firm) on behalf of (name of CDC). May I speak to the head of the household? (Or,
if not available:) May I speak to another adult?

We are doing a survey of your neighborhood for the (name of CDC). The
information is part of an effort to create a comprehensive plan for (name of
community). Your answers are strictly confidential. The information will not be
reported in any way that allows you, your house or your apartment to be
individually identified.

(Circle One)
Male 1
Female 2

Survey Questions
1. How long have you lived in this neighborhood?
Less than one year (skip to Q.2) 1
1-4 years (skip to Q.2) 2
5-10 years (skip to Q.3) 3
11-20 years (skip to Q.3) 4
21 years or more (skip to Q.3) 5
Not sure/No Response (skip to Q.2) 9
(If In Neighborhood Less Than Five Years)

2. Five years ago, did you live:

Somewhere else in Cleveland 1
Somewhere else in Ohio 2
Outside of Ohio 3
Not sure/No Response 9

3. Compared with five years ago, how would you rate (community) as a place to
live? It is (Read list and circle one)
A better place to live today 1
A worse place to live today 2
About the same 3
Not sure/No Response 9

4. What are the three things you like most about your neighborhood?
1) ..............................................................
2) ..............................................................
3) ..............................................................

Now I would like to ask about retail establishments, such as stores,

supermarkets, etc.

5. Would you say that most of these stores serve:(Read list)

YES NO NA
Neighborhood residents 1 2 9
People in other Cleveland neighborhoods 1 2 9
People from outside Cleveland 1 2 9

6. Compared to five years ago, do these stores serve the neighborhood:

Better 1
Worse 2
The same 3
Not sure/No Response 9

2
Now I would like to ask you a few questions about community involvement.

7. Have you ever wanted to change something or address a problem in

(community name) ?
No (Go to Q.10) 1
Yes 2
Not sure/No Response 9

8. Have you ever contacted anyone about changing something or addressing a

problem?
No (Go to Q. 10) 1
Yes (Go to Q. 9) 2
Not sure/No Response 9

9. Who have you contacted?

City government 1
Neighborhood organization 2
Other (specify:) 3
Not sure/No Response 9

10. Why have you not contacted anyone?

Lack of time 1
Wouldn't make a difference 2
Not interested/not important 3
Tried it, but frustrated with lack of results 4
Didn't know who to contact 5
Language/cultural barriers 6
Not sure/No Response 9

11. Do you feel you know enough about the development plans for your
neighborhood?
Yes 1
No 2
Not sure/No Response 9

3
12. In what ways would you like to get information about development plans in
(community name)? Would you like to get information through: (Read list)
YES NO NA
Newspaper articles 1 2 9
Community meetings 1 2 9
Meetings at city hall 1 2 9
Neighborhood newsletters 1 2 9
Mail/flyers 1 2 9
Word of mouth 1 2 9
Other 1 2 9

13. If the (name of CDC) is organizing a group that will advise on physical
improvements in the neighborhood, would you be interested in working with
this group?
Yes, I would be interested 1
No, not interested 2
Not sure/No Response 9

14. (If Yes) How often do you think you would attend meetings of this group?
Weekly 1
Monthly 2
Four times per year 3
Less than four times per year 4
Not sure/No Response 9

Now, I'd like you to answer the following questions about housing.

15. Do you think there is a need for more housing opportunities for residents in
your neighborhood?
Yes 1
No (Skip to Q.17) 2
Not sure/No Response 9

4
16. In your neighborhood, which is needed more -- rental housing or
homeownership opportunities?
Rental housing 1
Homeownership 2
Both are equally needed 3

17. Do you own or rent your home?

Own (Skip to Q.33) 1
Rent 2
No Response 9

18. Do you expect to own a home one day?

Yes 1
No 2
Not sure/No Response 9

19. Do you think you can afford to buy a house in the neighborhood?
Yes 1
No 2
Not sure/No Response 9

20. If you could afford to buy a house anywhere you like, would you buy....
In (community name) (Skip Q.21) 1
Somewhere else in Cleveland 2
Outside of Cleveland altogether 3
Not sure/No Response 9

5
21. Why would you buy outside of the neighborhood?
(Do NOT Read List)
Affordability 1
Location 2
Availability 3
Other 4
Describe:_______________________________________________
_______________________________________________________
_______________________________________________________

Not sure/No Response 9

22. Are you aware of any programs that help finance homeownership?
Yes 1
No 2
Not sure/No Response 9

23. How much does your household pay for rent each month?
$300 or less 1
$301-600 2
$601-900 3
$901-1,200 4
$1,201-1,500 5
More than $1,500 6
Not sure/No Response 9

24. Does your rent include utilities?

Yes 1
No 2
Not sure/No Response 9

6
25. Is your housing owned by the Housing Authority?
Yes (Skip to Q.34) 1
No 2
Not sure/No Response 9

26. Is your rent subsidized? (For example: Section 8, Section 7087 or rent
vouchers)
Yes 1
No 2
Not sure/No response 9

(HOMEOWNERS ONLY)

27. Are you aware of any programs that finance home improvement?
Yes 1
No 2
Not sure/No response 9

28. What type of building do you live in?

Single-family house 1
Two-family house or duplex 2
Three-family house 3
Building with four or more apartments 4
Not sure/No response 9

29. How many bedrooms do you have?

One 1
Two 2
Three 3
Four 4
Five or more 5
Not sure/No response 9

7
Now, I'd like to ask you some questions about employment.

30. Which of the following best describes your situation?

Working full-time (Skip to Q.32) 1
Working part-time (Skip to Q.32) 2
A homemaker (Skip to Q.43) 3
Unemployed (Ask Q.31) 4
Retired (Skip to Q.43) 5
No Response 9

