Respondent ID:

: 

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey 

DATE SURVEY: TIME STARTED SURVEY: 

1

Initials

Surveyor ___________

Complete ___________

Incomplete ___________

BLOCK A: PERSONAL INFORMATION

Question Asked

1 Enter Surveyor ID



2 Enter Branch Name

___________________________

3 Enter Member Name

FIRST

MIDDLE INITIAL

LAST

GENERATIONAL SUFFIX

___________________________

___________________________

___________________________

___________________________

4 What is the best phone number to reach you 

at? 

What type of phone is this –

Mobile? House? Work?

|__|__|__|-

|__|__|__|-

|__|__|__|__|

 Mobile  House  Work

5 What is the second best phone number to 

reach you at? 

What type of phone is this –

Mobile? House? Work?

|__|__|__|-

|__|__|__|-

|__|__|__|__|

 Mobile  House  Work

6 What is your current mailing address?

Street

Street 2

City 

State 

Zip Code

___________________________

___________________________

___________________________

___________________________

___________________________
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

2

7 Do you live at this address?

01 Yes

02 No

[If 01, skip to 9]

01 [ ] Yes

02 [ ] No

8 What is the address where you currently 

live?

Street

Street 2

City 

State 

Zip Code

___________________________

___________________________

___________________________

___________________________

___________________________

9 Have you moved addresses in the past 5 

years?

01 Yes

02 No

[If 01, skip to 11]

01 [ ] Yes

02 [ ] No

10 What is your most recent previous address?

Street

Street 2

City 

State 

Zip Code

___________________________

___________________________

___________________________

___________________________

___________________________

11 What is your SLCCU Member ID? ___________________________

>>SEPARATE THESE FIRST 2 PAGES FROM THE REMAINDER OF THE QUESTIONNAIRE>>
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

3

BLOCK B: DEMOGRAPHIC INFORMATION

12 What is your gender?

01 Female

02 Male

01 [ ] Female

02 [ ] Male

13 What is your ethnicity or origin?

01 Hispanic or Latino

02 Not Hispanic or Latino

01 [ ] Hispanic or Latino

02 [ ] Not Hispanic or 

Latino 

14 What is your race?

01 American Indian or Alaska Native

02 Asian

03 Black or African-American

04 Native Hawaiian or Other Pacific Islander

05 White

06 Other

01 [ ] American Indian 

or Alaska Native

02 [ ] Asian 

03 [ ] Black or African 

American

04 [ ] Native Hawaiian 

or Other Pacific Islander

05 [ ] White

06 [ ] Other

15 Are you married? 01 [ ] Yes

02 [ ] No

888 [ ] Don’t Know

999 [ ] Refused

16 Do you share an active credit card with your 

spouse or other family member?

01 [ ] Yes

02 [ ] No

888 [ ] Don’t Know

999 [ ] Refused

Note: This 

doesn’t count 

temporary visits. 

Adults are 

defined as 

people over 18 

years old.

17 How many adults live in your household, 

including you? Please only include in this number 

individuals with whom you share finances since 

later survey questions will ask about the finances 

of the household. 



888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

4

Note: This 

doesn’t count 

temporary visits. 

Children are 

defined as 

people under 18 

years old.

18 How many children live in your household? 



888 [ ] Don’t Know

999 [ ] Refused

19 What was your annual household income in 

2013?

01 Was it less than $10,000?

02 Between $10,000 and 20,000?

03 Between $20,000 and 30,000?

04 Between $30,000 and 40,000?

05 Between $40,000 and 50,000?

06 More than $50,000?

01 [ ] Less than $10,000

02 [ ] Between $10 and 

20,000

03 [ ] Between $20 and 

30,000

04 [ ] Between $30 and 

40,000

05 [ ] Between $40 and 

50,000

06 [ ] More than 

$50,000

888 [ ] Don’t Know

999 [ ] Refused

Note to 

interviewer: Be 

sure to read all 

responses/ 

distinguish 

between 

graduating and 

partial 

completion.

20 What is the highest level of schooling you’ve 

attained?

01 Less than 9th grade

02 Some High school

03 High school Graduate

04 GED

05 Trade School

06 Some College

07 Associates Degree

08 Bachelor’s Degree

09 Master’s Degree

10 Professional Degree

11 Doctorate Degree

01 [ ] Less than 9th gr. 

02 [ ] Some HS 

03 [ ] HS grad. 

04 [ ] GED

05 [ ] Trade School

06 [ ] Some College

07 [ ] Associates Degree

08 [ ] Bachelor’s Degree

09 [ ] Master’s Degree

10 [ ] Professional Deg. 

11 [ ] Doctorate Degree

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

5

BLOCK C: FINANCIAL INFORMATION

21 In the past 12 months, have you checked your 

credit score? 

01 Yes

02 No

01 [ ] Yes

02 [ ] No

888 [ ] Don’t Know

999 [ ] Refused

Note to 

interviewer: This 

is not their credit 

score but their 

credit report/ 

record.

22 In the past 12 months, have you obtained a copy 

of your credit report? 

01 Yes

02 No

01 [ ] Yes

02 [ ] No

888 [ ] Don’t Know

999 [ ] Refused

23 Have you had difficulty getting approved for 

loans in the past three years?

01 Yes

02 No

03 I have not tried to get approved for a loan.

01 [ ] Yes

02 [ ] No

03 [ ] I have not tried 

to get approved 

for a loan.

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

6

Note to 

interviewer: 

Include amount 

saved below 

each that apply.

This should be a 

“snapshot” of 

what the 

respondent 

currently has 

saved up in each 

of the options 

applicable.

24 Are you saving in any of the following ways? 

01 Saving cash at home or in wallet

02 Making deposits into a savings account

03 Buying financial investment products, other 

than pension funds

04 Other way (including remittances, buying 

property)

05 401k/Retirement Plan

06 I have not been actively saving (I don’t save/I 

have no money to save)

01 [ ] Saving cash at 

home/in wallet 

$_____________

02 [ ] Paying into 

savings account

$_____________

03 [ ] Buying fin 

investment products

 $_____________

04 [ ] Other way 

 $_____________

05 [ ] 401k/Retirement 

Plan

06 [ ] I have not been 

actively saving

888 [ ] Don’t Know

999 [ ] Refused

Note to 

interviewer: This 

includes debts in 

deferment, grace 

period, or not 

yet in 

repayment.

Clarify that this 

does not include 

regular bills.

25 Excluding any mortgages or auto loans, what is 

the size of your household’s overall debt (eg 

credit card debt, student debt, payday loans 

(small, short-term unsecured loans))?

01 Below $5,000 

02 Between $5000 and $10,000

03 Between $10,000 and $20,000

04 Above $20,000

01 [ ] Below $5,000

02 [ ] Between $5,000 

and $10,000

03 [ ] Between 

$10,000 and $20,000

04 [ ] Above $20,000

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

7

26 What is the size of your household’s monthly 

payments toward this debt?

01 Below $100

02 Between $100 and $200

03 Between $200 and $300

04 Above $300

01 [ ] Below $100

02 [ ] Between $100 

and $200

03 [ ] Between $200 

and $300

04 [ ] Above $300

888 [ ] Don’t Know

999 [ ] Refused

Note to 

interviewer: 

Cosign means to 

jointly sign onto 

a loan with 

shared liability; if 

the primary 

borrower 

defaults on the 

loan, the 

cosigner has a 

legal obligation 

to make 

payment on their 

behalf.

27 Have you ever cosigned on a loan for 

another person?

01 [ ] Yes

02 [ ] No

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

8

28 How often do you buy lottery tickets?

Would you say

01 “Multiple tickets per week”

02 “About one ticket per week”

03 “About once a month”

04 “A few times a year”

05 “Less than 1 ticket per year average my 

adult life”

06 “Never purchased a lottery ticket”

03 [ ] Multiple per 

week

04 [ ] About one per 

week

05 [ ] About once a 

month

06 [ ] A few times a 

year

07 [ ] Less than once 

per year

08 [ ] Never

888 [ ] Don’t Know

999 [ ] Refused

29 How often do you go to the casino?

Would you say

01 “At least once a week”

02 “At least once a month”

03 “At least once a year”

04 “I’ve never been to the casino”

01 [ ] At least once a 

week

02 [ ] At least once a 

month

03 [ ] At least once a 

year

04 [ ] I’ve never been 

to the casino

888 [ ] Don’t Know

999 [ ] Refused

30 Do you bring a debit card to the casino?

01 No, I bring a fixed amount of cash.

02 Yes, I bring a debit card and take out 

more cash if I need it.

01 [ ] No 

02 [ ] Yes

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

9

31 If you want to buy something that you desire 

but is not a necessity and you don’t currently 

have enough cash, which of the following do 

you do:

01 “Save up for it”

02 “Take out a loan”

03 “Put it on layaway”

04 “Borrow money from a friend or relative”

05 “Sell some possessions”

06 “Credit card”

07 “Rent-to-Own”

08 “Do not buy the item”

08 “Other” 

01 [ ] Save up for it

02 [ ] Take out a loan

03 [ ] Put it on layaway

04 [ ] Borrow money 

from a friend or relative

05 [ ] Sell some 

possessions

06 [ ] Credit card

07 [ ] Rent-to-own

08 [ ] Other

888 [ ] Don’t Know

999 [ ] Refused

32 How would you describe your overall 

financial situation? Would you say 

“excellent”, “very good”, “ok”, “not very 

good”, or “bad”?

01 [ ] Excellent

02 [ ] Very good

03 [ ] OK

04 [ ] Not very good

05 [ ] Bad 

 Read Aloud: I am going to read out some attitude and behavior statements. I would like to 

know how much you agree or disagree that each of the statements applies to you, personally. 

