Rockford Income Questionnaire
Please tell us about your household.
Physical Street Address
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Street Address
Street Address Line 2
City
Postal / Zip Code
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Q1. Is this your current residence?
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Yes
No
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Q2. How many people live in your household at this address at this time?
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Include all adults and children, including yourself whose actual or intended length of stay is more than 2 months. Do not include people living in separate rental units
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Q3. How many of the people in your household are members of your family?
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The definition of family is people related by blood, marriage, or adoption.
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Q4. What is the combined total annual income (before taxes) of all family members living here? Do not include income from individuals who live here but are NOT family members. If you prefer not to answer, please type SKIP and move on to the next question.
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Family income before taxes is money received by family members from all earnings (wages, salary, tips, bonuses, commissions), interest, dividends, child support, alimony, welfare, social security, disability, unemployment, retirement payments, net income from businesses activities, farms, rents, royalties, trusts, estates, and any other income received regularly by family members.
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Q5. If you chose to skip the last question, please use the table below to indicate whether your family's total annual income before taxes in 2025 was ABOVE or AT/BELOW the amount in the "income level" column. Please use the family size you reported in Question 3. Type in one answer from column C or D. If you answered Q4, please type ANSWERED.
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If you have more than 8 family members, please provide your total family income in Q4.
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Q6. Which category best describes you? (You may select more than one group)
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White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Other Multi-Racial
Prefer not to answer
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Q7. Are you Hispanic/Latino
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Yes
No
Prefer not to answer
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Q8. Does your family rent or own this property?
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Rent
Own
Prefer not to answer
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Is any member of your family age 62 or over?
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Yes
No
Prefer not to answer
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