Questionnaire Text

Questionnaire form view entire document:  text  image
15. In the past 12 months, did you or any member of this household receive benefits from the Nutritional Assistance Program?

Do not include WIC, the school lunch program, or assistance from food banks

[] Yes
[] No
Questionnaire instructions view entire document:  text  image
Answer questions 1 through 21 for the house, apartment, or mobile home at the address on the mailing label.

15. If you or any member of this household received benefits from the government to buy food for your family using a benefit card, mark the "yes" box.