Please again use a scale of 1 to 5, where 1 tells me that you completely agree that the 

statement describes you and 5 shows that you completely disagree: 

33 My financial situation is a source of stress in 

my life.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

10

34 Before I buy something I carefully consider 

whether I can afford it 

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

889 [ ] Don’t Know

1000 [ ] Refused

35 I tend to live for today and let tomorrow take 

care of itself 

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

11

36 In a typical month, it is difficult for me to

cover my expenses and pay all my bills.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused

37 I am confident that I could come up with 

$2000 if an unexpected need arose within the 

next month.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

12

Note to 

interviewer: 

Clarify that the 

chance is not a 

guarantee.

38 I am willing to take a risk financially if there is 

a chance of substantial gain.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused

39 I set long term financial goals of five years or 

more and strive to achieve them.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

13

40 The purpose of money is for it to be spent

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused

41 I often find that I regret spending money. I 

wish that when I had cash, I was better 

disciplined and saved my money rather than 

spent it.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

14

42 I demand the highest quality in everything I do.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused

43 I have trouble finishing or completing my tasks.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

15

44 Success is a matter of hard work; luck has little 

or nothing to do with it.

01 Completely agree

02 2

03 3

04 4

05 Completely disagree

06 Not applicable

01 [ ] Completely 

agree

02 [ ] 2

03 [ ] 3

04 [ ] 4

05 [ ] Completely 

disagree

06 [ ] Not applicable

888 [ ] Don’t Know

999 [ ] Refused

45 Suppose the credit union held a raffle and you 

won. You have a choice: you can collect $50 in 

cash today or $100 in cash one month from 

today. Which would you choose?

01 $50 today

02 $100 in one month

[If 02, skip to 47]

01 [ ] $50 today 

02 [ ] $100 in one 

month

888 [ ] Don’t Know

999 [ ] Refused

46 Ok, you prefer to receive $50 today in that first 

scenario. Now say you had the choice between 

collecting the $50 cash today and collecting 

$150 in 1 month?

01 $50 today

02 $150 in one month

[Skip to 48]

01 [ ] $50 today

02 [ ] $150 in one 

month 

888 [ ] Don’t Know

999 [ ] Refused

47 Ok, you’re willing to wait 1 month for $100 

instead of $50 today. Now let’s say the choice 

is between collecting a $50 cash prize today or

$75 in 1 month. Which would you choose?

01 $50 today

02 $75 in one month

01 [ ] $50 today

02 [ ] $75 in one 

month

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

16

48 Suppose you were choosing between 

collecting $50 in cash 6 months from today or 

$100 in cash 7 months from today. Which 

would you choose?

01 $50 in 6 months

02 $100 in 7 months

[If 02, skip to 50]

01 [ ] $50 in 6 months 

02 [ ] $100 in 7 

months 

888 [ ] Don’t Know

999 [ ] Refused

49 Ok, you prefer to receive $50 in 6 months. 

Now say you had the choice between 

collecting the $50 in 6 months and collecting 

$150 in 7 months?

01 $50 in 6 months

02 $150 in 7 months

[Skip to 51]

01 [ ] $50 in 6 months

02 [ ] $150 in 7 

months

888 [ ] Don’t Know

999 [ ] Refused

50 Ok, you’re willing to wait 7 months for $100 

instead of getting $50 in 6 months. Now let’s 

say the choice is between collecting a $50 cash 

prize in 6 months or $75 in 7 months. Which 

would you choose?

01 $50 in 6 months

02 $75 in 7 months

01 [ ] $50 in 6 months

02 [ ] $75 in 7 months

888 [ ] Don’t Know

999 [ ] Refused

Note to 

interviewer: Put 

decimal place in 

appropriate box.

51 Suppose you put $100 into a <no fee> 

savings account with a guaranteed 

interest rate of 2% per year. You don’t 

make any further payments into this 

account and you don’t withdraw any 

money. How much would be in the 

account at the end of the first year, once

the interest payment is made? 

01 $

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

17

52 How much would be in the account at the end 

of five years? Would it be: 

01 More than $110

02 Exactly $110

03 Less than $110

04 It is impossible to tell from the information 

given

01 [ ] More than $110

02 [ ] Exactly $110

03 [ ] Less than $110

04 [ ] It is impossible 

to tell from the 

information given

888 [ ] Don’t Know

999 [ ] Refused

 Read Aloud: Now I’m going to read out a list of things and you will tell me whether each of 

these can affect the amount of interest that you would pay on a bank loan.

53 Your credit rating?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused

54 The amount of money you have in savings?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

18

55 Your annual income?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused

56 Your health?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

19

57 Your age?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused

58 How much you borrow overall?

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused
 Respondent ID: 

«Unique Identifier»

St. Louis Community Credit Union Credit Builder Loan – Baseline Survey

20

59 How long you take to repay the loan? 

01 Yes – this affects the amount of interest you 

would pay on a bank loan.

02 No – this does NOT affect the amount of interest 

you would pay on a bank loan.

01 [ ] Yes – this 

affects the amount of 

interest you would 

pay on a bank loan.

02 [ ] No – this 

does NOT affect the 

amount of interest 

you would pay on a 

bank loan.

888 [ ] Don’t Know

999 [ ] Refused

TIME COMPLETED SURVEY: