AARP SNAP - NFCC - National Foundation for Credit Counseling

Thank you for participating!

AARP SNAP draft

Please complete the following survey

Please complete this survey if food insecurity is suspected or if reducing the client's food budget was recommended. Counselors should ask the client to respond to this survey during their session. Counselors should ask the questions and enter responses. Only complete surveys will be accepted and reimbursed.

NFCC Unit ID (5-digit number)(Required)

Counselor's name(Required)

Session Date(Required)

What date did the session occur?

State of Residence(Required)

Client must reside in Florida or Texas

Is the client considerered less than 50% AMI?(Required)

client must be less than 50% AMI

Client's age(Required)

Please enter a number from 50 to 125.

Client's gender(Required)

Client's race(Required)

Client's ethnicity(Required)

Client's primary language spoken at home(Required)

Client's education level(Required)

Client's household size(Required)

Select the number of individuals living in client's residence including client.

Client's total household monthly net income (take home pay)(Required)

Client's employment status(Required)

Sources of income(Required)

Sources of Debt and Amount Owed

Enter the amount of debt owed in all applicable field(s). Enter 0.00 if there is no debt of that type.

Credit card debt (balance carried over month to month)(Required)

Auto loan(Required)

Mortgage(Required)

Medical debt(Required)

Student loan(Required)

Personal loan(Required)

Payday, pawn, or title loan(Required)

Check the following box if none of these types of debt are held

I have none of these types of debt.

Recurring medical expenses(Required)

Seeking help and financial impact

Answer the following questions regarding seeking credit counseling and impacts to monthly finances.

What recent changes, if any, led you to reach out for credit couseling?(Required)

I was worried our food would run out before we received money to buy more within the past 12 months..(Required)

The food we bought didn’t last and we didn’t have money to get more within the past 12 months(Required)

Which of the following benefits do you currently use? (Select all that apply)(Required)

Food assistance (i.e. SNAP)

Medicare

Medicare Savings Programs

Extra help or low-income subsidy for prescription drugs

Free tax assistance (i.e. Tax Aide)

Paid Family Leave

Prefer not to answer

What other types of assistance do you receive? (i.e. meals on wheels, food pantry, etc.)(Required)

If your monthly debt payment was decreased by $50 each month, what would you do with that money?(Required)

Who We Are

Founded in 1951, the National Foundation for Credit Counseling is the oldest nonprofit financial counseling organization with a mission to help all Americans gain control over their finances. We support a network of committed member agencies to deliver high quality, practical financial education and counseling services.rnrn1,500+ NFCC certified credit counselors serve all U.S. states and territories, empowering millions of consumers to take charge of their finances. NFCC certified credit counselors offer one-on-one financial reviews that address credit card debt, mortgages and rentals, housing decisions, and money management.