A lot
	Sometimes
	Not much
	Never

	Yes
	No

	Full-time
	Part-time
	Freelance
	I'm on disability
	I am unemployed

	Yes
	No

	Yes
	No

	I was forced to take a second job
	I had to cut nonessential spending from my budget
	I can't afford to travel to my doctor's office
	I had to move out of my home
	I was laid off
	My local ASO has shut down
	I'm having difficulty paying for meds
	None of the above

	Very much
	A moderate amount
	Somewhat
	Not at all

	Nothing
	$99 or less
	$100–$199
	$200–$299
	$300–$399
	$400–$499
	$500 or more
	I don't know

	Nothing
	Less than $1,000
	$1,001–$2,500
	$2,501–$4,000
	$4,001–$5,500
	$5,501–$7,000
	More than $7,000
	I don't know

	Yes
	No
	I already have

	Less than $15,000
	$15,000–$34,999
	$35,000–$49,999
	$50,000–$74,999
	$75,000–$99,999
	$100,000 or more

	Male
	Female
	Transgender
	Other

	Straight
	Gay/Lesbian
	Bisexual
	Other

	American Indian or Alaska Native
	Arab or Middle Easternn
	Asian
	Black or African American
	Hispanic or Latino
	Native Hawaiian or other Pacific Islander
	White
	Other: (please specify)