<p>TAXPAYER SURVEY</p><p>2017 surve Question text for intake sheet Notes and entries for TaxSlayer y # 1 For volunteer use only. [IRS required cannot edit] This is the ethnicity question which has different answers than we do. </p><p>2 Are you or your spouse a veteran from the US Armed Forces? [IRS required cannot edit] Are you or your  Yes spouse a veteran from the US Armed Force?  No  Yes  No</p><p>3 Are you or a member of your household considered a person [IRS required cannot edit] Are you or a with a disability? member of your household considered a  Yes person with a disability?  No  Yes  No</p><p>4 Would you like to join our email list? You’ll get info about our If taxpayer provided an email, I entered it in services, changes that affect your tax refund, opportunities to the Tax Prep and E-file Info section above. boost your money, and ways to get involved with us. We won’t  No email provided share your info and won’t contact you more than twice a  Yes month.</p><p>Email address (print clearly) ______</p><p>5 What do you consider yourself? What do you consider yourself?  African  African  African American  African American  American Indian or Alaskan Native  American Indian or Alaskan Native  Asian or Pacific Islander  Asian or Pacific Islander  Hispanic or Latino  Hispanic or Latino  Multi-Racial  Multi-Racial  White, Non-Hispanic  White, Non-Hispanic  Other  Other  No response</p><p>6 What language do you primarily speak at home? What language do you primarily speak at  English home?  Spanish  English  Somali  Spanish  Oromo  Somali  Amharic  Oromo  Other African language  Amharic  Hmong  Other African language  Vietnamese  Hmong  Other Asian language  Vietnamese  Russian  Other Asian language  Other  Russian  Other  No response</p><p>D:\Docs\2017-12-15\0a7777f6163c894a6637e131dd187be0.doc 7 Did you put some of your refund into savings Did you put some of your refund into savings last year? last year?  Yes, in a savings account  Yes, in a savings account  Yes, a U.S. savings bond  Yes, a U.S. savings bond  Yes, in a retirement account  Yes, in a retirement account  Yes, more than one of the above  Yes, more than one of the above  No  No  No response 8 Do you have any money in savings? Do you have any money in savings?  Yes, less than $500  Yes, less than $500  Yes, between $500-1,000  Yes, between $500-1,000  Yes, more than $1,000  Yes, more than $1,000  I do not have savings  I do not have savings  I don’t know  I don’t know  No response</p><p>9 If you get a refund, will you save some today? If you get a refund, will you save some today?  Yes  Yes  No  No  I don’t expect to get a refund  I don’t expect to get a refund  No response 10 Are you saving into a retirement account? (e.g. Roth IRA, Simple IRA, 401(k), 403(b), Are you saving into a retirement account? (e.g. Roth IRA, Simple etc.)? IRA, 401(k), 403(b), etc.)?  Yes, through my employer  Yes, through my employer  Yes, on my own  Yes, on my own  Both on my own and through my Both on my own and through my employer  employer  No, I don’t have a retirement account  No, I don’t have access to a  No, I have a retirement account but don’t put money retirement account into it  No, I have a retirement account but don’t put money into it  No response</p><p>11 How did you hear about Prepare + Prosper? How did you hear about Prepare + Prosper?  Newspaper  Newspaper  Social media  Social media  Searching online  Searching online  Friend, colleague, or family member  Friend, colleague, or family member  Another organization  Another organization  Community presentation or event  Community presentation or event  Other  Other  No response</p><p>D:\Docs\2017-12-15\0a7777f6163c894a6637e131dd187be0.doc</p>