1. Are you concerned your debts are getting out of control?
   • Yes
   • No
2. Do you have a bank account?
   • Yes
   • No
3. What percentage of your monthly take-home income goes toward payments to creditors (excluding mortgages)? (calculator)
   • 0 – 20%
   • 21% – 42%
   • 43% – 49%
   • 50% or above
4. How much do you have in all savings accountsSavings would include contributions you make to retirement accounts (IRA, 401k, etc.).?
   • Savings? What savings?
   • Less than 3 months worth of take-home income
   • More than 3 months but less than 6 months worth of take-home income
   • More than 6 months worth of take-home income
5. On average, what portion of your paycheck is put into savings each month?
   • 0 – 5%
   • 6 – 10%
   • 11 – 20%
   • over 20%
6. On average, how often do you withdraw funds from savings?
   • Savings? What savings?
   • Monthly
   • Quarterly
   • Less than once a year
   • Depends on which savings account
   • Only when absolutely necessary
7. On how many credit cards do you carry balances month to month?
   • I don't have any credit cards
   • I have credit cards, but don't carry a balance
   • 1 – 3
   • 4 – 8
   • 9 or more
8. Within the last year, how many new credit accounts did you open?
   • None
   • 1 – 2
   • 3 – 4
   • 5 or more
9. Of the credit cards you carry balances on, are any over 30 days past due?
   • I don't carry a balance on any cards
   • Yes
   • No
10. Of the credit cards you carry balances on, are any over 60 days past due?
    • I don't carry a balance on any cards
    • Yes
    • No
11. What is the average interest rate on your credit cards? (calculator)
    • I don't have any credit cards
    • I don't know
    • I pay off my credit cards monthly
    • Less than 10%
    • 10% – 15%
    • 15% or above
12. On average, what percentage of the credit limit do you still have available on your credit cards? (calculator)
    • I don't have any credit cards
    • 0% (none left)
    • 1% – 20%
    • 21% – 50%
    • 51% – 70%
    • Over 70%
    • I don't know
13. In the past year, my savings has:
    • Increased
    • Stayed constant
    • Decreased
    • Depends on which savings account
    • Savings? What savings?
14. In the past year, my unsecured debtDebts that are not tied to any item of property: for instance, credit cards, signature loans, medical accounts, etc. has:
    • Increased
    • Stayed constant
    • Decreased
    • I don't know
    • I don't have any
15. My credit score is:
    • Over 700
    • 600 – 700
    • 300 – 600
    • I don't know
16. Are you behind on your mortgage or rent?
    • No
    • Not currently paying rent or mortgage (e.g., own home, paid for by others, etc.)
    • Yes, under 3 months
    • Yes, 3 – 6 months
    • Yes, over 6 months
17. On average, what portion of your total debt do you pay off each month?
    • I pay less than the minimum required payments
    • I pay the minimum required payments
    • I pay more than the minimum required payments
    • I pay balances in full
    • I don't have any debt
18. Within the last year, have you used credit to pay off other debts (including medical debt)?
    • No
    • Yes, but I pay in full
    • Yes, but rarely
    • Yes, often
19. Within the last year, have you used credit to pay living expensesNecessities such as utilities, food, clothing, entertainment, car maintenance, housekeeping supplies, and personal care items.?
    • No
    • Yes, but I pay in full
    • Yes, but rarely
    • Yes, often
20. How confident are you in your money management skills?
    • Very!
    • I think I've got the basics down
    • ...I have no idea what I'm doing