T.I.E. Survey Question Title * 1. What is your name? OK Question Title * 2. What is your email address? OK Question Title * 3. What is your cell phone number? OK Question Title * 4. Do you currently have a job? Yes No OK Question Title * 5. Where are you working? OK Question Title * 6. What is the address where you currently work? OK Question Title * 7. How many hours do you work per week? Less than 20 hours per week 20 to 39 hours per week 40 hours or more per week Not employed, looking for work Disabled, not able to work Retired Other (please specify) OK Question Title * 8. What is your average weekly income? Less than $300 per week $300 to $450 per week $455 to $650 per week $655 to $850 per week $855 to $1050 per week $1055 per week or more Other (please specify) OK Question Title * 9. What type of health insurance do you have? Private Insurance Medicaid No Insurance Other Other (please specify) OK Question Title * 10. If you have Medicaid, which is your Medicaid Provider? Aetna AmeriHealth Caritas Healthy Blue Louisiana Louisiana Healthcare Connections United Healthcare Other (please specify) OK Question Title * 11. How did you get to court? Drove my car Took the bus Rode my bike Caught a ride Other (please specify) OK DONE