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1.
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Are you a U.S. citizen or legal immigrant?
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2.
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Are you a resident of Massachusetts?
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Note: To be eligible for most assistance programs in Massachusetts, you need to be a resident of the state.
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3.
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What city or town do you live in?
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4.
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How old are you? Example: 35
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5.
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Counting yourself as one person, how many people are in your household?
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Note: If you or a member of your household is pregnant, count the unborn baby as a member of your household.
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6.
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Do you and other members of your household have Social Security numbers?
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Note: If you are currently applying for a Social Security number, answer "yes".
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7.
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Are you a parent or adult caretaker of any children?
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8.
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How many children are living with you for whom you are a parent or adult caretaker?
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9.
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How many years old is the youngest child who lives with you for whom you are a parent or adult caretaker?
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10.
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Are you a woman who is pregnant?
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11.
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What best describes your current living situation:
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Note: If you live in a licensed commercial lodge, boarding house, or single room dwelling unit, answer, "I rent."
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12.
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Check all that apply to your employment situation:
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13.
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Do you have a disability?
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14.
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Do you care for someone who has a disability?
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15.
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Are you a veteran who served during wartime, or are you the spouse, parent, or child of such a veteran?
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