Living at Home: Elder Economic Survey All information is required. When entering dollar amounts, use whole numbers (no cents). Question Title * 1. What municipality do you live in? Amawalk Ardsley Armonk Baldwin Place Bedford Bedford Hills Briarcliff Manor Bronxville Buchanan Chappaqua Cortlandt Manor Crestwood Crompond Cross River Croton Falls Croton-on-Hudson Crugers Dobbs Ferry Eastchester Elmsford Goldens Bridge Granite Springs Greenburgh Harrison Hartsdale Hastings-on-Hudson Hawthorne Heathcote Irvington Jefferson Valley Katonah Larchmont Lewisboro Lincolndale Mamaroneck Maryknoll Millwood Mohegan Lake Montrose Mount Kisco Mount Vernon New Rochelle North Salem Ossining OTHER Peekskill Pelham Pelham Manor Pleasantville Pocantico Hills Port Chester Pound Ridge Purchase Purdys Rye Rye Brook Scarborough Scarsdale Shenorock Shrub Oak Sleepy Hollow Somers Tarrytown Thornwood Tuckahoe Valhalla Verplanck Vista Waccabuc White Plains Yonkers Yorktown Heights Question Title * 2. Zip Code Question Title * 3. Are you responding as a single person or a couple? Single Couple Question Title * 4. What are your ages? Couple, both 60-64 Couple, both 65+ Couple, one 60-64, one 65+ Single, 60-64 Single, 65+ Question Title * 5. Monthly Income: Enter your total personal income for a calendar month or consecutive 30-day period on the "Monthly Income" line. Monthly Income Question Title * 6. Monthly Expenses: These are the total amount of bills you pay in a calendar month or consecutive 30-day period. Enter the amounts on the appropriate lines from Utilities to Miscellaneous. Utilities Telephone Property Taxes Transportation Car Health Care Insurance Prescription not covered by Insurance Food Miscellaneous Question Title * 7. Add your monthly expenses and enter that figure on the "Subtotal" line. Subtotal Question Title * 8. What is left for housing? Subtract the total of your monthly expenses from your monthly income. Enter that figure below. Question Title * 9. Enter your monthly housing expense. Housing Expense Question Title * 10. Choose the one that applies to you. Owner with mortgage Owner without mortgage Renter Senior Housing Question Title * 11. Add the numbers for "Subtotal" and "Housing Expense." Enter the result on the line for "Total Monthly Expenses (index)." Total Monthly Expenses (index) Question Title * 12. Subtract your total monthly expenses from your Monthly Income. Enter the result below. Question Title * 13. If your expenses are less than your income, fill in the circle for the "above water" box. If your expenses are more than your income, fill in the circle for the "under water" box. Above water Under water Done