(If Unemployed)

31. How long have you been out of work?

Less than 6 months 1
6 to 12 months 2
More than 12 months 3
Not sure/No response 9

(For Working People)

32. Do you work in:

Cleveland 1
Elsewhere in the State of Ohio 2
Somewhere else 3
Not sure/No response 9

8
33. How do you usually get to work?
Car, van, truck, motorcycle 1
Bus, train 2
Taxicab 3
Bicycle 4
Walk 5
Work at home 6
Other 7
Not sure/No response 9

34. What kind of business or industry do you work in?

(For example, college, hospital, government, manufacturing plant, research
and development, restaurant, retail store)
___________________________________________________________

35. What kind of work do you do?

(For example, registered nurse, assembler, sales clerk, bookkeeper)
_______________________________________________________
(If s/he works more than one job, indicate the job worked most)
_______________________________________________________

36. In 1996, was your income derived from:

A wage or salary (including own business) 1
Social Security, pensions, annuities, or other Retirement income 2
Public assistance, such as AFDC or welfare 3
Scholarships, stipends or support from family or friends 4
Child support or alimony 5
Other 6
Not sure/No response 9

9
Finally, I'd like to ask you a few questions about you and your household.
37. How long have you lived in Cleveland?

Less than one year 1

1-5 years 2
6-10 years 3
11-20 years 4
21 years or more 5
Not sure/No response 9

38. How would you describe your household? Are you:

A couple with children 1
A couple without children 2
A single parent 3
Roommates 4
A single person living alone 5
Two or more families sharing living quarters 6
Not sure/No response 9

39. Are you:

White 1
Black 2
Asian/Pacific Islander 3
American Indian, Eskimo, or Aleutian 4
Not sure/No response 9

40. Are you of Spanish or Hispanic origin?

Yes, Mexican-American/Chicano 1
Yes, Puerto Rican 2
Yes, Cuban 3
Yes, Central American 4
Yes, other Spanish/Hispanic 5
No (not Spanish/Hispanic) 6

10
41. Do you speak a language other than English at home?
Yes 1
No (Skip to Q.43) 2
No Response 9

42. What languages do you speak at home?

(Do Not Read List)
Cambodian 01

Chinese 02

Creole (Haitian) 03

French 04

Portuguese 06
Spanish 07
Other 08
No Response 09

43. What is the highest grade of school you have ever completed?
Eighth grade or less 1
Some high school 2
High school graduate or GED recipient 3
Some college or technical school 4
College or technical school graduate 5
Post-graduate or professional degree 6
No Response 9

44. Do you have any children enrolled in school?

Yes 1
No (Skip to Q.55) 2

11
No Response 9

12
45. I'd like you to tell me your age within the following ranges.
15-19 years 1
20-34 years 2
35-44 years 3
45-54 years 4
55-64 years 5
65+ years 6
No Response 9

46. How many people in your household are in the following age
groups?
0-4 years _____
5-14 _____
15-19 _____
20-34 _____
35-44 _____
45-54 _____
55-64 _____
65+ years _____
No Response _____

47. How many people live in your household? Include anyone staying or visiting
who has no other home, and family members away at school or in the
military.
Number of persons _____

48. In 1996, what was the total yearly income of your household from all sources?
(Identify income code from Income Chart, below)
Income code _____

13
Those are all of the questions. Thank you very much for your time. If you have
any questions or would like to be more involved in this process, please call
(CDC, Contact Person, Phone Number).

Household Income Chart

Number of People
Income Income
Range Code
in Household
1 $6,000 or less 11
$6,000 - 11,000 12
$11,001 - 11,000 13
$19,001 - 23,000 14
$23,001 - 28,000 15
$28,001 - 35,000 16
$35,001 - 47,000 17
Over $47,000 18

2 $7,000 or less 21
$7,001 - 15,000 22
$15,001 - 24,000 23
$24,001 - 30,000 24
$30,001 - 36,000 25
$36,001 - 45,000 26
$45,001 - 60,000 27
Over $60,000 28

3 $8,000 or less 31
$8,001 - 17,000 32
$17,001 - 27,000 33
$27,001 - 34,000 34
$34,001 - 40,000 35
$40,001 - 50,000 36
$50,001 - 67,000 37
Over $67,000 38

14
Number of People
Income Income
Range Code
in Household
4 $9,000 or less 41
$9,001 - 19,000 42
$19,001 - 30,000 43
$30,001 - 37,000 44
$37,001 - 45,000 45
$45,001 - 56,000 46
$56,001 - 75,000 47
Over $75,000 48

5 $10,000 or less 51
$10,001 - 20,000 52
$20,001 - 32,000 53
$32,001 - 40,000 54
$40,001 - 48,000 55
$48,001 - 60,000 56
$60,001 - 80,000 57
Over $80,000 58

6 $11,000 or less 61
$11,001 - 22,000 62
$22,001 - 34,000 63
$34,001 - 42,000 64
$42,001 - 50,000 65
$50,001 - 63,000 66
$63,001 - 84,000 67
Over $84,000 68

7 $12,000 or less 71
$12,001 - 23,000 72
$23,001 - 36,000 73
$36,001 - 44,000 74
$44,001 - 53,000 75

15
Number of People
Income Income
Range Code
in Household
$53,001 - 67,000 76
$67,001 - 89,000 77
Over $89,000 78

8 $12,000 or less 81
$12,001 - 25,000 82
$25,001 - 37,000 83
$37,001 - 47,000 84
$47,001 - 56,000 85
$56,001 - 70,000 86
$70,001 - 94,000 87
Over $94,000 88
No Response 99

16