Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Alliance for Retired Americans Issue Survey
We want to know what retiree issues you are most concerned about. Please tell us what’s on your mind by filling out the survey below. All answers will be kept confidential.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Which is the biggest area of concern for retirees?
Cutting Social Security, Medicare, and Medicaid
Rising prescription drug prices
Defending the Affordable Care Act
All of the above
Clear selection
Have you or someone you know been negatively impacted by high prescription drug costs?
Yes
No
Clear selection
Please feel free to share your prescription drug story here:
Your answer
What do you think is the most pressing issue facing retirees today?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of AFL-CIO.
Report Abuse
Forms
