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1.What is your gender?
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2.What is your citizenship status in the U.S.?
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3.What is your current marital status?
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4.Are you a parent or primary caregiver?
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5.Do you have debt in any of the following areas?
(check all that apply)
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Housing Debt/Mortgage
Credit Card Debt
6.How would you categorize your health insurance?
Underinsured
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Fully Insured
7. Do you have a U.S. Drivers license or ID?
Yes
No

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