PLEASE TAKE THIS 3 MINUTE SURVEY!

LIFELINE DEMOGRAPHICS SURVEY

IMPORTANT: Help the Fight to Keep Lifeline!
We need your info to help fight to keep your Lifeline service active!

Lawmakers in Congress and The Senate have asked NaLA to gather important information about Lifeline recipients so they can help the fight to keep Lifeline active. Sadly, many lawmakers do not know enough about Lifeline recipients and how important this service is to them.

Please take 3 minutes and provide us with answers to the questions below.

YOUR INFORMATION WILL REMAIN 100% CONFIDENTIAL AND ANONYMOUS!

Thank you!

National Lifeline Association and the Lifeline Connects Coalition

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* 1. Do you currently receive Lifeline wireless phone service?

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* 2. What is your gender?

Female

Male

Other (specify)

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* 3. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-54

55-59

60-69

70 or older

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* 4. Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 5. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 6. How much total combined money did all members of your HOUSEHOLD earn last year?

$0 to $9,999

$10,000 to $24,999

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $124,999

$125,000 to $149,999

$150,000 to $174,999

$175,000 to $199,999

$200,000 and up

Prefer not to answer

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* 7. Has anyone in your household, including yourself, ever served in any branch of the United States military, or not?

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* 8. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 9. Do you currently reside on federally recognized Tribal lands?

Your information will remain confidential and will NOT be shared!

This information is only being used for statistical purposes.