• Are you currently pregnant?
• Which of the following best represents how you think of yourself at this time?
• What is the highest level of education you have achieved outside or in the United States? Grades roughly equivalent to years of school.
• Date of Housing, Employment and Insurance Collection
• What best describes your family at home:
• Are you currently living in transitional housing, staying in a shelter, or experiencing homelessness?
• Do you live in any of these?
• Where do you stay/live?
• Have you, or has anyone in your household, experienced a loss of employment income since the start of the COVID-19 pandemic (March 2020)?
• We would like to know about what you do -- are you working now, looking for work, retired, keeping house, a student, or something else?
• Current employment status, Other - specify
• Are you considered an essential worker? An essential worker is someone who was required to go to work even when stay at home orders were in place
• Would any of these describe where you work?
• What is the primary kind of health insurance or health care plan that you have now?
• Did you lose health coverage because of the COVID-19 pandemic?
• Getting the health care I need (including for mental health)
• Having a place to stay/live
• Getting enough food to eat
• Having clean water to drink
• Getting the medicine I need