Final Survey Draft : Jan 30, 2015

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About the house and household (to be filled out only once per user)

Please enter the following information about your housing unit:

Make

Model:

Which of the following describes this housing unit?

Travel Trailer/Camper

Mobile Home

Park Model

Modular Home

Other:

Clear selection

Year of Manufacture (only accepts between 1950 and current year)

Which country is your housing unit located in?

USA

Canada

Other:

Clear selection

Zip Code (maybe this should be turned to state if we ask zip in login-NS)

Please describe your use of this unit

Recreation

Primary residence

Other:

Who owns this unit?

I do

Another member of the household does

The owner does not live in the home

Other:

Clear selection

(If option 3 above) Does any resident of the home pay rent to live here?

Check any that apply. Leave blank if no resident pays rent

I do

Another occupant does

Other:

(If options 1 or 2 in Who owns this unit: From whom did you buy or inherit this unit?) (If option 3, and rent indicated in next question: From whom do you rent this home?)

Business name (if individual, please indicate individual's name)

City, State of purchase (please seperate by comma)

Move-in (or purchase date if unoccupied)

YYYY

Do you know or suspect that this unit is a FEMA trailer or FEMA mobile home?

Yes

Other:

Clear selection

How many people currently live in the unit?

(4 or more nights per week)

Clear form

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