### 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 9 th 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 [ ] Professi onal 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

0 2 Making deposits into a savings account

0 3 Buying financ ial investment products, other

than pension funds

04 Other way (including remittances, buying

property)

05 401k/Retirement Plan

0 6 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

interviewe r: This

includes debts in

defer ment, grace

period, or not

yet in

repayment.

Clarify that this

does not include

regular bills. 25 Excluding any mortgages or auto loans, w hat 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 ”

0 4 “A few times a year”

0 5 “Less than 1 ticket per year average my

adult life”

0 6 “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”

0 8 “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 th e

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

[ S kip 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

[ S kip 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 l oan.

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: