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WAVE 62<br />

This booklet highlights the significant changes made during <strong>MRI</strong>’s most<br />

recent review cycle. Items that are boxed in red or highlighted in yellow<br />

were added or changed in Wave 62.<br />

Please contact your <strong>MRI</strong> Representative if you have any questions.

OTHER MAGAZINES<br />

21. Have you read or looked into any other magazines in the last 6 months?<br />

Yes 11-1<br />

No 2<br />

Don’t know 3<br />

2 8<br />

7 8<br />

22. Digital newspapers or magazines are exact replicas of print copies<br />

downloaded and viewed on a computer, cell phone or mobile device. Digital<br />

editions contain everything you’d find in a print copy including page<br />

numbers, photos and advertisements. Have you read or looked into a digital<br />

edition of a newspaper or magazine in the last 6 months?<br />

ELECTRONIC BOOK READER<br />

Yes 12-1<br />

No 2<br />

Don’t know 3<br />

SC14<br />

23A. An electronic book reader is a portable, wireless reading device that <strong>all</strong>ows you to download<br />

and read electronic books, magazines and newspapers. It is not a laptop, cell phone or PDA.<br />

Do you person<strong>all</strong>y own an electronic book reader such as the Amazon Kindle<br />

or Sony Reader?<br />

(IF “YES” IN Q. 23A, ASK:)<br />

23B. Which of the following, if any, have you read or looked into using an<br />

electronic book reader in the past 6 months? (READ LIST)<br />

(CIRCLE AS MANY AS APPLY)<br />

RADIO<br />

(SHOW CARD 14)<br />

24. These are time periods during which people can listen to or hear a radio. You may be listening to radio on AM, FM, Sirius,<br />

XM, or the Internet.<br />

(IF TODAY IS SUNDAY OR MONDAY, ASK FOR FRIDAY) (ATTEMPT TO ASK TIME PERIODS, EVEN IF NO LISTENING IS<br />

VOLUNTEERED)<br />

Thinking about YESTERDAY, to the nearest half hour, how much time, if any, did you spend listening to or hearing a radio<br />

during the time period of (TIME PERIOD)—either in your home, car or any other place? (READ EACH TIME PERIOD AND<br />

CIRCLE CORRESPONDING CODES FOR EACH)<br />

(ASK FOR EACH TIME PERIOD LISTENED TO OR HEARD IN Q. 24)<br />

25A. During the time period of (TIME PERIOD), what station or stations did you listen to? Please give me the C<strong>all</strong> Letters of each<br />

station and whether it was AM, FM, Sirius, XM, or the Internet. (RECORD UP TO 3 STATIONS FOR EACH TIME PERIOD)<br />

(IF D.K. CALL LETTERS, RECORD STATION NUMBER, SLOGAN, OR PERSONALITY AND AM, FM, SIRIUS, XM, INTERNET<br />

OR OTHER)<br />

SKIP<br />

TO<br />

Q. 24<br />

DO NOT READ<br />

Yes 13-1<br />

No 2<br />

Don’t know 3<br />

Book 14-1<br />

Magazine 2<br />

Newspaper 3<br />

Something else 4<br />

None 5<br />

END<br />

C 28<br />

D<br />

Q. 24 Q. 25A<br />

HOURS<br />

RADIO STATIONS<br />

TIME PERIODS 0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4 4¹⁄ ² 5+ STATION #1 STATION #2 STATION #3<br />

9 1<br />

7 8<br />

18<br />

6 AM - 10 AM 11-0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4<br />

10 AM - 3 PM 12-0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4 4¹⁄ ² 5+<br />

3 PM - 7 PM 13-0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4<br />

7 PM - Midnight 14-0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4 4¹⁄ ² 5+<br />

Midnight - 6 AM 15-0 ¹⁄ ² 1 1¹⁄ ² 2 2¹⁄ ² 3 3¹⁄ ² 4 4¹⁄ ² 5+<br />

1 2 3 4 5 6 7 8 9 0 X<br />

FOR OFFICE USE ONLY<br />

□ AM<br />

□ AM<br />

□<br />

AM AM<br />

□<br />

AM<br />

FM<br />

□ FM<br />

□ FM<br />

16- ________ □ Sirius _________ 21- □ Sirius FM ________ 26-<br />

□ FM Sirius<br />

□ Int/Sat XM<br />

□ XM Int/Sat □ Int/Sat XM<br />

□ Internet<br />

□ Internet<br />

□ Internet<br />

□ AM Other<br />

□ Other AM □ AM Other<br />

□ AM<br />

□ AM<br />

□ AM<br />

□ FM<br />

□ FM<br />

□ FM<br />

31- ________ □ Sirius _________ 36- □ Sirius FM ________ 41-<br />

□ FM Sirius<br />

□<br />

Int/Sat XM<br />

□<br />

Int/Sat XM<br />

□<br />

Int/Sat XM<br />

□ Internet<br />

□ Internet<br />

□ Internet<br />

□ Other □ AM □ Other □ AM □ Other<br />

□ AM<br />

□ AM<br />

□ AM<br />

□ FM<br />

□ FM<br />

□ FM<br />

46- ________ □ Sirius _________ 51- □ Sirius FM ________ 56-<br />

□<br />

FM Sirius<br />

□ XM<br />

□ □ Int/Sat XM<br />

Int/Sat XM<br />

□ Internet<br />

□ □ Int/Sat<br />

Internet<br />

Internet<br />

□ Other<br />

□ Other<br />

□ Other<br />

□ AM<br />

□ AM<br />

□ AM<br />

□ FM<br />

□ FM<br />

□ FM<br />

□ □ □<br />

61-<br />

Sirius<br />

________ _________ 66- Sirius<br />

FM ________ 71-<br />

Sirius<br />

FM<br />

□ XM<br />

□ XM<br />

□ XM<br />

□ Internet<br />

□ Internet<br />

□ Internet<br />

□ Other<br />

□ Other<br />

□ Other<br />

□ AM<br />

□ AM<br />

□ AM<br />

□ FM<br />

□ FM<br />

□ FM<br />

□ Sirius<br />

□ Sirius<br />

□ Sirius<br />

11- ________ □ XM 16- _________ □ XM FM ________ 21-<br />

□ FM XM<br />

□ Internet<br />

□ Other<br />

□ Internet<br />

□ Other<br />

IF NO RADIO LISTENED TO YESTERDAY, X HERE<br />

THEN SKIP TO Q. 25B<br />

□ Internet<br />

□ Other<br />

9 2<br />

7 8

SC19<br />

SC19<br />

PREMIUM CABLE CHANNELS<br />

(SHOW CARD 19)<br />

36J. Here is a list of premium channels available to cable, satellite, or fiber optic subscribers. Please tell me the number next to<br />

any premium channel that you have watched in the past 30 days since (DATE).<br />

(IF BOX 1-7 CHECKED IN COL. J, ASK Q. 36K, OTHERWISE SKIP TO Q. 36L)<br />

36K. About how many hours have you watched (SERVICE) in the last 7 days? (RECORD HOURS IN COL. K)<br />

(ASK EVERYONE) (SHOW CARD 19)<br />

36L. Whether or not you watched any of these channels in the last 30 days, which, if any, of these premium channels does<br />

your household subscribe to?<br />

Col. K<br />

Col. J Hours<br />

Watched Watched Col. L<br />

Past 30 Days Last 7 Days Subscribed<br />

Cinemax (1) □ (11-12) 33-1<br />

Encore (2) □ (13-14) 2<br />

Home Box Office (HBO) (3) □ (15-16) 3<br />

The Movie Channel (4) □ (17-18) 4<br />

Showtime (5) □ (19-20) 5<br />

Starz (6) □ (21-22) 6<br />

Other (SPECIFY) (7) □ (23-24) 7<br />

NONE □ 8<br />

ASK EVERYONE<br />

2 6<br />

7 8<br />

36M. Digital Video Recorders or DVRs digit<strong>all</strong>y record, store and playback television programming. They are different than<br />

recordable DVDs and VCRs in that they record without the use of tapes, CDs or DVDs. A DVR can also control live TV<br />

with pause, rewind and instant replay functions.<br />

Does your household have a DVR?<br />

Yes 30-1<br />

SKIP TO Q. 36O No 2<br />

SC20A<br />

(IF “YES” IN Q. 36M, ASK:) (SHOW CARD 20A)<br />

36N. What type or types of DVR do you currently use in your home? (CIRCLE AS MANY AS APPLY)<br />

DVR from my local cable company (1) 31-1<br />

Dish DVR from Dish Network (satellite) (2) 2<br />

DirecTV DVR with TiVo service (satellite) (3) 3<br />

DirecTV Plus DVR (satellite) (4) 4<br />

TiVo brand DVR (Standalone product that works with cable,<br />

satellite or antenna) (5) 5<br />

DVR from a phone company or fiber optic service (for example,<br />

Verizon FiOS or AT&T U-Verse) (6) 6<br />

Other (7) 7<br />

Don’t Know 8<br />

END<br />

C 26<br />

D<br />

26

SC20B<br />

(ASK EVERYONE) (SHOW CARD 20B)<br />

36O. Which of the following broadcast TV networks have you watched in the past 30 days since (DATE)?<br />

(IF ANY BOX CHECKED IN COL. O, ASK:)<br />

36P. About how many hours have you watched (NETWORK) in the past 7 days?<br />

NAME OF TV<br />

NETWORK<br />

Col. O<br />

Watched Past<br />

30 Days<br />

Col. P<br />

Hours Watched<br />

Past 7 Days<br />

ABC (1) □ (11-12)<br />

CBS (2) □ (13-14)<br />

CW (3) □ (15-16)<br />

FOX (4) □ (17-18)<br />

ION (5) □ (19-20)<br />

NBC (6) □ (21-22)<br />

PBS (7) □ (23-24)<br />

Other (SPECIFY) (8) □ (25-26)<br />

2 5<br />

7 8<br />

IF NONE CHECKED IN COLUMN O, X HERE<br />

THEN SKIP TO Q. 37A<br />

END<br />

C 25<br />

D<br />

SC21<br />

SC21<br />

OUTDOOR TRAVEL<br />

(SHOW CARD 21)<br />

37A. In the past 7 days, that is, the 7 days since last (TODAY’S DAY OF THE WEEK), how many miles did you person<strong>all</strong>y travel in a<br />

town, city, or suburb as a driver or passenger in a car or truck? (CIRCLE ONE CODE IN COL. Q. 37A) (IF “NONE”, RECORD<br />

BELOW AND ASK Q. 37B)<br />

(IF “NONE” IN Q. 37A, ASK Q. 37B, OTHERWISE SKIP TO Q.37C) (CONTINUE WITH SHOW CARD 21)<br />

37B. In the past four weeks, that is, the 30 days since (DATE), how many miles did you person<strong>all</strong>y travel in a town, city or suburb, as<br />

a driver or passenger in a car or truck?<br />

0 5<br />

7 8<br />

PAST 7 DAYS<br />

PAST 4 WEEKS<br />

Q. 37A Q. 37B<br />

Under 10 miles (1) 10-1 11-1<br />

10-20 (2) -2 -2<br />

21-35 (3) -3 -3<br />

SKIP TO Q. 37C<br />

36-50 (4) -4 -4<br />

51-100 (5) -5 -5<br />

101-150 (6) -6 -6<br />

151-250 (7) -7 -7<br />

Over 250 miles (8) -8 -8<br />

ASK Q. 37B<br />

NONE (9) -9 -9<br />

37C. The last time you rode in a car or truck, how many people including yourself were in it?<br />

12- ______________________________<br />

Number of People<br />

IF “ONE”, SKIP TO Q. 38A, OTHERWISE ASK Q. 37D<br />

(IF ANSWER TO Q. 37C IS > 1 ASK:)<br />

37D. How many of these people were eighteen years of age or older?<br />

13- ______________________________<br />

Number of People (18 or older)<br />

There is No Question 38<br />

27

SC25C&D (IF “YES” IN Q. 45D OR Q. 45F, ASK:) (SHOW CARD 25C AND CARD 25D)<br />

45G. Here is a list of activities available on the Internet. Which, if any, of these activities did you do on the Internet in the last 30<br />

days? (CIRCLE AS MANY AS APPLY)<br />

SC25E<br />

Visited a chat room (1) 16-1<br />

Used e-mail (2) 2<br />

Used instant messenger/IM (3) 3<br />

Participated in online dating (4) 4<br />

Made a purchase for personal use (5) 5<br />

Made a purchase for business use (6) 6<br />

Made personal or business travel plans (lodging, air travel, car rental, etc.) (7) 7<br />

Played games online (8) 8<br />

Downloaded a video game (9) 9<br />

Used online gambling site (10) 0<br />

Obtained financial information (11) X<br />

Tracked Investments/Traded stocks, bonds, or mutual funds (12) Y<br />

Paid bills online (13) 17-1<br />

Obtained the latest news/current events (14) 2<br />

Obtained sports news/information (15) 3<br />

Obtained information for new or used car purchase (16) 4<br />

Obtained information about real estate (for purchase or rental) (17) 5<br />

Obtained medical information (18) 6<br />

Obtained childcare or parenting information (19) 7<br />

Looked for employment (Used classified listings) (20) 8<br />

Looked for recipes (21) 9<br />

Visited a TV network or TV show’s website (22) 0<br />

Looked at TV listings online (23) X<br />

Looked up movie listings or show times (24) Y<br />

Listened to radio on the Internet (25) 18-1<br />

Visited a radio station, radio program or radio personality’s website (26) 2<br />

Downloaded music (27) 3<br />

Downloaded podcasts/podcasting (28) 4<br />

Downloaded a TV program (29) 5<br />

Watched a TV program online (30) 6<br />

Downloaded a movie (31) 7<br />

Watched a movie online (32) 8<br />

Watched other online video (33) 9<br />

Visited online blogs (34) 0<br />

Wrote an online blog (35) X<br />

Posted a comment or review on a blog, online forum, message or bulletin board (36) Y<br />

Made a phone c<strong>all</strong> (37) 19-1<br />

Uploaded or added video to website (38) 2<br />

Shared photos through Internet website (39) 3<br />

Sent an electronic greeting card (40) 4<br />

Other (41) 5<br />

(SHOW CARD 25E)<br />

45H. In the last 30 days, which websites or search engines, if any, did you use to find other websites or information?<br />

(IF “DON’T KNOW” OR “NONE” IN Q. 45H, SKIP TO Q. 45J, OTHERWISE FOR EACH WEBSITE CIRCLED ASK Q. 45I)<br />

45I. Did you visit (WEB SITE) yesterday?<br />

PAST 30 DAYS YESTERDAY<br />

Q. 45H Q. 45I<br />

YES NO<br />

AOL/AOL.com (1) 21-1 22-1 N<br />

Ask.com (2) 2 2 N<br />

Excite.com (3) 3 3 N<br />

Google.com (4) 4 4 N<br />

Lycos.com (5) 5 5 N<br />

Bing (formerly MSN/<br />

Windows Live<br />

Search) (6) 6 6 N<br />

PAST 30 DAYS YESTERDAY<br />

Q. 45H Q. 45I<br />

YES NO<br />

Netscape.com (7) 23-7 24-7 N<br />

Yahoo.com (8) 8 8 N<br />

Other (9) 9 9 N<br />

None (10) 0<br />

SKIP TO<br />

Don’t know<br />

X<br />

Q. 45J<br />

31

SC25F<br />

SC26<br />

(SHOW CARD 25F)<br />

45J. What types of Instant Messenger, or IM, if any, did you use in the last 30 days?<br />

(SHOW CARD 26)<br />

45K. On the average, how often do you look at or use the Internet in a typical month?<br />

AIM/AOL Instant Messenger (1) 30-1<br />

eBuddy (2) 2<br />

Facebook (3) 3<br />

Google Talk/Gmail Chat (4) 4<br />

ICQ (5) 5<br />

Meebo (6) 6<br />

MySpace (7) 7<br />

SKYPE (8) 8<br />

Windows Live Messenger (9) 9<br />

Yahoo! Messenger (10) 0<br />

Other (11) X<br />

None (12) Y<br />

Don’t know 31-1<br />

5 or more times per day (1) 32-1<br />

2-4 times per day (2) 2<br />

Once a day (3) 3<br />

3-6 times per week (4) 4<br />

1-2 times per week (5) 5<br />

Less than once a week (6) 6<br />

SC27<br />

(IF TODAY IS SUNDAY OR MONDAY, ASK FOR FRIDAY) (SHOW CARD 27)<br />

45L. Thinking of yesterday, how much time in total did you spend using the Internet? Please do not include time spent using<br />

email or IM. Please read me the letter from this card.<br />

10 hours or more (A) 33-1<br />

5 hrs. – less than 10 hours (B) 2<br />

2 hrs. – less than 5 hours (C) 3<br />

1 hr. – less than 2 hours (D) 4<br />

1/2 hour – less than 1 hour (E) 5<br />

Less than 1/2 hour (F) 6<br />

None (G) 7<br />

SC27<br />

(SHOW CARD 27)<br />

45M. Thinking of last Saturday, how much time in total did you spend using the Internet? Please do not include time spent using<br />

email or IM. Please read me the letter from this card.<br />

10 hours or more (A) 34-1<br />

5 hrs. – less than 10 hours (B) 2<br />

2 hrs. – less than 5 hours (C) 3<br />

1 hr. – less than 2 hours (D) 4<br />

1/2 hour – less than 1 hour (E) 5<br />

Less than 1/2 hour (F) 6<br />

None (G) 7<br />

SC27<br />

(SHOW CARD 27)<br />

45N. Thinking of last Sunday, how much time in total did you spend using the Internet? Please do not include time spent using<br />

email or IM. Please read me the letter from this card.<br />

10 hours or more (A) 35-1<br />

5 hrs. – less than 10 hours (B) 2<br />

2 hrs. – less than 5 hours (C) 3<br />

1 hr. – less than 2 hours (D) 4<br />

1/2 hour – less than 1 hour (E) 5<br />

Less than 1/2 hour (F) 6<br />

None (G) 7<br />

32

SC28A-C<br />

(IF “YES” IN Q. 45D, ASK:) (SHOW CARDS 28A, 28B, 28C)<br />

46A. Which, if any, of the following web sites did you visit in the last 30 days? (CIRCLE AS MANY AS APPLY)<br />

(IF “NONE” IN Q. 46A SKIP TO Q. 47, OTHERWISE FOR EACH WEBSITE CIRCLED IN Q. 46A, ASK:)<br />

46B. Did you visit (WEB SITE) yesterday?<br />

PAST 30 DAYS YESTERDAY<br />

Q. 46A Q. 46B<br />

YES NO<br />

EMAIL<br />

AOL Mail (1) 41-1 51-1 N<br />

Gmail (2) 2 2 N<br />

Windows Live Hotmail (3) 3 3 N<br />

Yahoo! Mail (4) 4 4 N<br />

ENTERTAINMENT<br />

ABC.com (5) 5 5 N<br />

CBS.com (6) 6 6 N<br />

Disney.com (7) 7 7 N<br />

Fox.com (8) 8 8 N<br />

Hulu.com (9) 9 9 N<br />

IMDb.com (10) 0 0 N<br />

iTunes.com (11) X X N<br />

iVillage.com (12) Y Y N<br />

Moviefone.com (13) 42-1 52-1 N<br />

MSN Movies (14) 2 2 N<br />

MTV.com (15) 3 3 N<br />

NBC.com (16) 4 4 N<br />

PBS.org (17) 5 5 N<br />

Ticketmaster.com (18) 6 6 N<br />

Yahoo! Movies (19) 7 7 N<br />

JOBS/CAREERS<br />

CareerBuilder.com (20) 8 8 N<br />

Monster.com (21) 9 9 N<br />

Yahoo! HotJobs (22) 0 0 N<br />

INFORMATION/REFERENCE<br />

About.com (23) X X N<br />

Bankrate.com (24) Y Y N<br />

EverydayHealth.com (25) 43-1 53-1 N<br />

Switchboard.com (26) 2 2 N<br />

Superpages.com (27) 3 3 N<br />

WebMD.com (28) 4 4 N<br />

WhitePages.com (29) 5 5 N<br />

Wikipedia.org (30) 6 6 N<br />

Yellowpages.com (31) 7 7 N<br />

NEWS/COMMENTARY<br />

ABCNews.com (32) 8 8 N<br />

AOL News (33) 9 9 N<br />

CBSNews.com (34) 0 0 N<br />

CNN.com (35) X X N<br />

FOXNews.com (36) Y Y N<br />

MSNBC.com (37) 44-1 54-1 N<br />

NYTimes.com (38) 2 2 N<br />

USAToday.com (39) 3 3 N<br />

WSJ.com (40) 4 4 N<br />

Yahoo! News (41) 5 5 N<br />

SHOPPING<br />

Amazon.com (42) 6 6 N<br />

BizRate.com (43) 7 7 N<br />

eBay.com (44) 8 8 N<br />

NexTag.com (45) 9 9 N<br />

Overstock.com (46) 0 0 N<br />

Shopping.com (47) X X N<br />

Shopzilla.com (48) Y Y N<br />

PAST 30 DAYS YESTERDAY<br />

Q. 46A Q. 46B<br />

YES NO<br />

SOCIALIZING/NETWORKING/PHOTOS/VIDEOS<br />

Classmates.com (49) 45-1 55-1 N<br />

Facebook.com (50) 2 2 N<br />

Flickr.com (51) 3 3 N<br />

KodakG<strong>all</strong>ery.com (52) 4 4 N<br />

LinkedIn.com (53) 5 5 N<br />

MySpace.com (54) 6 6 N<br />

Photobucket.com (55) 7 7 N<br />

Shutterfly.com (56) 8 8 N<br />

Twitter.com (57) 9 9 N<br />

YouTube.com (58) 0 0 N<br />

SPANISH LANGUAGE<br />

AOLLatino.com (59) 46-1 56-1 N<br />

MSNLatino.com (60) 2 2 N<br />

Terra.com (61) 3 3 N<br />

Univision.com (62) 4 4 N<br />

Yahoo! en Español (63) 5 5 N<br />

SPORTS<br />

CBSSports.com (64) 6 6 N<br />

ESPN.com (65) 7 7 N<br />

FanHouse (66) 8 8 N<br />

FOXSports.com (67) 9 9 N<br />

MLB.com (68) 0 0 N<br />

NASCAR.com (69) X X N<br />

NBA.com (70) Y Y N<br />

NBC Sports (71) 47-1 57-1 N<br />

NFL.com (72) 2 2 N<br />

Yahoo! Sports (73) 3 3 N<br />

TECHNOLOGY<br />

CNET.com (74) 4 4 N<br />

ZDNet.com (75) 5 5 N<br />

TRAVEL/MAP<br />

CheapTickets.com (76) 6 6 N<br />

Expedia.com (77) 7 7 N<br />

Hotels.com (78) 8 8 N<br />

Hotwire.com (79) 9 9 N<br />

MapQuest.com (80) 0 0 N<br />

Maps.google.com<br />

(Google Maps) (81) X X N<br />

MSN Maps & Directions<br />

(Live Search Maps) (82) Y Y N<br />

Orbitz.com (83) 48-1 58-1 N<br />

Priceline.com (84) 2 2 N<br />

Travelocity.com (85) 3 3 N<br />

TripAdvisor.com (86) 4 4 N<br />

Yahoo! Maps (87) 5 5 N<br />

WEATHER<br />

AccuWeather.com (88) 6 6 N<br />

Weather.com (89) 7 7 N<br />

WeatherBug.com (90) 8 8 N<br />

IF NONE CIRCLED IN Q. 46A, X HERE THEN SKIP TO Q. 47<br />

33

TELEPHONES<br />

47. How many telephones (including extension phones) are currently in use in your household? Please do not include cell<br />

phones.<br />

72-<br />

IF NONE, SKIP TO Q. 50A<br />

___________________________________________<br />

# of phones in household<br />

There is No Question 48<br />

50B. How many of these cell phones are provided by an employer?<br />

50C. How many working cell phones do you person<strong>all</strong>y have?<br />

SKIP TO Q. 51<br />

49. How many different phone numbers do you have in your household? Please do not include phone lines used only for a fax<br />

machine or a modem. Also, do not include cell phones.<br />

75-<br />

One 1<br />

Two 2<br />

Three or more 3<br />

50A. How many working cell phones in total do you or does any member of your household have?<br />

76-<br />

One 1<br />

CONTINUE<br />

Two 2<br />

WITH<br />

Three 3<br />

Q. 50B<br />

Four or more 4<br />

SKIP TO Q. 51 None 5<br />

77-<br />

One 1<br />

Two 2<br />

Three 3<br />

Four or more 4<br />

None 5<br />

Don’t know 6<br />

80-<br />

One 1<br />

Two 2<br />

Three 3<br />

Four or more 4<br />

None 5<br />

SC29<br />

(SHOW CARD 29)<br />

50D. Thinking only of the cell phone you person<strong>all</strong>y use most often, which cell phone service does that phone have?<br />

(ONE ANSWER ONLY).<br />

Alltel (1) 78-1<br />

AT&T (2) 2<br />

Cellular One (3) 3<br />

Centennial (4) 4<br />

Metro PCS (5) 5<br />

Qwest (6) 6<br />

Sprint (7) 7<br />

T-Mobile (8) 8<br />

Verizon Wireless (9) 9<br />

Virgin Mobile (10) 0<br />

Other (SPECIFY)_________________(11) X<br />

Don’t know<br />

Y<br />

50E. Did your household “bundle” or purchase together from the same company, any of the following services: television,<br />

Internet, telephone and/or cell phone?<br />

Yes 79-1<br />

No 2<br />

Don’t know 3<br />

END<br />

C 24<br />

D<br />

34

SC42<br />

(SHOW CARD 42)<br />

90. What is the current (approximate) total net worth of<br />

yourself and <strong>all</strong> members of your household? (Please<br />

include the estimated value of your home, other real<br />

estate, vehicles and <strong>all</strong> personal and household possessions<br />

as well as bank accounts, stocks, bonds, equity in<br />

your own company and other investments.)<br />

CHECK ONE: 71-<br />

Stated by respondent □ 1<br />

Interviewer (estimate) □ 2<br />

Under $50,000 (1) 22-1<br />

$50,000-$99,999 (2) 2<br />

$100,000-$149,999 (3) 3<br />

$150,000-$199,999 (4) 4<br />

$200,000-$249,999 (5) 5<br />

$250,000-$299,999 (6) 6<br />

$300,000-$349,999 (7) 7<br />

$350,000-$399,999 (8) 8<br />

$400,000-$499,999 (9) 9<br />

$500,000-$749,999 (10) 0<br />

$750,000-$999,999 (11) X<br />

$1,000,000 or more (12) Y<br />

91. Thinking of your household, what language is spoken in<br />

your home most often? (CIRCLE ONE CODE BELOW)<br />

English 23-1<br />

Spanish 2<br />

Other (SPECIFY) 3<br />

92. What other languages are spoken in your home?<br />

English 23-4<br />

Spanish 5<br />

Other (SPECIFY) 6<br />

No other language 7<br />

93A. Are you person<strong>all</strong>y of Spanish, Hispanic or Latino origin or descent?<br />

(DO NOT ASK AND CIRCLE CODE 3 IF ONLY ONE ADULT IN HOUSEHOLD;<br />

OTHERWISE, ASK EVERYONE)<br />

93B. Are any other adults in your household, aged 18 or older, of Spanish,<br />

Hispanic or Latino origin or descent?<br />

Yes 24-1<br />

No 2<br />

Yes 66-1<br />

No 2<br />

DID NOT ASK: Only 1<br />

Adult in Household 3<br />

(IF “YES” TO Q. 93A, ASK Q. 94-96; OTHERWISE SKIP TO Q. 98)<br />

(DO NOT ASK IF EITHER “ENGLISH” OR “SPANISH” IN Q. 91 AND “NO OTHER LANGUAGE” IN Q. 92 – SKIP TO Q. 94C)<br />

94A. Thinking of yourself, when you are at home do you person<strong>all</strong>y speak: (READ LIST)<br />

Only English 61-1<br />

SKIP TO Q. 94C<br />

Mostly English, but some Spanish 2<br />

Only Spanish 3<br />

Mostly Spanish, but some English 4<br />

ASK Q. 94B<br />

DO NOT READ<br />

Both Equ<strong>all</strong>y 5<br />

SKIP TO Q. 94C<br />

DO NOT READ<br />

Another language or languages 6<br />

(IF “BOTH EQUALLY” IN Q. 94A, ASK:)<br />

94B. Would you say that is “mostly English, but some<br />

Spanish” or “mostly Spanish, but some English”?<br />

DO NOT READ<br />

Mostly English, but some Spanish 61-8<br />

Mostly Spanish, but some English 9<br />

Both Equ<strong>all</strong>y 0<br />

(IF “YES” TO Q. 93A, ASK:)<br />

94C. Thinking of yourself, when you are outside the home do you person<strong>all</strong>y speak: (READ LIST)<br />

Only English 65-1<br />

SKIP TO Q. 95<br />

Mostly English, but some Spanish 2<br />

Only Spanish 3<br />

Mostly Spanish, but some English 4<br />

ASK Q. 94D<br />

DO NOT READ<br />

Both Equ<strong>all</strong>y 5<br />

SKIP TO Q. 95<br />

DO NOT READ<br />

Another language or languages 6<br />

45

HEALTH AND BEAUTY AIDS<br />

Page 4<br />

DEODORANTS AND<br />

ANTIPERSPIRANTS<br />

010<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 7<br />

months days<br />

TOTAL: ................ M 00<br />

TYPES:<br />

Scented ............... M 01<br />

Unscented ............. M 02<br />

KINDS:<br />

Antiperspirant/Deodorant .. M 03<br />

Deodorant Only ......... M 04<br />

BRANDS:<br />

Adidas. ................ M 05<br />

Arm & Hammer Roll-On .... M 06<br />

Arm & Hammer Stick/Solid . M 07<br />

Arrid Extra Dry Clear Gel ... M 08<br />

Arrid Extra Dry Spray. ..... M 09<br />

Arrid XX Roll-On ......... M 10<br />

Arrid XX Solid ........... M 11<br />

Arrid XX Spray. .......... M 12<br />

Other Arrid ............. M 13<br />

Avon .................. M 14<br />

Axe Bodyspray. .......... M 15<br />

Axe Dry Solid/Gel. ....... M 16<br />

Ban Roll-On ............ M 17<br />

Ban Solid .............. M 18<br />

Brut Spray ............. M 19<br />

Brut Stick .............. M 20<br />

Degree Clinical Protection . M 21<br />

Degree Women Solid ..... M 22<br />

Degree Women Spray .... M 23<br />

Degree Women Ultra Clear . M 24<br />

Degree Men Spray ....... M 25<br />

Degree Men Stick/Solid ... M 26<br />

Dove Clinical Protection ... M 27<br />

Dove Roll-On ........... M 28<br />

Dove Solid ............. M 29<br />

Dove Spray. ............ M 30<br />

Dry Idea ............... M 31<br />

Gillette Clinical Strength. .. M 32<br />

Gillette Series Gel ....... M 33<br />

Gillette Series Solid ...... M 34<br />

Lady Speed Stick ........ M 35<br />

Lady Speed Stick 24/7 .... M 36<br />

Lady’s Choice. .......... M 37<br />

Mitchum Gel ............ M 38<br />

Mitchum Roll-On ........ M 39<br />

Mitchum Solid. .......... M 40<br />

Mitchum for Women ...... M 41<br />

Old Spice High Endurance. M 42<br />

Old Spice Red Zone. ..... M 43<br />

Old Spice Red Zone Body<br />

Spray ............... M 44<br />

Old Spice Stick. ......... M 45<br />

Right Guard Sport Gel . . . . . M 46<br />

Right Guard Sport Spray .. M 47<br />

Right Guard Sport Solid ... M 48<br />

Right Guard Xtreme ...... M 49<br />

Secret Clinical Strength ... M 50<br />

Secret Flawless Solid. .... M 51<br />

Secret Invisible Solid ..... M 52<br />

Secret Roll-On .......... M 53<br />

Secret Solid ............ M 54<br />

Secret Spray. ........... M 55<br />

Soft & Dri DriGel ........ M 56<br />

Soft & Dri Solid. ......... M 57<br />

Soft & Dri Spray ......... M 58<br />

Speed Stick ............ M 59<br />

Speed Stick 24/7 ........ M 60<br />

Suave ................. M 61<br />

Sure Solid. ............. M 62<br />

Sure Spray ............. M 63<br />

Tag Body Spray ......... M 64<br />

M 999<br />

OTHER (Write In)<br />

COMPLEXION CARE You Person<strong>all</strong>y:<br />

PRODUCTS Used in Times/<br />

(Facial Cleansers, last 6 last 7<br />

Facial Toners, etc.) months days<br />

011<br />

TOTAL: ................ M 00<br />

TYPES:<br />

Astringent .............. M 01<br />

Cleansers .............. M 02<br />

Toner ................. M 03<br />

FORMS:<br />

Mask. ................. M 04<br />

Pad. .................. M 05<br />

Sponge. ............... M 06<br />

Cloths/Towelettes ........ M 07<br />

KINDS:<br />

Bar ................... M 08<br />

Cream ................ M 09<br />

Gel ................... M 10<br />

Lotion ................. M 11<br />

Scrub ................. M 12<br />

BRANDS:<br />

Almay ................. M 13<br />

Aveeno ................ M 14<br />

Avon Clearskin .......... M 15<br />

Other Avon ............. M 16<br />

Bioré. ................. M 17<br />

Bioré Deep Cleansing<br />

Pore Strips. .......... M 18<br />

Cetaphil ............... M 19<br />

Clean & Clear Advantage. . M 20<br />

Clean & Clear Morning Burst . M 21<br />

Clean & Clear Oxygenating . M 22<br />

Other Clean & Clear. ..... M 23<br />

Clearasil Daily Face Wash . M 24<br />

Clearasil Ultra. .......... M 25<br />

Other Clearasil .......... M 26<br />

Clinique Facial Soap ..... M 27<br />

Other Clinique .......... M 28<br />

Dove Cleansing Cloths. ... M 29<br />

Dove Cleansing Pillows ... M 30<br />

Estée Lauder ........... M 31<br />

Lancôme .............. M 32<br />

L’Oréal ................ M 33<br />

Mary Kay .............. M 34<br />

Neutrogena Advanced<br />

Solutions. ............ M 35<br />

Neutrogena Deep Clean<br />

Cleanser ............. M 36<br />

Neutrogena Oil Free Acne<br />

Wash. ............... M 37<br />

Neutrogena Pore Refining . M 38<br />

Other Neutrogena ....... M 39<br />

Nivea for Men ........... M 40<br />

Noxzema Plus Skin Cream . M 41<br />

Noxzema Skin Cream .... M 42<br />

Olay Daily Facials. ....... M 43<br />

Olay Foaming Face Wash . M 44<br />

Olay Refreshing Toner .... M 45<br />

Olay Regenerist . . . . . . . . . . M 46<br />

Olay Total Effects ........ M 47<br />

Other Olay ............. M 48<br />

pHisoderm ............. M 49<br />

Pond’s Cold Cream ...... M 50<br />

Pond’s Towelettes. ....... M 51<br />

Sea Breeze Astringent .... M 52<br />

St. Ives Apricot Scrub. .... M 53<br />

Other St. Ives ........... M 54<br />

Stridex ................ M 55<br />

M 999<br />

OTHER (Write In)<br />

Facial skin type: 012-0<br />

Dry ................... M 1<br />

Normal ................ M 2<br />

Oily ................... M 3<br />

Partly oily/partly dry ...... M 4<br />

Sensitive. .............. M 5<br />

You Person<strong>all</strong>y:<br />

HAND & BODY<br />

Used in Times/<br />

CREAM, LOTION OR<br />

last 6 last 7<br />

OIL months days<br />

013<br />

TOTAL: ................ M 00<br />

TYPES:<br />

Cream ................ M 01<br />

Lotion ................. M 02<br />

Oil. ................... M 03<br />

BRANDS:<br />

Aquaphor Ointment ...... M 04<br />

Aveeno Daily Moisturizing . M 05<br />

Other Aveeno ........... M 06<br />

Avon .................. M 07<br />

Baby Magic Baby Lotion. .. M 08<br />

Baby Magic Creamy Baby Oil M 09<br />

Bath & Body Works ...... M 10<br />

The Body Shop. ......... M 11<br />

Burt’s Bees. ............ M 12<br />

Caress ................ M 13<br />

Cetaphil ............... M 14<br />

Corn Huskers ........... M 15<br />

Curél. ................. M 16<br />

Dove .................. M 17<br />

Eucerin Original ......... M 18<br />

Eucerin Plus Intensive<br />

Repair ............... M 19<br />

Other Eucerin ........... M 20<br />

Gold Bond Medicated Lotion M 21<br />

Gold Bond Ultimate Lotion . M 22<br />

Jergens Natural Glow. .... M 23<br />

Jergens Original Scent. ... M 24<br />

Jergens Skin Firming ..... M 25<br />

Jergens Soothing Aloe Relief M 26<br />

Jergens Ultra Healing. .... M 27<br />

Other Jergens .......... M 28<br />

Johnson’s Baby Lotion .... M 29<br />

Johnson’s Baby Oil. ...... M 30<br />

Other Johnson’s ......... M 31<br />

Keri Lotion ............. M 32<br />

Kiss My Face ........... M 33<br />

L’Oréal ................ M 34<br />

Lubriderm Advanced<br />

Therapy. ............. M 35<br />

Lubriderm Daily Moisture .. M 36<br />

Lubriderm Sensitive Skin .. M 37<br />

Mary Kay .............. M 38<br />

Neutrogena Hand Cream .. M 39<br />

Neutrogena Body Lotion .. M 40<br />

Neutrogena Body Oil ..... M 41<br />

Nivea Smooth Sensation .. M 42<br />

Other Nivea ............ M 43<br />

Olay Quench ........... M 44<br />

Olay Touch of Sun ....... M 45<br />

Other Olay ............. M 46<br />

Origins ................ M 47<br />

Palmer’s ............... M 48<br />

S<strong>all</strong>y Hansen ........... M 49<br />

St. Ives ................ M 50<br />

Suave ................. M 51<br />

Vaseline Aloe Fresh ...... M 52<br />

Vaseline Clinical Therapy .. M 53<br />

Vaseline Cocoa Butter .... M 54<br />

Vaseline Intensive Rescue . M 55<br />

Vaseline Men ........... M 56<br />

Vaseline Petroleum Jelly .. M 57<br />

Vaseline Total Moisture. ... M 58<br />

Other Vaseline .......... M 59<br />

Store’s Own Brand ....... M 60<br />

M 999<br />

OTHER (Write In)<br />

Used for: 014-0<br />

Anti-Aging ............. M 1<br />

Anti-Cellulite/Firming ..... M 2<br />

Dry Skin ............... M 3<br />

Moisturizing ............ M 4<br />

Self Tan/Glow ........... M 5<br />

Sensitive Skin. .......... M 6

Page 9<br />

HEALTH AND BEAUTY AIDS<br />

SANITARY NAPKINS<br />

(Women)<br />

046<br />

You Person<strong>all</strong>y:<br />

Used in Number/<br />

last 6 last 30<br />

months days<br />

You Person<strong>all</strong>y:<br />

PERFUME AND<br />

Used in Times/<br />

COLOGNE<br />

last 6 last 7<br />

FOR WOMEN months days<br />

049<br />

You Person<strong>all</strong>y:<br />

AFTERSHAVE LOTION<br />

Used in Times/<br />

& COLOGNE<br />

last 6 last 7<br />

FOR MEN months days<br />

050<br />

TOTAL: ................ 00<br />

TYPES:<br />

Deodorant ............. 01<br />

Non-deodorant .......... 02<br />

KINDS:<br />

Regular (non-winged). .... 03<br />

With Wings ............. 04<br />

BRANDS:<br />

Always Maximum Protection 05<br />

Always Overnight Maxi. ... 06<br />

Always Regular Maxi ..... 07<br />

Always Ultra Thin ........ 08<br />

Other Always ........... 09<br />

Kotex Maxi ............. 10<br />

Kotex Overnight Pads. .... 11<br />

Kotex Ultra Thin ......... 12<br />

Other Kotex ............ 13<br />

Stayfree Maxi Regular .... 14<br />

Stayfree Maxi Super ..... 15<br />

Stayfree Ultra Thin ....... 16<br />

Other Stayfree .......... 17<br />

Store’s Own Brand ....... 18<br />

999<br />

OTHER (Write In)<br />

PANTILINERS<br />

(Women)<br />

048<br />

You Person<strong>all</strong>y:<br />

Used in Number/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Deodorant ............. 01<br />

Non-deodorant .......... 02<br />

Odor Absorbing ......... 03<br />

KINDS:<br />

Regular. ............... 04<br />

Long/Extra Coverage ..... 05<br />

Thong ................. 06<br />

BRANDS:<br />

Always Regular ......... 07<br />

Always Long ........... 08<br />

Always Maximum<br />

Protection ........... 09<br />

Other Always ........... 10<br />

Carefree Original ........ 11<br />

Carefree Body Shape. .... 12<br />

Other Carefree .......... 13<br />

Kotex Lightdays Regular .. 14<br />

Kotex Lightdays Extra<br />

Coverage ............ 15<br />

Kotex Lightdays Long ..... 16<br />

Other Kotex Lightdays .... 17<br />

Tena .................. 18<br />

Store’s Own Brand ....... 19<br />

999<br />

OTHER (Write In)<br />

You Person<strong>all</strong>y:<br />

IN-HOME<br />

Used in Times/<br />

PREGNANCY TEST<br />

last 12 last 12<br />

(Women) months months<br />

047<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Clearblue Easy. ......... 01<br />

e.p.t. . ................. 02<br />

First Response .......... 03<br />

Store’s Own Brand ....... 04<br />

999<br />

OTHER (Write In)<br />

TOTAL: ................ 00<br />

TYPES:<br />

Cologne ............... 01<br />

Perfume ............... 02<br />

After Bath Splash ........ 03<br />

Body Spray. ............ 04<br />

BRANDS:<br />

Amarige ............... 05<br />

Anais Anais ............ 06<br />

Armani Code ........... 07<br />

Armani Mania. .......... 08<br />

Avon .................. 09<br />

Baby Phat. ............. 10<br />

Bath & Body Works ...... 11<br />

Beautiful ............... 12<br />

Beckham Intimately ...... 13<br />

Beyond Paradise ........ 14<br />

Body Fantasies. ......... 15<br />

Celine Dion. ............ 16<br />

Chance ............... 17<br />

Chanel No. 5. ........... 18<br />

Other Chanel ........... 19<br />

Chantilly ............... 20<br />

Charlie ................ 21<br />

cK One ................ 22<br />

Cool Water Woman ...... 23<br />

Curious. ............... 24<br />

Curve ................. 25<br />

Dolce & Gabbana. ....... 26<br />

Emeraude. ............. 27<br />

Escada ................ 28<br />

Escape ................ 29<br />

Eternity. ............... 30<br />

Euphoria. .............. 31<br />

Glow By J.Lo ........... 32<br />

Green Tea. ............. 33<br />

Happy. ................ 34<br />

Hypnôse ............... 35<br />

J’adore ................ 36<br />

Jean Naté. ............. 37<br />

Jovan Musk ............ 38<br />

Jovan White Musk ....... 39<br />

Juicy Couture ........... 40<br />

Kenneth Cole Black ...... 41<br />

L’Air du Temps .......... 42<br />

Liz. ................... 43<br />

Lovely Sarah Jessica Parker 44<br />

Lucky You .............. 45<br />

Magnifique ............. 46<br />

Marc Jacobs. ........... 47<br />

Mary Kay .............. 48<br />

Miracle ................ 49<br />

Notorious .............. 50<br />

Obsession ............. 51<br />

Opium. ................ 52<br />

Oscar de la Renta ....... 53<br />

Passion. ............... 54<br />

Pleasures .............. 55<br />

Poison ................ 56<br />

Polo Sport for Women .... 57<br />

Ralph ................. 58<br />

Red Door .............. 59<br />

Romance .............. 60<br />

Sensuous .............. 61<br />

Shalimar ............... 62<br />

Shania ................ 63<br />

Tresor ................. 64<br />

Vanilla Fields ........... 65<br />

Vera Wang ............. 66<br />

Victoria’s Secret ......... 67<br />

White Diamonds ......... 68<br />

White Linen ............ 69<br />

Wind Song ............. 70<br />

999<br />

OTHER (Write In)<br />

TOTAL: ................ 00<br />

TYPES:<br />

After Shave. ............ 01<br />

Cologne ............... 02<br />

BRANDS:<br />

Acqua di Gio. ........... M 03<br />

Adidas Moves For Him .... M 04<br />

Afta. .................. M 05<br />

Aqua Velva Ice Blue ...... M 06<br />

Aqua Velva Ice Sport ..... M 07<br />

Aqua Velva Musk ........ M 08<br />

Armani Code ........... M 09<br />

Armani Mania. .......... M 10<br />

Aspen ................. M 11<br />

Avon .................. 12<br />

Beckham Instinct ........ 13<br />

BOD .................. 14<br />

British Sterling .......... 15<br />

Brut. .................. 16<br />

Chrome ............... 17<br />

cK One ................ 18<br />

Cool Water ............. 19<br />

Curve ................. 20<br />

Diesel Fuel For Life ...... 21<br />

Dolce & Gabbana. ....... 22<br />

Drakkar Noir ............ 23<br />

English Leather ......... 24<br />

Escape For Men. ........ 25<br />

Eternity For Men. ........ 26<br />

Euphoria. .............. 27<br />

Gillette ................ 28<br />

Givenchy pour homme .... 29<br />

Grey Flannel. ........... 30<br />

Hugo Boss ............. 31<br />

Joop! ................. 32<br />

Jovan Musk ............ 33<br />

Kenneth Cole Black ...... 34<br />

Kenneth Cole Reaction ... 35<br />

L’Homme .............. 36<br />

McGraw ............... 37<br />

Nautica Voyage. ......... 38<br />

Nivea for Men ........... 39<br />

Obsession For Men ...... 40<br />

Old Spice .............. 41<br />

Pierre Cardin ........... 42<br />

Polo Black. ............. 43<br />

Polo Sport ............. 44<br />

Other Polo ............. 45<br />

Preferred Stock ......... 46<br />

Skin Bracer. ............ 47<br />

Stetson ................ 48<br />

Stetson Fresh ........... 49<br />

Tommy (Hilfiger) ......... 50<br />

999<br />

OTHER (Write In)<br />

TOTAL PERFUME<br />

AND COLOGNE<br />

EXPENDITURES<br />

Amount you person<strong>all</strong>y<br />

spent on perfume<br />

& cologne,<br />

last 12 months:<br />

As a gift: For Men For Women<br />

051-0 052-0<br />

$ 1-49 ........... 1 1<br />

$ 50-99 ........... 2 2<br />

$100-249 .......... 3 3<br />

$250 or more ...... 4 4<br />

For yourself: For Men For Women<br />

$ 1-49 ........... 5 5<br />

$ 50-99 ........... 6 6<br />

$100-249 .......... 7 7<br />

$250 or more ...... 8 8<br />

Write in number bought,<br />

last 12 months: For Men For Women<br />

14K<br />

14L<br />

As a gift. ........... 01 01<br />

For yourself.......... 02 02

Page 11<br />

HEALTH AIDS<br />

You Person<strong>all</strong>y:<br />

SORE THROAT<br />

Used in Times/<br />

REMEDIES &<br />

last 6 last 30<br />

COUGH DROPS months days<br />

064<br />

TOTAL: ................. 00<br />

TYPES:<br />

Drops/Lozenges ......... 01<br />

Liquid ................. 02<br />

Spray ................. 03<br />

Strips ................. 04<br />

BRANDS:<br />

Cepacol Sore Throat<br />

Lozenges ............ 05<br />

Cepacol Sore Throat Spray . 06<br />

Cepastat Lozenges ...... 07<br />

Chloraseptic Gargle . . . . . . . 08<br />

Chloraseptic Lozenges. ... 09<br />

Chloraseptic Relief Strips. . 10<br />

Chloraseptic Spray ....... 11<br />

Equate ................ 12<br />

Fisherman’s Friend. ...... 13<br />

H<strong>all</strong>s Defense Vitamin C. .. 14<br />

H<strong>all</strong>s Fruit Breezers ...... 15<br />

H<strong>all</strong>s Plus .............. 16<br />

H<strong>all</strong>s (Regular) .......... 17<br />

Other H<strong>all</strong>s ............. 18<br />

Ludens (Regular) ........ 19<br />

N’ice Lozenges (Regular). . 20<br />

N’ice Vitamin C. ......... 21<br />

Ricola ................. 22<br />

Smith Brothers .......... 23<br />

Sucrets 8 Hour Cough<br />

Suppressant .......... 24<br />

Sucrets Lozenges. ....... 25<br />

Vicks 44 Sore Throat Spray . 26<br />

Vicks Cough Drops ...... 27<br />

Vicks Vitamin C ......... 28<br />

Store’s Own Brand ....... 29<br />

999<br />

OTHER (Write In)<br />

Used for: 065-0<br />

Coughs. ............... 1<br />

Sore Throat ............ 2<br />

Other Throat Irritation. .... 3<br />

You Person<strong>all</strong>y:<br />

COUGH SYRUP/<br />

Used in Times/<br />

SUPPRESSANT<br />

last 6 last 30<br />

(Nonprescription) months days<br />

066<br />

TOTAL: ................. 00<br />

BRANDS:<br />

Benylin . . . . . . . . . . . . . . . . . 01<br />

Delsym ................ 02<br />

Nyquil Cough ........... 03<br />

Robitussin CF. .......... 04<br />

Robitussin DM .......... 05<br />

Other Robitussin ........ 06<br />

Tylenol Cough & Sore<br />

Throat ............... 07<br />

Vicks 44 Dry Cough ...... 08<br />

Vicks 44D Congestion .... 09<br />

Vicks 44M Cough and Cold . 10<br />

Other Vicks. ............ 11<br />

Store’s Own Brand ....... 12<br />

999<br />

OTHER (Write In)<br />

WART & CORN<br />

REMOVERS<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 30<br />

months days<br />

074<br />

TOTAL: ................. 00<br />

BRANDS:<br />

Band-Aid .............. 01<br />

Clear Away ............. 02<br />

Compound W ........... 03<br />

Dr. Scholl’s ............. 04<br />

999<br />

OTHER (Write In)<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

NASAL SPRAYS<br />

last 6 last 30<br />

months days<br />

068<br />

TOTAL: ................. 00<br />

TYPES:<br />

Long lasting ............ 01<br />

Regular. ............... 02<br />

BRANDS:<br />

Afrin .................. 03<br />

Ayr ................... 04<br />

Dristan ................ 05<br />

4-Way ................. 06<br />

Mucinex ............... 07<br />

NaSal Saline ........... 08<br />

Neo-Synephrine ......... 09<br />

Ocean. ................ 10<br />

Simply Saline ........... 11<br />

Vicks Sinex ............. 12<br />

Zicam ................. 13<br />

Store’s Own Brand ....... 14<br />

999<br />

OTHER (Write In)<br />

EYE WASH AND<br />

DROPS<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 30<br />

months days<br />

069<br />

TOTAL: ................. 00<br />

TYPES:<br />

Drops ................. 01<br />

Wash ................. 02<br />

KINDS:<br />

Antihistamine ........... 03<br />

Dry Eye Protection ....... 04<br />

Regular. ............... 05<br />

BRANDS:<br />

Bausch & Lomb Dry Eye .. 06<br />

Bausch & Lomb Eye Wash. 07<br />

Bausch & Lomb Opcon-A. . 08<br />

Clear Eyes ............. 09<br />

Clear Eyes ACR ......... 10<br />

GenTeal ............... 11<br />

HypoTears ............. 12<br />

Murine Tears. ........... 13<br />

Murine Tears Plus. ....... 14<br />

Naphcon-A ............. 15<br />

Opti-Free .............. 16<br />

Refresh Plus. ........... 17<br />

Refresh Tears ........... 18<br />

Similasan .............. 19<br />

Systane ............... 20<br />

Tears Naturale .......... 21<br />

TheraTears ............. 22<br />

Visine-A ............... 23<br />

Visine A.C. ............. 24<br />

Visine Advanced Relief. ... 25<br />

Visine L.R. Long Lasting. .. 26<br />

Visine Tears ............ 27<br />

Visine Original .......... 28<br />

Store’s Own Brand ....... 29<br />

999<br />

OTHER (Write In)<br />

Used for: 070-0<br />

Redness Removal ....... 1<br />

Lubrication ............. 2<br />

Allergy ................ 3<br />

LASIK<br />

EYE SURGERY<br />

14M-0<br />

Have you had LASIK eye surgery in the last<br />

12 months?<br />

Yes 1<br />

ADHESIVE<br />

BANDAGES<br />

090<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Band-Aid Advanced Healing 01<br />

Band-Aid Antibiotic. ...... 02<br />

Band-Aid Clear. ......... 03<br />

Band-Aid Extra Large. .... 04<br />

Band-Aid Flex-Fabric ..... 05<br />

Band-Aid Liquid Bandage . 06<br />

Band-Aid Plastic. ........ 07<br />

Band-Aid Sheer ......... 08<br />

Band-Aid Tough Strips .... 09<br />

Other Band-Aid Bandages . 10<br />

Curad Flexible .......... 11<br />

Curad Plastic ........... 12<br />

Curad Sheer. ........... 13<br />

Other Curad ............ 14<br />

Nexcare Active .......... 15<br />

Nexcare Skin Crack Care. . 16<br />

Nexcare Tattoo .......... 17<br />

Store’s Own Brand ....... 18<br />

999<br />

OTHER (Write In)<br />

EYEGLASSES,<br />

You Person<strong>all</strong>y:<br />

CONTACT LENSES &<br />

Wear<br />

SUNGLASSES<br />

091-0<br />

Prescription Eyeglasses (sun,<br />

tinted, regular) ............. 1<br />

Bi-focals .................... 2<br />

Contact Lenses (RGP/hard). .... 3<br />

Contact Lenses (soft) .......... 4<br />

Contact Lenses (tinted/colored) .. 5<br />

Disposable Contact Lenses . . . . . . 6<br />

Sunglasses (Nonprescription) ... 7<br />

Transition Lenses . . . . . . . . . . . . . . 8<br />

Where did you purchase prescription eyewear?<br />

103-0<br />

Discount Store Optical Center ... 1<br />

Private Ophthalmologist, Optician<br />

or Optometrist. ............. 2<br />

Retail Optical Chain ........... 3<br />

Internet/online ............... 4<br />

Other ...................... 5<br />

Contact Lens Brands, used last 12 months:<br />

15X-0<br />

Acuvue ..................... 1<br />

Bausch & Lomb .............. 2<br />

O 2<br />

Optix (CIBA). .............. 3<br />

Other CIBA. ................. 4<br />

Other ...................... 5<br />

Amount Spent 092<br />

Last 12 Months<br />

Eyeglasses. ............ $ 01<br />

Sunglasses (nonprescription) $ 02<br />

Contact Lenses ......... $ 03<br />

CONTACT LENS<br />

CLEANING/WETTING<br />

SOLUTIONS<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 30<br />

months days<br />

093<br />

TOTAL: ................ 00<br />

TYPES:<br />

Disinfecting Solution. ..... 01<br />

Lens Cleaning Solution ... 02<br />

Lubricating/Rewetting<br />

Solutions. ............ 03<br />

Multipurpose Solutions. ... 04<br />

Saline Solution .......... 05<br />

BRANDS:<br />

Bausch & Lomb ReNu .... 06<br />

Other Bausch & Lomb .... 07<br />

Opti-Free Express ....... 08<br />

Opti-Free RepleniSH ..... 09<br />

Visine for Contacts ....... 10<br />

Private Label/Store Brand . 11<br />

999<br />

OTHER (Write In)

PERSONAL CARE, DIET AND BODY CARE PRODUCTS<br />

Page 14<br />

BODY POWDER<br />

009<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 7<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Ammens ............... 01<br />

Avon .................. 02<br />

Burt’s Bees. ............ 03<br />

Gold Bond Powder ....... 04<br />

Gold Bond Baby Powder .. 05<br />

Johnson’s Baby Powder ... 06<br />

Johnson’s Baby Powder<br />

Pure Corn Starch ...... 07<br />

Shower to Shower ....... 08<br />

999<br />

OTHER (Write In)<br />

DIET CONTROL/<br />

EATING HABITS<br />

Are you presently controlling your diet?<br />

095-0<br />

Yes ............................... 1<br />

No. ............................... 2<br />

If yes, reason for diet control:<br />

Blood sugar level .................... 3<br />

Cholesterol level. .................... 4<br />

Lactose intolerance .................. 5<br />

Maintain weight ..................... 6<br />

Physical fitness. ..................... 7<br />

Regularity .......................... 8<br />

Salt restriction ...................... 9<br />

Weight loss. ........................ 0<br />

Other ............................. X<br />

Do you buy foods specific<strong>all</strong>y<br />

labeled as: 096-0<br />

Fat-free. ........................... 1<br />

Gluten-free ......................... 2<br />

High fiber .......................... 3<br />

High protein ........................ 4<br />

Lactose-free ........................ 5<br />

Low-calorie. ........................ 6<br />

Low-carb. .......................... 7<br />

Low-cholesterol ..................... 8<br />

Low-fat ............................ 9<br />

Low-sodium ........................ 0<br />

15R-0<br />

Natural or Organic ................... 1<br />

Probiotic ........................... 2<br />

Sugar-free ......................... 3<br />

Do you consider yourself to be:<br />

Semi-vegetarian ..................... 4<br />

Vegetarian ......................... 5<br />

Vegan ............................. 6<br />

If you are dieting, which methods are you using:<br />

097-0<br />

Alli ............................... 1<br />

Jenny Craig ........................ 2<br />

LA Weight Loss Center. ............... 3<br />

NutriSystem ........................ 4<br />

South Beach Diet .................... 5<br />

Weight Watchers .................... 6<br />

Other diet organization or<br />

club ............................. 7<br />

Atkins diet. ......................... 8<br />

Doctor’s care/diet .................... 9<br />

Diet control book .................... 0<br />

Exercise program .................... X<br />

Other ............................. Y<br />

You Person<strong>all</strong>y:<br />

LACTOSE<br />

Used in Times/<br />

INTOLERANCE<br />

last 6 last 30<br />

PRODUCTS months days<br />

098<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Dairy Ease ............. 01<br />

Lactaid ................ 02<br />

999<br />

OTHER (Write In)<br />

You Person<strong>all</strong>y:<br />

MEAL/DIETARY/<br />

Used in Times/<br />

WEIGHT LOSS last 6 last 7<br />

SUPPLEMENTS months days<br />

099<br />

TOTAL: ................ 00<br />

TYPES:<br />

Liquid ................. 01<br />

Powder ................ 02<br />

Tablet ................. 03<br />

BRANDS:<br />

Alli ................... 04<br />

Atkins Advantage ........ 05<br />

Boost ................. 06<br />

Carnation Instant Breakfast . 07<br />

Dexatrim. .............. 08<br />

Ensure ................ 09<br />

Glucerna. .............. 10<br />

Hydroxycut ............. 11<br />

Relacore. .............. 12<br />

Sensa ................. 13<br />

Slim-Fast .............. 14<br />

Slim-Fast Optima ........ 15<br />

SlimQuick .............. 16<br />

999<br />

OTHER (Write In)<br />

Used For: 15Q-0<br />

Weight Loss ............ 1<br />

Gain/Maintain Weight ..... 2<br />

Nutritional Supplement. ... 3<br />

Meal Replacement ....... 4<br />

INCONTINENCE<br />

PRODUCTS<br />

You Person<strong>all</strong>y:<br />

Used in Bought in<br />

last 6 last 6<br />

months months<br />

101 1 2<br />

Yes .................... 01<br />

BRANDS:<br />

Depend ................. 02<br />

Poise ................... 03<br />

Tena Serenity ............ 04<br />

Other ................... 05<br />

You Person<strong>all</strong>y:<br />

Bought in<br />

CONDOMS last 6<br />

months<br />

102-0<br />

Yes ...................... 1<br />

KINDS:<br />

Latex. .................... 2<br />

Natural Skin ............... 3<br />

BRANDS:<br />

Durex .................... 4<br />

LifeStyles ................. 5<br />

Naturalamb. ............... 6<br />

Trojan .................... 7<br />

Trojan-ENZ ................ 8<br />

Trojan Her Pleasure ......... 9<br />

Trojan Magnum. ............ 0<br />

Other .................... X<br />

You Person<strong>all</strong>y:<br />

BLEACH AND<br />

Used in Times/<br />

DEPILATORIES<br />

last 6 last 30<br />

(Hair Removal) months days<br />

104<br />

TOTAL: ................ 00<br />

TYPES:<br />

Bleach ................ 01<br />

Cream ................ 02<br />

Gel ................... 03<br />

Lotion ................. 04<br />

Spray ................. 05<br />

Wax .................. 06<br />

BRANDS:<br />

Hair Off. ............... 07<br />

Jolen. ................. 08<br />

Nair. .................. 09<br />

S<strong>all</strong>y Hansen ........... 10<br />

Veet .................. 11<br />

999<br />

OTHER (Write In)<br />

You Person<strong>all</strong>y:<br />

SUNTAN &<br />

Used in Times/last<br />

SUNSCREEN<br />

last 12 30 days<br />

PRODUCTS months (in season)<br />

105<br />

TOTAL: ................ 00<br />

TYPES:<br />

SPF 1-8 ............... 01<br />

SPF 15 ............... 02<br />

SPF 30 + .............. 03<br />

KINDS:<br />

Suntan Lotion/Sunscreen. . 04<br />

Sunless Tanner. ......... 05<br />

FORMS:<br />

Gel ................... 06<br />

Lotion ................. 07<br />

Oil. ................... 08<br />

Spray ................. 09<br />

Tube (cream) ........... 10<br />

BRANDS:<br />

Aveeno Continuous<br />

Protection ............ 11<br />

Bain de Soleil ........... 12<br />

Banana Boat ........... 13<br />

Banana Boat Sport. ...... 14<br />

Bull Frog ............... 15<br />

Bull Frog Mosquito Coast .. 16<br />

Clarins ................ 17<br />

Clinique ............... 18<br />

Coppertone Sport. ....... 19<br />

Other Coppertone ....... 20<br />

Estée Lauder ........... 21<br />

Hawaiian Tropic ......... 22<br />

Johnson’s Baby Oil. ...... 23<br />

Lancôme Sôleil Bronzer ... 24<br />

L’Oréal Sublime Bronze ... 25<br />

Mary Kay .............. 26<br />

Neutrogena Instant Bronze . 27<br />

Neutrogena Sunblock. .... 28<br />

Neutrogena Sunless<br />

Tanning .............. 29<br />

Other Neutrogena ....... 30<br />

No Ad ................ 31<br />

Ocean Potion ........... 32<br />

Panama Jack ........... 33<br />

Sea & Ski .............. 34<br />

999<br />

OTHER (Write In)<br />

SUNBURN<br />

REMEDIES<br />

106<br />

You Person<strong>all</strong>y:<br />

Used in Times/last<br />

last 12 30 days<br />

months (in season)<br />

TOTAL: ................ 00<br />

TYPES:<br />

Cream ................ 01<br />

Gel ................... 02<br />

Spray ................. 03<br />

BRANDS:<br />

Avon .................. 04<br />

Bactine ................ 05<br />

Banana Boat ........... 06<br />

Lanacane Spray ......... 07<br />

Noxzema .............. 08<br />

Solarcaine ............. 09<br />

999<br />

OTHER (Write In)

ailments/DOCTOR VISITS<br />

Page 16<br />

AILMENTS/<br />

REMEDIES<br />

You Person<strong>all</strong>y:<br />

How treated in the last 12 months?<br />

Have/ Used a prescription Used a Used a<br />

Had in remedy non- home/<br />

last 12 prescription herbal<br />

months Branded Generic remedy remedy<br />

Have not<br />

treated<br />

107 1 2 3 4 5 6<br />

AILMENTS<br />

Acne ........................ 01<br />

ADD/ADHD. .................. 02<br />

Allergy/Hay Fever .............. 03<br />

Anxiety/Panic ................. 04<br />

Arthritis/Rheumatoid arthritis (RA) . 05<br />

Arthritis/Osteoarthritis. .......... 06<br />

Asthma ...................... 07<br />

Athlete’s Foot ................. 08<br />

Backache/Back Pain. ........... 09<br />

Bipolar Disorder ............... 10<br />

Cancer ...................... 11<br />

Cold Sores ................... 12<br />

Constipation .................. 13<br />

Dandruff/Dry Scalp ............. 14<br />

Depression ................... 15<br />

Diabetes (Insulin Dependent). .... 16<br />

Diabetes (Non-Insulin Dependent) . 17<br />

Dry Eyes. .................... 18<br />

Eczema/Skin Itch/Rash ......... 19<br />

Epilepsy/Seizures. ............. 20<br />

Erectile Dysfunction (ED) ........ 21<br />

Fibromyalgia .................. 22<br />

Hair Loss .................... 23<br />

Hearing Loss ................. 24<br />

Heart Attack/Heart Disease ...... 25<br />

Heartburn/Acid Reflux .......... 26<br />

High Cholesterol. .............. 27<br />

Hypertension/High Blood<br />

Pressure ................... 28<br />

Insomnia. .................... 29<br />

Irritable Bowel Syndrome (IBS) ... 30<br />

Kidney Ailments ............... 31<br />

Macular Degeneration .......... 32<br />

Menopause/Hormone Replacement 33<br />

Migraine Headaches. ........... 34<br />

Multiple Sclerosis (MS). ......... 35<br />

Muscle Strain/Sprain ........... 36<br />

Nail Fungus .................. 37<br />

Obesity/Overweight ............ 38<br />

Osteoporosis ................. 39<br />

Overactive Bladder ............. 40<br />

Prostate ..................... 41<br />

Restless Legs Syndrome ........ 42<br />

Rosacea or Skin Disease ........ 43<br />

Sinus Congestion/Headache ..... 44<br />

Sleep Apnea. ................. 45<br />

Snoring ...................... 46<br />

Ulcer ........................ 47<br />

Urinary Tract Infection (UTI) ...... 48<br />

Wrinkles ..................... 49<br />

Yeast Infection ................ 50<br />

In the last 12 months, how did you obtain information about an ailment or prescription drug?<br />

15A-0<br />

Television Advertisement ........ 1 Patient support group ........... 7<br />

Magazine Advertisement ........ 2 Pharmacist ................... 8<br />

Other Advertisement ........... 3 Pharmaceutical company ........ 9<br />

Doctor or Health care professional . <br />

Medical journals ............... 0<br />

4<br />

Online/Internet site ............. X<br />

Friends/Family ................ 5<br />

Other. ....................... Y<br />

Pamphlets/Brochures. .......... 6<br />

DOCTOR<br />

VISITS<br />

094<br />

You Person<strong>all</strong>y:<br />

Visited Times/<br />

in last 12 last 12<br />

months months<br />

TOTAL: ................ 00<br />

TYPES:<br />

Acupuncturist ........... 01<br />

Allergist ............... 02<br />

Cardiologist ............ 03<br />

Chiropractor ............ 04<br />

Dentist ................ 05<br />

Dermatologist. .......... 06<br />

Ear, Nose & Throat. ...... 07<br />

Eye Doctor . . . . . . . . . . . . . . 08<br />

Gastroenterologist ....... 09<br />

General/Family Practitioner . 10<br />

Internist ............... 11<br />

Nurse Practitioner. ....... 12<br />

OB/Gyn ............... 13<br />

Osteopath. ............. 14<br />

Physical Therapist ....... 15<br />

Plastic Surgeon ......... 16<br />

Podiatrist .............. 17<br />

Psychiatrist. ............ 18<br />

Urologist ............... 19<br />

999<br />

OTHER (Write In)<br />

CAREGIVER/<br />

CARETAKER<br />

Are you, person<strong>all</strong>y, the primary caregiver for<br />

someone with a medical condition? Yes 1 15L-0<br />

If yes, what services/support do you provide?<br />

15N-0<br />

Assist with chores ........... 1<br />

Assist with personal care ...... 2<br />

Give medication ............. 3<br />

Make doctor’s appointments. ... 4<br />

Provide transportation ........ 5<br />

Research medical information .. 6<br />

Other ..................... 7<br />

Age of patient(s): 15W-0<br />

Less than 18 years old ..... 1<br />

18-64 years old. .......... 2<br />

65 years or older ......... 3<br />

Patient’s relationship to you: 15Y-0<br />

Relative ................ 1<br />

Friend .................. 2<br />

Other .................. 3<br />

HEALTHCARE<br />

ADVERTISING<br />

ACTIONS TAKEN<br />

14B-0<br />

Actions you took as a result of seeing or<br />

hearing healthcare advertising, in the last<br />

12 months:<br />

Bought a non-prescription product ..... 1<br />

Refilled a prescription. .............. 2<br />

Made an appointment to see a doctor . . 3<br />

Discussed an ad with your doctor ..... 4<br />

Discussed an ad with a friend or<br />

relative ......................... 5<br />

Asked your doctor to prescribe a<br />

specific drug ..................... 6<br />

Consulted a pharmacist ............. 7<br />

Visited a product or drug website ...... 8<br />

Visited another website ............. 9<br />

Requested a free sample ............ 0<br />

C<strong>all</strong>ed a toll-free number for information . . X<br />

Other ........................... Y

Page 17<br />

PRESCRIPTION DRUGS/HEALTH ATTITUDES<br />

PRESCRIPTION<br />

DRUGS<br />

You Person<strong>all</strong>y:<br />

Used<br />

in last<br />

12 months<br />

PRESCRIPTION<br />

DRUGS<br />

(Continued)<br />

You Person<strong>all</strong>y:<br />

Used<br />

in last<br />

12 months<br />

PRESCRIPTION<br />

DRUGS<br />

(Continued)<br />

108-0<br />

BRANDS:<br />

Abilify ...................... 1<br />

AcipHex. .................... 2<br />

Actonel ..................... 3<br />

Actos. ...................... 4<br />

Adder<strong>all</strong>. .................... 5<br />

Advair ...................... 6<br />

Allegra/Allegra D .............. 7<br />

Altace ...................... 8<br />

Ambien/Ambien CR ........... 9<br />

Asmanex .................... 0<br />

Astelin ...................... X<br />

Avandia ..................... Y<br />

109-0<br />

Avodart ..................... 1<br />

Boniva ...................... 2<br />

Botox. ...................... 3<br />

Caduet ..................... 4<br />

Celebrex .................... 5<br />

Cialis ....................... 6<br />

Clarinex. .................... 7<br />

Coreg ...................... 8<br />

Crestor ..................... 9<br />

Cymbalta. ................... 0<br />

Detrol/Detrol LA .............. X<br />

Diflucan. .................... Y<br />

110-0<br />

Diovan/Diovan HCT ........... 1<br />

Ditropan XL. ................. 2<br />

Effexor/Effexor XR. ............ 3<br />

Elidel ....................... 4<br />

Enablex ..................... 5<br />

Evista ...................... 6<br />

Flomax ..................... 7<br />

Flonase ..................... 8<br />

Flovent ..................... 9<br />

Fosamax .................... 0<br />

Glucophage/Glucophage XR .... X<br />

Glucovance .................. Y<br />

15S-0<br />

Imitrex ...................... 1<br />

Lamisil. ..................... 2<br />

Levitra ...................... 3<br />

Lexapro ..................... 4<br />

Lipitor ...................... 5<br />

Lunesta ..................... 6<br />

Lyrica ...................... 7<br />

111-0<br />

Mirapex ..................... 1<br />

Nasacort AQ ................. 2<br />

Nasonex .................... 3<br />

Nexium ..................... 4<br />

Norvasc. .................... 5<br />

Ortho Tri-cyclen. .............. 6<br />

Paxil/Paxil CR ................ 7<br />

Plavix ...................... 8<br />

Pravachol ................... 9<br />

Prevacid .................... 0<br />

Protonix. .................... X<br />

112-0<br />

Prozac. ..................... 1<br />

Pulmicort. ................... 2<br />

Requip. ..................... 3<br />

Restasis .................... 4<br />

Restylane ................... 5<br />

Rhinocort ................... 6<br />

Rozerem .................... 7<br />

Seroquel .................... 8<br />

Singulair .................... 9<br />

Spiriva. ..................... 0<br />

Topamax .................... X<br />

Valtrex ...................... Y<br />

15T-0<br />

Vesicare .................... 1<br />

Viagra ...................... 2<br />

Vytorin. ..................... 3<br />

Wellbutrin ................... 4<br />

Zetia ....................... 5<br />

Zocor. ...................... 6<br />

Zoloft. ...................... 7<br />

Number of prescriptions filled for yourself in<br />

the last 30 days 15E-0<br />

Write in number<br />

On the average, how much do you spend out<br />

of pocket per month on your prescription<br />

medication(s)?<br />

$ 15F-0<br />

Write in amount<br />

In the last 12 months, where did you fill a<br />

prescription?<br />

15H-0<br />

Drug Store/Pharmacy .......... 1<br />

Supermarket ................. 2<br />

Discount/Department Store ..... 3<br />

Mail order ................... 4<br />

Internet/Online ............... 5<br />

Other. ...................... 6<br />

You Person<strong>all</strong>y:<br />

CONTRACEPTION<br />

Used in last<br />

(Women) 12 months<br />

15J-0<br />

Depo-Provera ............... 1<br />

Loestrin ................... 2<br />

Mirena .................... 3<br />

NuvaRing .................. 4<br />

Ortho Evra ................. 5<br />

Ortho Tri-cyclen ............. 6<br />

Ortho Tri-cyclen Lo ........... 7<br />

Plan B. .................... 8<br />

Seasonique ................ 9<br />

Yasmin .................... 0<br />

Yaz ....................... X<br />

14R-0<br />

IUD ....................... 1<br />

Diaphragm or Cervical Cap .... 2<br />

3<br />

OTHER (Write In)<br />

HEALTH<br />

ATTITUDES<br />

Please indicate how much you AGREE or DISAGREE with each of the following statements by checking the box that comes closest<br />

to how you feel.<br />

Agree Somewhat Somewhat Disagree<br />

15C Strongly Agree Disagree Strongly<br />

1 2 3 4<br />

1. I go to the doctor regularly for check-ups ....................................... 01<br />

2. I prefer alternative medicine to traditional medical practices ........................ 02<br />

3. Generic medications are as effective as brand-name prescription drugs. .............. 03<br />

4. In general, I feel I eat right .................................................. 04<br />

5. In general, I think herbal supplements are effective ............................... 05<br />

6. I take my prescription medicines exactly as prescribed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06<br />

7. I’m often first to try the most advanced medicines ................................ 07<br />

8. I prefer popular brand-name drugs, even if they cost more ......................... 08<br />

9. I rely on my physician to recommend drug brands. ............................... 09<br />

10. In general, newer drug brands work better than older brands ....................... 10<br />

11. If a drug brand works, I stick with it ........................................... 11<br />

12. To save money, I would buy prescription drugs from countries other than the United States. 12<br />

13. Before I begin taking any drug, I look for as much information about it as possible. ...... 13<br />

14. I am willing to take prescription drugs even if my insurance company doesn’t cover them. . 14<br />

15. Over the counter medications are safer than prescription drugs. . .................... 15<br />

16. I only go to the doctor when I’m very ill. . ....................................... 16<br />

17. Sometimes I skip a dose of my prescription drugs because I worry about the side effects. . 17<br />

18. I take medicine as soon as I don’t feel well. . .................................... 18<br />

19. Medication has improved the quality of my life. .............................. 19<br />

20. I follow a regular exercise routine. ............................................ 20<br />

21. My medical conditions limit my lifestyle somewhat. ............................... 21<br />

22. I am always looking for new ways to live a healthier life. ........................... 22<br />

23. I am happy with my weight. . ................................................ 23<br />

24. I consult my pharmacist for health advice. ...................................... 24

ARTIFICIAL SWEETENERS AND GUM/SNACKS<br />

Page 18<br />

MINTS<br />

You Person<strong>all</strong>y:<br />

Bought/ Packages/<br />

last 6 last 7<br />

months days<br />

121<br />

TOTAL: ................ 00<br />

TYPES:<br />

Sugarless. ............. 01<br />

Regular. ............... 02<br />

BRANDS:<br />

Altoids ................ 03<br />

Breath Savers. .......... 04<br />

Certs. ................. 05<br />

Doublemint Twins ........ 06<br />

Eclipse Mints ........... 07<br />

Ice Breakers ............ 08<br />

Life Savers . . . . . . . . . . . . . . 09<br />

Mentos Mint ............ 10<br />

Tic Tac Mint ............ 11<br />

999<br />

OTHER (Write In)<br />

NUTRITION/<br />

ENERGY BARS<br />

15V<br />

You Person<strong>all</strong>y:<br />

Used in Bars/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Atkins Advantage ........ 01<br />

Balance Bar ............ 02<br />

Balance Gold ........... 03<br />

Clif Bar ................ 04<br />

Eas AdvantEdge Bar ..... 05<br />

Glucerna Bar ........... 06<br />

Harvest Bar ............ 07<br />

Kashi Golean Bar ...... 08<br />

Luna Bar. .............. 09<br />

Met Rx Bar ............. 10<br />

PowerBar .............. 11<br />

Pria Bar ............... 12<br />

Pure Protein ............ 13<br />

Slim-Fast Bar ........... 14<br />

Snickers Marathon ....... 15<br />

SoyJoy Bar. ........... 16<br />

Zone Perfect Bar ........ 17<br />

999<br />

OTHER (Write In)<br />

ARTIFICIAL<br />

SWEETENERS<br />

122<br />

You Person<strong>all</strong>y:<br />

Used in Times/<br />

last 6 last 7<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Tablets ................ 01<br />

Packets. ............... 02<br />

Loose Powder .......... 03<br />

BRANDS:<br />

Equal ................. 04<br />

NatraTaste ............. 05<br />

NutraSweet . . . . . . . . . . . . . 06<br />

PureVia ............... 07<br />

Splenda ............... 08<br />

Sugar Twin ............. 09<br />

Sweet ’n Low ........... 10<br />

Truvia ................. 11<br />

999<br />

OTHER (Write In)<br />

CHEWING GUM<br />

You Person<strong>all</strong>y:<br />

Chewed Sticks/<br />

in last 6 pieces last<br />

months 7 days<br />

123<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Altoids Gum ............ 01<br />

Bazooka ............... 02<br />

Big League Chew. ....... 03<br />

Bubble Yum Sugarless .... 04<br />

Other Bubble Yum ....... 05<br />

Bubblicious. ............ 06<br />

Chiclets ............... 07<br />

Clorets (Squares) ........ 08<br />

Dentyne Cinnamon (Classic) . 09<br />

Dentyne Spicy Cinnamon. . 10<br />

Dentyne Ice ............ 11<br />

Dubble Bubble .......... 12<br />

5 Gum ................ 13<br />

Freshen-Up ............ 14<br />

Fruit Stripe Gum. ........ 15<br />

Hubba Bubba ........... 16<br />

Ice Breakers ............ 17<br />

Mentos Gum. ........... 18<br />

Stride ................. 19<br />

Trident Bubble Gum ...... 20<br />

Trident Splash. .......... 21<br />

Trident Sugarless ........ 22<br />

Trident White. ........... 23<br />

Wrigley’s Big Red ........ 24<br />

Wrigley’s Doublemint ..... 25<br />

Wrigley’s Eclipse ........ 26<br />

Wrigley’s Extra Bubble Gum 27<br />

Other Wrigley’s Extra ..... 28<br />

Wrigley’s Freedent ....... 29<br />

Wrigley’s Juicy Fruit ...... 30<br />

Wrigley’s Orbit .......... 31<br />

Wrigley’s Orbit White ..... 32<br />

Wrigley’s Spearmint ...... 33<br />

Wrigley’s Winterfresh ..... 34<br />

999<br />

OTHER (Write In)<br />

HARD ROLL CANDY<br />

You Person<strong>all</strong>y:<br />

Bought/ Rolls/<br />

last 6 last 7<br />

months days<br />

124<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Charms. ............... 01<br />

Jolly Rancher ........... 02<br />

Life Savers . . . . . . . . . . . . . . 03<br />

Life Savers Creme Savers . 04<br />

Mentos Mixed Fruit. ...... 05<br />

Sweet ’n Low Sugar Free .. 06<br />

Werther’s Original. ....... 07<br />

999<br />

OTHER (Write In)<br />

NUTS<br />

125<br />

You Person<strong>all</strong>y:<br />

Bought Containers/<br />

in last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Dry-roasted ............ 01<br />

Honey Roasted. ......... 02<br />

Regular. ............... 03<br />

FORMS:<br />

Salted ................. 04<br />

Unsalted ............... 05<br />

KINDS:<br />

Almonds (Smoked). ...... 06<br />

Almonds (Other Types). ... 07<br />

Beer Nuts .............. 08<br />

Cashews. .............. 09<br />

Hazelnuts .............. 10<br />

Macadamia. ............ 11<br />

Mixed Nuts ............. 12<br />

Peanuts ............... 13<br />

Pecans ................ 14<br />

Pistachios. ............. 15<br />

Sunflower Seeds ........ 16<br />

Walnuts. ............... 17<br />

BRANDS:<br />

Blue Diamond. .......... 18<br />

David ................. 19<br />

Diamond. .............. 20<br />

Dole .................. 21<br />

Emerald ............... 22<br />

Fisher ................. 23<br />

Mauna Loa ............. 24<br />

Planters ............... 25<br />

999<br />

OTHER (Write In)<br />

SNACK MIXES<br />

126<br />

You Person<strong>all</strong>y:<br />

Bought Boxes/<br />

in last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Cheerios Snack Mix ...... 01<br />

Cheez-it Party Mix ....... 02<br />

Chex Mix .............. 03<br />

Gardetto’s. ............. 04<br />

Planters Trail Mix ........ 05<br />

Ritz Snack Mix . . . . . . . . . . . 06<br />

999<br />

OTHER (Write In)<br />

BOXED<br />

CHOCOLATES<br />

127<br />

You Person<strong>all</strong>y:<br />

Bought Boxes/<br />

in last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Cadbury Milk Tray. ....... 01<br />

Fannie May. ............ 02<br />

Ferrero Rocher. ......... 03<br />

Ghirardelli. ............. 04<br />

Godiva ................ 05<br />

Hershey’s Pot of Gold. .... 06<br />

Lindt .................. 07<br />

Perugina. .............. 08<br />

Russell Stover .......... 09<br />

See’s ................. 10<br />

Whitman’s. ............. 11<br />

999<br />

OTHER (Write In)<br />

How purchased: 128-0<br />

Bought as gift ........... 1<br />

Bought for self .......... 2

Page 19<br />

CANDY<br />

CANDY<br />

(Regular or King Size)<br />

129<br />

You Person<strong>all</strong>y:<br />

Individual<br />

bars, boxes,<br />

Bought bags bought<br />

last 6 last 7<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Regular Size. ........... 01<br />

King Size .............. 02<br />

BRANDS:<br />

Airheads ............... 03<br />

Almond Joy. ............ 04<br />

Baby Ruth. ............. 05<br />

Bit-O-Honey . . . . . . . . . . . . . 06<br />

Brach’s Peanut Clusters ... 07<br />

Butterfinger. ............ 08<br />

Cadbury Caramello ...... 09<br />

Cadbury Creme Egg ..... 10<br />

Cadbury Fruit and Nut .... 11<br />

Cadbury Milk Chocolate ... 12<br />

Cadbury Roast Almond ... 13<br />

Other Cadbury .......... 14<br />

Charleston Chew ........ 15<br />

Chunky ................ 16<br />

Clark. ................. 17<br />

Dove Chocolate ......... 18<br />

5th Avenue ............. 19<br />

Ghirardelli. ............. 20<br />

Goobers ............... 21<br />

Good & Plenty .......... 22<br />

Green & Black’s ......... 23<br />

Heath ................. 24<br />

Hershey’s-Almond ....... 25<br />

Hershey’s Bliss. ......... 26<br />

Hershey’s Extra Dark . . . . . . 27<br />

Hershey’s Golden Almond . 28<br />

Hershey’s Kisses (Single<br />

serving pack) ......... 29<br />

Hershey’s Kisses with<br />

Almonds (Single serving<br />

pack). ............... 30<br />

Hershey’s Milk Chocolate. . 31<br />

Hershey’s Special Dark ... 32<br />

Hershey’s Symphony ..... 33<br />

Junior Mints ............ 34<br />

Kit Kat. ................ 35<br />

Life Savers Gummies ..... 36<br />

Lindt .................. 37<br />

M & M’s Almond ......... 38<br />

M & M’s Dark Chocolate. .. 39<br />

M & M’s Dark Chocolate<br />

Peanut .............. 40<br />

M & M’s Milk Chocolate ... 41<br />

M & M’s Mini’s .......... 42<br />

M & M’s Mint. ........... 43<br />

M & M’s Peanut ......... 44<br />

M & M’s Peanut Butter .... 45<br />

Milk Duds .............. 46<br />

Milky Way .............. 47<br />

Milky Way Midnight. ...... 48<br />

Mounds ............... 49<br />

Mr. Goodbar ............ 50<br />

Nerds ................. 51<br />

Nestlé Crunch .......... 52<br />

Nestlé Milk Chocolate .... 53<br />

Now and Later .......... 54<br />

100 Grand ............. 55<br />

PayDay ................ 56<br />

Push Pop .............. 57<br />

Raisinets .............. 58<br />

Red Vines. ............. 59<br />

CANDY<br />

(Regular or King Size)<br />

(Continued)<br />

You Person<strong>all</strong>y:<br />

Individual<br />

bars, boxes,<br />

Bought bags bought<br />

last 6 last 7<br />

months days<br />

Reese’s Peanut Butter Cup . 60<br />

Reese’s Pieces. ......... 61<br />

ReeseSticks ............ 62<br />

Reese’s White Choc. PB Cup 63<br />

Riesen Chocolate Chew. .. 64<br />

Rolo .................. 65<br />

Russell Stover .......... 66<br />

Skittles ................ 67<br />

Skor .................. 68<br />

Snickers ............... 69<br />

Snickers Cruncher ....... 70<br />

Snickers Dark. .......... 71<br />

Sno-Caps .............. 72<br />

Spree ................. 73<br />

Starburst Fruit Chews .... 74<br />

Sugar Babies ........... 75<br />

Sugar Daddy ........... 76<br />

Sweetarts .............. 77<br />

Take 5. ................ 78<br />

3 Musketeers ........... 79<br />

Tootsie Rolls ............ 80<br />

Twix .................. 81<br />

Twizzlers. .............. 82<br />

Twizzlers Pull & Peel ..... 83<br />

Whatchamac<strong>all</strong>it ......... 84<br />

Whoppers .............. 85<br />

York Peppermint Pattie .... 86<br />

Zero .................. 87<br />

999<br />

OTHER (Write In)<br />

PACKAGES OF<br />

MINIATURE/LOOSE<br />

CANDY<br />

You Person<strong>all</strong>y:<br />

Bought Packages<br />

last 6 last 30<br />

months days<br />

130<br />

TOTAL: ................ 00<br />

BRANDS:<br />

After Eight ............. 01<br />

Almond Joy. ............ 02<br />

Andes Candies. ......... 03<br />

Baby Ruth. ............. 04<br />

Brach’s Candy Corn ...... 05<br />

Brach’s Jelly Beans ...... 06<br />

Brach’s Pick-A-Mix ....... 07<br />

Butterfinger . . . . . . . . . . . . . . 08<br />

Cadbury Mini Eggs. ...... 09<br />

Dove Promises Chocolate . 10<br />

5th Avenue ............. 11<br />

Hershey’s-Almond ....... 12<br />

Hershey’s Bliss. ......... 13<br />

Hershey’s Hugs ......... 14<br />

Hershey’s Kisses ........ 15<br />

Hershey’s Kisses with<br />

Almonds ............. 16<br />

Hershey’s Krackel. ....... 17<br />

Hershey’s Milk Chocolate. . 18<br />

Hershey’s Miniatures ..... 19<br />

Hershey’s Nuggets ....... 20<br />

Jelly Belly beans ........ 21<br />

Jolly Rancher Fruit Chews . 22<br />

Jolly Rancher Gummies ... 23<br />

Jolly Rancher Hard Candy . 24<br />

Junior Mints Minis. ....... 25<br />

Kraft Caramels .......... 26<br />

Life Savers . . . . . . . . . . . . . . 27<br />

Life Savers Gummies ..... 28<br />

M & M’s Almond ......... 29<br />

M & M’s Milk Chocolate ... 30<br />

M & M’s Peanut ......... 31<br />

M & M’s Peanut Butter .... 32<br />

M & M’s Premiums ....... 33<br />

Milk Duds .............. 34<br />

Milky Way .............. 35<br />

Mounds ............... 36<br />

Mr. Goodbar ............ 37<br />

Nestlé Crunch .......... 38<br />

Nestlé Treasures ........ 39<br />

Raisinets .............. 40<br />

Reese’s Peanut Butter Cup . 41<br />

Reese’s Pieces. ......... 42<br />

Riesen Chocolate Chew. .. 43<br />

Rolo .................. 44<br />

Skittles ................ 45<br />

Snickers ............... 46<br />

Sour Patch Kids ......... 47<br />

Starburst Fruit Chews. .... 48<br />

Starburst Jellybeans. ..... 49<br />

Swedish Fish ........... 50<br />

3 Musketeers ........... 51<br />

Tootsie Rolls ............ 52<br />

Twix .................. 53<br />

Twizzlers. .............. 54<br />

Werther’s Original. ....... 55<br />

Whoppers .............. 56<br />

York Peppermint Pattie .... 57<br />

999<br />

OTHER (Write In)<br />

Continued in next Column

BEVERAGES<br />

Page 20<br />

DIET COLA DRINKS<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 7 days<br />

133<br />

TOTAL: ................ 00<br />

KINDS:<br />

Plastic Bottles. .......... 01<br />

Glass Bottles ........... 02<br />

Cans. ................. 03<br />

BRANDS:<br />

Caffeine Free Diet Coke ... 04<br />

Coca-Cola Zero ......... 05<br />

Diet Black Cherry Vanilla<br />

Coke ................ 06<br />

Diet Cherry Coke ........ 07<br />

Diet Coke . . . . . . . . . . . . . . . 08<br />

Diet Coke w/Lime ........ 09<br />

Diet Coke Plus . . . . . . . . . . . 10<br />

Diet Rite Cola ........... 11<br />

Caffeine Free Diet Pepsi. .. 12<br />

Diet Pepsi .............. 13<br />

Diet Pepsi Lime ......... 14<br />

Jazz by Diet Pepsi ....... 15<br />

Pepsi One. ............. 16<br />

Store’s Own Brand ....... 17<br />

999<br />

OTHER (Write In)<br />

REGULAR COLA<br />

DRINKS, NOT DIET<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 7 days<br />

134<br />

TOTAL: ................ 00<br />

KINDS:<br />

Plastic Bottles. .......... 01<br />

Glass Bottles ........... 02<br />

Cans. ................. 03<br />

BRANDS:<br />

Black Cherry Vanilla Coke . 04<br />

Caffeine Free Coca-Cola .. 05<br />

Cherry Coke ............ 06<br />

Coca-Cola Classic ....... 07<br />

Pepsi-Cola ............. 08<br />

Caffeine Free Pepsi ...... 09<br />

Wild Cherry Pepsi. ....... 10<br />

RC Cola ............... 11<br />

Store’s Own Brand ....... 12<br />

999<br />

OTHER (Write In)<br />

SPORTS DRINKS/<br />

THIRST QUENCHERS<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks/<br />

last 6 last 30<br />

months days<br />

135<br />

TOTAL: ................ 00<br />

BRANDS:<br />

All Sport . . . . . . . . . . . . . . . . 01<br />

Capri Sun Sport ......... 02<br />

Gatorade .............. 03<br />

Gatorade Endurance ..... 04<br />

Gatorade Frost .......... 05<br />

Powerade .............. 06<br />

999<br />

OTHER (Write In)<br />

READY TO DRINK<br />

ICED TEA<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 7 days<br />

136<br />

TOTAL: ................ 00<br />

TYPES:<br />

Flavored ............... 01<br />

Unflavored ............. 02<br />

BRANDS:<br />

Arizona ................ 03<br />

Crystal Light ............ 04<br />

Enviga ................ 05<br />

Gold Peak. ............. 06<br />

Lipton Brisk ............ 07<br />

Lipton’s Iced Tea. ........ 08<br />

Nestea ................ 09<br />

POM Tea .............. 10<br />

Snapple ............... 11<br />

999<br />

OTHER (Write In)<br />

OTHER DIET SOFT<br />

DRINKS, NOT COLAS<br />

137<br />

You Person<strong>all</strong>y:<br />

Drank Drinks or<br />

in last 6 glasses/<br />

months last 7 days<br />

TOTAL: ................ 00<br />

KINDS:<br />

Plastic Bottles. .......... 01<br />

Glass Bottles ........... 02<br />

Cans. ................. 03<br />

BRANDS:<br />

Diet A & W Root Beer. .... 04<br />

Diet Barq’s Root Beer. .... 05<br />

Canada Dry Diet Ginger Ale 06<br />

Diet Dr Pepper .......... 07<br />

Fresca ................ 08<br />

Diet Mountain Dew. ...... 09<br />

Diet Mug Root Beer ...... 10<br />

Diet Schweppes ......... 11<br />

Diet 7 Up .............. 12<br />

Diet Cherry 7 Up ........ 13<br />

Diet Sierra Mist. ......... 14<br />

Diet Sprite ............. 15<br />

Diet Squirt ............. 16<br />

Diet Sunkist Orange ...... 17<br />

999<br />

OTHER (Write In)<br />

BOTTLED WATER &<br />

SELTZER<br />

You Person<strong>all</strong>y:<br />

Drank Drinks or<br />

in last 6 glasses/<br />

months last 7 days<br />

138<br />

TOTAL: ................ 00<br />

TYPES:<br />

Flavored ............... 01<br />

Non-Flavored ........... 02<br />

KINDS:<br />

Sparkling .............. 03<br />

Non-Sparkling .......... 04<br />

FORMS:<br />

Sweetened ............. 05<br />

Unsweetened ........... 06<br />

BRANDS:<br />

Aquafina ............... 07<br />

Arrowhead ............. 08<br />

Calistoga .............. 09<br />

Canada Dry Seltzer ...... 10<br />

Clearly Canadian ........ 11<br />

Crystal Geyser .......... 12<br />

Crystal Springs. ......... 13<br />

Dasani ................ 14<br />

Deer Park .............. 15<br />

Deja Blue .............. 16<br />

Evian ................. 17<br />

Fiji. ................... 18<br />

FlavorSplash ........... 19<br />

Fruit 2 O ................ 20<br />

Ice Mountain. ........... 21<br />

Mountain V<strong>all</strong>ey ......... 22<br />

Natural Mineral Water. .... 23<br />

Ozarka ................ 24<br />

Perrier ................ 25<br />

Poland Spring. .......... 26<br />

Propel. ................ 27<br />

S.Pellegrino ............ 28<br />

Schweppes Seltzer. ...... 29<br />

Smartwater (Glacéau) .... 30<br />

Special K 2O Protein Water . 31<br />

Sparkletts .............. 32<br />

SoBe Lifewater .......... 33<br />

Spring! ................ 34<br />

Vintage Seltzer .......... 35<br />

Vitamin Water (Glacéau) .. 36<br />

Zephyrhills ............. 37<br />

999<br />

OTHER (Write In)<br />

Do you receive home delivery of bottled<br />

water? Yes 1 139-0<br />

OTHER REGULAR You Person<strong>all</strong>y:<br />

CARBONATED SOFT Drank in Drinks or<br />

DRINKS<br />

last 6 glasses/<br />

(Not seltzer, colas or diet) months last 7 days<br />

140<br />

TOTAL: ................ 00<br />

KINDS:<br />

Plastic Bottles. .......... 01<br />

Glass Bottles ........... 02<br />

Cans. ................. 03<br />

BRANDS:<br />

A & W Root Beer ........ 04<br />

Barq’s Root Beer ........ 05<br />

Canada Dry Club Soda ... 06<br />

Canada Dry Ginger Ale ... 07<br />

Other Canada Dry ....... 08<br />

Crush-Orange .......... 09<br />

Dad’s Root Beer ......... 10<br />

Dr Pepper .............. 11<br />

Cherry Vanilla Dr Pepper .. 12<br />

Fanta ................. 13<br />

Faygo . . . . . . . . . . . . . . . . . . 14<br />

Hires Root Beer ......... 15<br />

IBC Root Beer .......... 16<br />

Mello Yello ............. 17<br />

Mountain Dew .......... 18<br />

Mountain Dew Code Red .. 19<br />

Mountain Dew LiveWire ... 20<br />

Mug Root Beer .......... 21<br />

Pibb Xtra. .............. 22<br />

Seagram’s Ginger Ale .... 23<br />

7 Up .................. 24<br />

Cherry 7 Up ............ 25<br />

7 Up Plus .............. 26<br />

Schweppes Club Soda. ... 27<br />

Schweppes Ginger Ale. ... 28<br />

Schweppes Tonic . . . . . . . . . 29<br />

Shasta ................ 30<br />

Sierra Mist ............. 31<br />

Slice .................. 32<br />

Sprite ................. 33<br />

Sprite Remix. ........... 34<br />

Squirt ................. 35<br />

Sunkist ................ 36<br />

Vault .................. 37<br />

Vernors. ............... 38<br />

Welch’s Grape Soda. ..... 39<br />

999<br />

OTHER (Write In)<br />

ENERGY DRINKS<br />

143<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

SIZE:<br />

Shot .................. 01<br />

Regular. ............... 02<br />

BRANDS:<br />

180 Energy Drink ........ 03<br />

AMP .................. 04<br />

Extreme Energy 6-Hour Shot 05<br />

5-hour Energy .......... 06<br />

Full Throttle ............ 07<br />

Gatorade Energy Drink ... 08<br />

Monster ............... 09<br />

NOS .................. 10<br />

Red Bull ............... 11<br />

Rockstar ............... 12<br />

6 Hour Power . . . . . . . . . . . . 13<br />

SoBe Adrenaline Rush. ... 14<br />

Tab Energy ............. 15<br />

999<br />

OTHER (Write In)

BEVERAGES<br />

Page 22<br />

IMPORTED DINNER/<br />

TABLE WINES<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 7 days<br />

150<br />

TOTAL: ................ 00<br />

KINDS:<br />

Australian Red .......... 01<br />

Australian White ......... 02<br />

French Red. ............ 03<br />

French Rosé. ........... 04<br />

French White ........... 05<br />

German White .......... 06<br />

Italian Red ............. 07<br />

Italian Rosé ............ 08<br />

Italian White ............ 09<br />

South American Red ..... 10<br />

South American White .... 11<br />

Spanish Red. ........... 12<br />

Spanish White .......... 13<br />

Other ................. 14<br />

BRANDS:<br />

Alice White ............. 15<br />

Bella Sera. ............. 16<br />

Black Swan. ............ 17<br />

Bolla .................. 18<br />

Cavit .................. 19<br />

Concha y Toro .......... 20<br />

Ecco Domani ........... 21<br />

George DuBoeuf ........ 22<br />

Jacob’s Creek. .......... 23<br />

Lindemans ............. 24<br />

The Little Penguin. ....... 25<br />

Luna di Luna ........... 26<br />

Mouton Cadet. .......... 27<br />

Real Sangria ........... 28<br />

Riunite ................ 29<br />

Rosemount Estate ....... 30<br />

Ruffino ................ 31<br />

Santa Margherita ........ 32<br />

Schmitt Söhne .......... 33<br />

Yellow Tail .............. 34<br />

999<br />

OTHER (Write In)<br />

CHAMPAGNE, COLD<br />

DUCK & SPARKLING<br />

WINES<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

151<br />

TOTAL: ................ 00<br />

KINDS:<br />

Asti Spumanti ........... 01<br />

Champagne ............ 02<br />

Cold Duck. ............. 03<br />

Prosecco .............. 04<br />

Other Sparkling Wines .... 05<br />

BRANDS:<br />

Andre ................. 06<br />

B<strong>all</strong>atore ............... 07<br />

Chandon. .............. 08<br />

Cook’s ................ 09<br />

Dom Perignon .......... 10<br />

Freixenet. .............. 11<br />

Korbel ................. 12<br />

Krug .................. 13<br />

Martini & Rossi. ......... 14<br />

Moët & Chandon ........ 15<br />

Mumm ................ 16<br />

Perrier-Jouët. ........... 17<br />

Tosti .................. 18<br />

Verdi Spumante ......... 19<br />

Veuve Clicquot .......... 20<br />

999<br />

OTHER (Write In)<br />

PORT, SHERRY &<br />

DESSERT WINES<br />

153<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Dry ................... 01<br />

Sweet ................. 02<br />

BRANDS:<br />

Christian Brothers ....... 03<br />

G<strong>all</strong>o. ................. 04<br />

Harvey’s Bristol Cream. ... 05<br />

Taylor ................. 06<br />

999<br />

OTHER (Write In)<br />

CORDIALS &<br />

LIQUEURS<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

154<br />

TOTAL: ................ 00<br />

KINDS:<br />

Amaretto. .............. 01<br />

Anisette ............... 02<br />

Blackberry ............. 03<br />

Coffee. ................ 04<br />

Creme de Cacao ........ 05<br />

Creme de Menthe ....... 06<br />

Hazelnut ............... 07<br />

Irish Cream. ............ 08<br />

Melon ................. 09<br />

Sambuca .............. 10<br />

Peach Schnapps ........ 11<br />

Peppermint Schnapps .... 12<br />

Other Schnapps ......... 13<br />

Triple Sec/Orange. ....... 14<br />

Other ................. 15<br />

BRANDS:<br />

Alizé . . . . . . . . . . . . . . . . . . . 16<br />

Amaretto Di Amore. ...... 17<br />

Bailey’s Orig. Irish Cream. . 18<br />

B & B ................. 19<br />

Campari ............... 20<br />

Chambord ............. 21<br />

Cointreau .............. 22<br />

DeKuyper .............. 23<br />

DiSaronno Originale ..... 24<br />

Drambuie .............. 25<br />

Frangelico. ............. 26<br />

Godiva ................ 27<br />

Goldschläger ........... 28<br />

Grand Marnier .......... 29<br />

Hpnotiq. ............... 30<br />

Jägermeister ........... 31<br />

Kahlúa ................ 32<br />

Kamora. ............... 33<br />

Midori ................. 34<br />

PAMA ................. 35<br />

Romana Sambuca ....... 36<br />

Southern Comfort. ....... 37<br />

Starbucks Liqueur ....... 38<br />

Tequila Rose. ........... 39<br />

999<br />

OTHER (Write In)<br />

VERMOUTH<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

152<br />

TOTAL: ................ 00<br />

TYPES:<br />

Dry ................... 01<br />

Sweet ................. 02<br />

BRANDS:<br />

Martini & Rossi. ......... 03<br />

Stock ................. 04<br />

999<br />

OTHER (Write In)<br />

MIXED DRINKS<br />

155<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Apple Martini ........... 01<br />

Black Russian. .......... 02<br />

Bloody Mary ............ 03<br />

Bourbon & Coke. ........ 04<br />

Cosmopolitan ........... 05<br />

Daiquiri. ............... 06<br />

Fuzzy Navel ............ 07<br />

Gin & Tonic ............. 08<br />

Gin Martini ............. 09<br />

Irish Coffee. ............ 10<br />

Jack & Coke ............ 11<br />

Kahlúa & Coffee ......... 12<br />

Kahlúa & Cream. ........ 13<br />

Kahlúa & Milk ........... 14<br />

Lemon Drop ............ 15<br />

Long Island Iced Tea ..... 16<br />

Manhattan ............. 17<br />

Margarita .............. 18<br />

Mimosa. ............... 19<br />

Mojito ................. 20<br />

Mudslide. .............. 21<br />

Piña Colada ............ 22<br />

Rum & Coke. ........... 23<br />

Scotch & Water. ......... 24<br />

Screwdriver ............ 25<br />

Sea Breeze. ............ 26<br />

7 & 7. ................. 27<br />

Tequila Sunrise. ......... 28<br />

Tom Collins. ............ 29<br />

Vodka Martini ........... 30<br />

Vodka & Cranberry ....... 31<br />

Vodka & Tonic. .......... 32<br />

Whiskey Sour ........... 33<br />

White Russian .......... 34<br />

999<br />

OTHER (Write In)<br />

PREPARED<br />

MIXED DRINKS<br />

WITH LIQUOR<br />

156<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Arbor Mist Wine Blenders. . 01<br />

Bacardi Party Drinks ..... 02<br />

Chi Chi’s Margaritas ...... 03<br />

José Cuervo Authentic<br />

Margaritas. ........... 04<br />

José Cuervo Golden<br />

Margarita ............ 05<br />

Kahlúa White Russian .... 06<br />

Smirnoff Signatures ...... 07<br />

TGI Friday’s ............ 08<br />

999<br />

OTHER (Write In)<br />

PREPARED<br />

MIXED DRINKS<br />

WITHOUT LIQUOR<br />

157<br />

You Person<strong>all</strong>y:<br />

Drank in Drinks or<br />

last 6 glasses/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Frozen Concentrate ...... 01<br />

Liquid ................. 02<br />

BRANDS:<br />

Bacardi Mixers .......... 03<br />

Hood Egg Nog .......... 04<br />

José Cuervo Margarita Mix . 05<br />

Mr. & Mrs. T ............ 06<br />

999<br />

OTHER (Write In)

ATV’S/MOTORCYCLES/TRUCK RENTAL/AUTO CLUBS<br />

Page 26<br />

MOTORCYCLES<br />

ATVs/UTVs<br />

Do you or does anyone else in your household own any motorcycles?<br />

234-0<br />

Yes 1 No 2<br />

If so, how many motorcycles does your whole household own?<br />

235-0<br />

One 1 Two 2 Three or more 3<br />

Most 2nd Most<br />

Recent Recent Other<br />

Purchase Purchase Purchase<br />

What year model is it? 236-0 243-0 250-0<br />

2010 .......................... 1 1 1<br />

2009 .......................... 2 2 2<br />

2008 .......................... 3 3 3<br />

2007 .......................... 4 4 4<br />

2006 .......................... 5 5 5<br />

2005 or earlier .................. 6 6 6<br />

Was it bought new or used?<br />

New .......................... 7 7 7<br />

Used. ......................... 8 8 8<br />

Who decided which make to buy? 237-0 244-0 251-0<br />

Yourself (alone or with<br />

someone else). ................ 1 1 1<br />

Someone else .................. 2 2 2<br />

When was motorcycle acquired? 238-0 245-0 252-0<br />

In past 12 months. ............... 1 1 1<br />

1-2 years ago ................... 2 2 2<br />

3-4 years ago ................... 3 3 3<br />

5 or more years ago .............. 4 4 4<br />

What type is it? 239-0 246-0 253-0<br />

Dirt bike (off-road—Competition) .... 1 1 1<br />

Dirt bike (off-road—Enduro) ........ 2 2 2<br />

Other dirt/trail bike ............... 3 3 3<br />

Dual purpose dirt/street bike ....... 4 4 4<br />

Street Bike:<br />

Cruiser ...................... 5 5 5<br />

Custom ...................... 6 6 6<br />

Standard ..................... 7 7 7<br />

Touring ...................... 8 8 8<br />

Sport/Performance . . . . . . . . . . . . . 9 9 9<br />

Which engine size is it? 240-0 247-0 254-0<br />

Under 100cc. ................... 1 1 1<br />

100-449cc ..................... 2 2 2<br />

450-749cc ..................... 3 3 3<br />

750-899cc ..................... 4 4 4<br />

900cc or larger .................. 5 5 5<br />

Which make is it? 241-0 248-0 255-0<br />

BMW ......................... 1 1 1<br />

Harley Davidson. ................ 2 2 2<br />

Honda. ........................ 3 3 3<br />

Kawasaki ...................... 4 4 4<br />

Suzuki ........................ 5 5 5<br />

Yamaha ....................... 6 6 6<br />

Other ......................... 7 7 7<br />

Who is the primary rider? 242-0 249-0 256-0<br />

Yourself. ....................... 1 1 1<br />

Someone else .................. 2 2 2<br />

How do you transport your off-road bike? 257-0<br />

Truck 1 Trailer 2<br />

AUTO CLUBS<br />

260-0<br />

Do you belong to any auto club?<br />

Yes ........................... 1<br />

If Yes, which one?<br />

AAA .......................... 2<br />

AARP Roadside Assistance. ....... 3<br />

Allstate Motor Club. .............. 4<br />

BP Motor Club .................. 5<br />

Car Dealer/Manufacturer/<br />

Dealer Warranty. .............. 6<br />

Other Insurance Company ......... 7<br />

Other ......................... 8<br />

Do you or does anyone else in your household own any ATVs or utility<br />

vehicles (UTVs)?<br />

228-0<br />

Yes 1 No 2<br />

If so, how many does your whole household own?<br />

229-0<br />

One 1 Two 2 Three or more 3<br />

Most<br />

Recent<br />

Purchase<br />

Other<br />

Purchase(s)<br />

What kind is it? 230-0 232-0<br />

Utility ATV. ............................ 1 1<br />

Sport ATV. ............................ 2 2<br />

Utility Vehicle (UTV) . . . . . . . . . . . . . . . . . . . . . . 3 3<br />

Which make is it?<br />

Arctic Cat ............................. 4 4<br />

Honda. ............................... 5 5<br />

John Deere. ........................... 6 6<br />

Kawasaki ............................. 7 7<br />

Polaris ............................... 8 8<br />

Suzuki ............................... 9 9<br />

Yamaha .............................. 0 0<br />

Other ................................ X X<br />

When was it acquired? 231-0 233-0<br />

In past 12 months. ...................... 1 1<br />

1-2 years ago .......................... 2 2<br />

3-4 years ago .......................... 3 3<br />

5 or more years ago ..................... 4 4<br />

What is it used for?<br />

Recreation ............................ 5 5<br />

Work. ................................ 6 6<br />

Both Recreation and Work ................ 7 7<br />

How is it transported?<br />

Truck. ................................ 8 8<br />

Trailer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9<br />

Who is the primary rider?<br />

Yourself. .............................. 0 0<br />

Someone else ......................... X X<br />

TRUCK/TRAILER<br />

RENTAL<br />

Have you person<strong>all</strong>y rented a truck/trailer in the last twelve months?<br />

258-0<br />

Yes ........................................ 1<br />

Which company (or companies) did you rent from:<br />

Budget ..................................... 2<br />

Enterprise. .................................. 3<br />

Penske . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />

U-Haul ..................................... 5<br />

6<br />

OTHER (Write In)<br />

Reason for rental of truck or trailer:<br />

Moving personal/household goods. ............... 7<br />

Commercial/business purposes .................. 8<br />

Other ...................................... 9<br />

PROFESSIONAL<br />

MOVING VAN<br />

61X-0<br />

Have you used a professional moving van line in the last 12 months?<br />

Yes 1

Page 27<br />

AUTOMOTIVE/TRAFFIC REPORTS<br />

AUTOS/OTHER<br />

VEHICLE INSURANCE<br />

Number of vehicles in<br />

your household covered<br />

by insurance:<br />

:<br />

Cars/<br />

Trucks/<br />

Vans/<br />

SUVs<br />

Other<br />

Vehicles<br />

(e.g. Motorcycles,<br />

ATVs, RVs,<br />

Marine)<br />

64V<br />

1 2<br />

None ................. 01<br />

One .................. 02<br />

Two .................. 03<br />

Three or more . . . . . . . . . . . 04<br />

With which company(s)?<br />

64W<br />

1 2<br />

AAA . . . . . . . . . . . . . . . . . . . 01<br />

Allstate. ............... 02<br />

American Family ........ 03<br />

Amica. ................ 04<br />

Encompass ............ 05<br />

Esurance . . . . . . . . . . . . . . . 06<br />

Farm Bureau ........... 07<br />

Farmers Insurance Group . 08<br />

GEICO ................ 09<br />

The Hartford. ........... 10<br />

Infinity ................ 11<br />

Liberty Mutual .......... 12<br />

Mercury ............... 13<br />

MetLife ................ 14<br />

Nationwide. ............ 15<br />

Progressive ............ 16<br />

SafeAuto .............. 17<br />

State Farm ............. 18<br />

Travelers. .............. 19<br />

21 st Century ............ 20<br />

USAA. ................ 21<br />

Other ................. 22<br />

How was it acquired?<br />

262-0<br />

From an agent .......... 1<br />

Direct from insurance<br />

company via phone .... 2<br />

Direct from insurance<br />

company via website ... 3<br />

At place of work or union .. 4<br />

At dealership where car/<br />

vehicle was purchased<br />

or leased ............ 5<br />

Other ................. 6<br />

How did you hear about the company?<br />

263-0<br />

Insurance agent ........ 1<br />

Newspaper or magazine ad . 2<br />

Television or radio ad. .... 3<br />

Internet ad. ............ 4<br />

Search engine .......... 5<br />

Direct mail at home ...... 6<br />

Internet quote<br />

comparison service . . . . . 7<br />

Family or Friends ....... 8<br />

Other ................. 9<br />

What type carried? 264-0<br />

Collision ............... 1<br />

Liability- Bodily Injury. .... 2<br />

Liability- Property Damage . 3<br />

Medical Payments ....... 4<br />

Uninsured Motorist ...... 5<br />

Comprehensive ......... 6<br />

Towing ................ 7<br />

How many times, if any, have you changed your<br />

auto insurance carrier in the last 5 years?<br />

64X-0<br />

Did not change. . . . . . . . . . 1<br />

One time . . . . . . . . . . . . . . 2<br />

Two times. . . . . . . . . . . . . . 3<br />

Three or more times . . . . . 4<br />

Did you acquire a new or different policy in the<br />

last 12 months?<br />

Yes 1 268-0<br />

CAR RENTAL<br />

BUSINESS USE<br />

269<br />

For business use you:<br />

Rented/ Times/<br />

last 12 last 12<br />

months months<br />

TOTAL: ................ 00<br />

FROM WHAT COMPANIES:<br />

Alamo ................. 01<br />

Avis. .................. 02<br />

Budget ................ 03<br />

Dollar ................. 04<br />

Enterprise. ............. 05<br />

Hertz. ................. 06<br />

National ............... 07<br />

Thrifty ................. 08<br />

999<br />

OTHER (Write In)<br />

WHERE RENTED:<br />

270-0<br />

Airport ................ 1<br />

Adjacent to airport ....... 2<br />

At home (local rental). .... 3<br />

Somewhere else ........ 4<br />

Your organization’s guidelines on rentals for<br />

business use: 271-0<br />

I can rent from any firm I like . . . . . . . . . . 1<br />

I must always rent from specified firm(s) . 2<br />

Most recent rental (choose one):<br />

Alamo . . . . . . . . . 3 Hertz ......... 8<br />

Avis ........... 4 National ....... 9<br />

Budget ........ 5 Thrifty ........ 0<br />

Dollar ......... 6 Other ......... X<br />

Enterprise ...... 7<br />

CAR RENTAL<br />

PERSONAL USE<br />

272<br />

You Person<strong>all</strong>y:<br />

Rented/ Times/<br />

last 12 last 12<br />

months months<br />

TOTAL: ................ 00<br />

FROM WHAT COMPANIES:<br />

Alamo ................. 01<br />

Avis. .................. 02<br />

Budget ................ 03<br />

Dollar ................. 04<br />

Enterprise. ............. 05<br />

Hertz. ................. 06<br />

National ............... 07<br />

Thrifty ................. 08<br />

999<br />

OTHER (Write In)<br />

WHERE RENTED:<br />

273-0<br />

Airport ................... 1<br />

Adjacent to airport.. . . . . . . . . 2<br />

At home (local rental)........ 3<br />

Somewhere else .. . . . . . . . . . 4<br />

Why Rented:<br />

Leisure ................. 5<br />

Own car in accident/repair . . . 6<br />

Other. .................. 7<br />

HOW Rented:<br />

Direct from company/walk-in<br />

(no reservation). ................... 8<br />

Direct from company by phone ......... 9<br />

Direct from company via company's<br />

website .......................... 0<br />

Through general travel or price comparison<br />

website .......................... X<br />

Other. ............................. Y<br />

Most recent rental (choose one): 336-0<br />

Alamo . . . . . . . . . 1 Hertz ......... 6<br />

Avis ........... 2 National ....... 7<br />

Budget ........ 3 Thrifty ........ 8<br />

Dollar ......... 4 Other ......... 9<br />

Enterprise ...... 5<br />

YOUR<br />

TRANSPORTATION<br />

Transportation method(s), if any, you use on an<br />

average weekday and average weekend:<br />

Average<br />

Weekday<br />

Average<br />

Weekend<br />

64E<br />

Walking ............... 01<br />

Bicycle. ............... 02<br />

Driving (not in a carpool). . 03<br />

Driving in a carpool ...... 04<br />

Motorcycle. ............ 05<br />

Taxi .................. 06<br />

Bus .................. 07<br />

Subway/Metro .......... 08<br />

Train. ................. 09<br />

Ferry ................. 10<br />

Other ................. 11<br />

1 2<br />

DRIVING<br />

Do you person<strong>all</strong>y have a current driver’s<br />

license? 278-0<br />

Yes .. . . . . . . . . . . . . . . . . . 1<br />

Which vehicle(s) do you drive?<br />

Automobile. ............ 2<br />

Motorcycle ............. 3<br />

Van. .................. 4<br />

Minivan ............... 5<br />

Compact Pick-up ........ 6<br />

Regular Pick-up ......... 7<br />

Heavy Duty Truck. ....... 8<br />

Recreational Vehicle ..... 9<br />

Sport/Utility Vehicle ...... 0<br />

Other Truck ............ X<br />

Other Vehicle ........... Y<br />

Number of miles you person<strong>all</strong>y drove in the<br />

past 12 months:<br />

279-0<br />

None .......... 1<br />

50,001-49,999 . . . . . . . . . . . 2<br />

51,000-42,999 . . . . . . . . . . . 3<br />

33,000-44,999 . . . . . . . . . . . 4<br />

55,000-47,999 . . . . . . . . . . . 5<br />

58,000-49,999 . . . . . . . . . . . 6<br />

10,000-14,999 . . . . . . . . . . . 7<br />

15,000-19,999 . . . . . . . . . . . 8<br />

20,000-29,999 . . . . . . . . . . . 9<br />

30,000-39,999 . . . . . . . . . . . 0<br />

40,000-49,999 . . . . . . . . . . . X<br />

50,000 or more ......... Y<br />

Primary reason(s) you person<strong>all</strong>y drive:<br />

651-0<br />

Commute to work. ....... 1<br />

Other driving for work. .... 2<br />

Leisure ................ 3<br />

Errands. ............... 4<br />

Transport others. ........ 5<br />

Other ................. 6<br />

TRAFFIC REPORTS<br />

If you have listened to traffic reports on the<br />

radio in the past 12 months, how often did you<br />

do so? 64Y-0<br />

Regularly. ............. 1<br />

Occasion<strong>all</strong>y.. . . . . . . . . . . 2

Page 31<br />

RESTAURANTS<br />

FAST FOOD & DRIVE-<br />

IN RESTAURANTS<br />

You Person<strong>all</strong>y:<br />

Ate/Bought Number of<br />

at last times/last<br />

6 months 30 days<br />

351<br />

TOTAL: ................ 00<br />

RESTAURANTS:<br />

A & W ................. 01<br />

Arby’s . . . . . . . . . . . . . . . . . . 02<br />

Au Bon Pain . . . . . . . . . . . . . 03<br />

Baja Fresh Mexican Grill .. 04<br />

Baskin-Robbins ......... 05<br />

Ben & Jerry’s ........... 06<br />

Blimpie Subs & Salads. ... 07<br />

Bojangles .............. 08<br />

Boston Market .......... 09<br />

Burger King ............ 10<br />

Captain D’s. ............ 11<br />

Carl’s Jr. ............... 12<br />

Checkers .............. 13<br />

Chick-Fil-A ............. 14<br />

Chipotle Mexican Grill .... 15<br />

Chuck E. Cheese ........ 16<br />

Church’s Fried Chicken ... 17<br />

Cold Stone Creamery. .... 18<br />

Culver’s. ............... 19<br />

Dairy Queen. ........... 20<br />

Del Taco ............... 21<br />

Domino’s Pizza. ......... 22<br />

Dunkin’ Donuts .......... 23<br />

Einstein Bros. Bagel Shop . 24<br />

El Pollo Loco ........... 25<br />

Fazoli’s ................ 26<br />

Fuddruckers ............ 27<br />

Godfather’s Pizza ........ 28<br />

Hardee’s ............... 29<br />

Jack in the Box .......... 30<br />

KFC .................. 31<br />

Krispy Kreme Doughnuts .. 32<br />

Krystal ................ 33<br />

Little Caesars ........... 34<br />

Long John Silver’s ....... 35<br />

McDonald’s. ............ 36<br />

Orange Julius ........... 37<br />

Panda Express .......... 38<br />

Panera Bread ........... 39<br />

Papa John’s ............ 40<br />

Papa Murphy’s .......... 41<br />

Pizza Hut .............. 42<br />

Pizza Inn .............. 43<br />

Popeyes Chicken ........ 44<br />

Quizno’s ............... 45<br />

R<strong>all</strong>y’s. ................ 46<br />

Round Table Pizza . . . . . . . . 47<br />

Sbarro ................ 48<br />

Schlotzsky’s Deli ........ 49<br />

Sonic Drive-In. .......... 50<br />

Starbucks .............. 51<br />

Steak ’N Shake. ......... 52<br />

Subway. ............... 53<br />

Taco Bell. .............. 54<br />

Taco John’s. ............ 55<br />

Taco Time .............. 56<br />

TCBY ................. 57<br />

Wendy’s ............... 58<br />

Whataburger. ........... 59<br />

White Castle ............ 60<br />

Wienerschnitzel ......... 61<br />

Wing•Stop. ............. 62<br />

Zaxby’s ................ 63<br />

999<br />

OTHER (Write In)<br />

Who made the decision of where to go?<br />

352-0<br />

Yourself. ............... 1<br />

Other Adult. ............ 2<br />

Child. ................. 3<br />

You Person<strong>all</strong>y:<br />

FAMILY<br />

RESTAURANTS & Ate/Bought Number of<br />

at last times/last<br />

STEAK HOUSES 6 months 30 days<br />

353<br />

TOTAL: ................ 00<br />

RESTAURANTS:<br />

Applebee’s ............. 01<br />

Baker’s Square. ......... 02<br />

Benihana .............. 03<br />

Bennigans ............. 04<br />

Bertucci’s .............. 05<br />

Big Boy. ............... 06<br />

Black Angus Steakhouse .. 07<br />

Bob Evans Farms. ....... 08<br />

Buffalo Wild Wings ....... 09<br />

California Pizza Kitchen ... 10<br />

Carino’s Italian Grill ...... 11<br />

Carrabba’s Italian Grill .... 12<br />

The Cheesecake Factory .. 13<br />

Chevy’s. ............... 14<br />

Chili’s Grill & Bar ........ 15<br />

CiCi’s Pizza ............ 16<br />

Cracker Barrel .......... 17<br />

Damon’s ............... 18<br />

Dave & Buster’s ......... 19<br />

Denny’s ............... 20<br />

Don Pablo’s ............ 21<br />

El Torito ............... 22<br />

Friendly’s .............. 23<br />

Golden Corral. .......... 24<br />

HomeTown Buffet ........ 25<br />

Hooters. ............... 26<br />

Houlihan’s. ............. 27<br />

International House of<br />

Pancakes (IHOP) ...... 28<br />

Joe’s Crab Shack ........ 29<br />

Logan’s Roadhouse ...... 30<br />

Lone Star Steakhouse .... 31<br />

LongHorn Steakhouse .... 32<br />

Marie C<strong>all</strong>enders ........ 33<br />

O’Charley’s. ............ 34<br />

Old Country Buffet ....... 35<br />

Olive Garden ........... 36<br />

On The Border .......... 37<br />

Outback Steakhouse ..... 38<br />

Perkins ................ 39<br />

Ponderosa ............. 40<br />

Red Lobster ............ 41<br />

Red Robin ............. 42<br />

Romano’s Macaroni Grill .. 43<br />

Ruby Tuesday. .......... 44<br />

Ruth’s Chris Steak House . 45<br />

Ryan’s. ................ 46<br />

Shoney’s. .............. 47<br />

Sizzler ................ 48<br />

Smokey Bones .......... 49<br />

Texas Roadhouse. ....... 50<br />

T.G.I. Friday’s ........... 51<br />

Tony Roma’s. ........... 52<br />

Uno Chicago Grill ........ 53<br />

Village Inn Restaurant .... 54<br />

Waffle House ........... 55<br />

999<br />

OTHER (Write In)<br />

Who made the decision of where to go?<br />

354-0<br />

Yourself. ............... 1<br />

Other Adult. ............ 2<br />

Child. ................. 3<br />

MORE ABOUT<br />

RESTAURANTS<br />

61Y<br />

You Person<strong>all</strong>y:<br />

Ate/Bought Number of<br />

at last times/last<br />

6 months 30 days<br />

FAST FOOD & DRIVE-IN RESTAURANTS<br />

What Meals:<br />

Breakfast .............. 01<br />

Lunch ................. 02<br />

Snacks . . . . . . . . . . . . . . . . . 03<br />

Supper/Dinner .......... 04<br />

What Days:<br />

Weekdays. ............. 05<br />

Weekends. ............. 06<br />

How Ordered:<br />

Eat-in ................. 07<br />

Home Delivery .......... 08<br />

Take-Out: Drive-Thru ..... 09<br />

Take-Out: Walk-In ........ 10<br />

FAMILY RESTAURANTS & STEAK HOUSES<br />

What Meals:<br />

Breakfast .............. 11<br />

Lunch ................. 12<br />

Snacks . . . . . . . . . . . . . . . . . 13<br />

Supper/Dinner .......... 14<br />

What Days:<br />

Weekdays. ............. 15<br />

Weekends. ............. 16<br />

How Ordered:<br />

Eat-in ................. 17<br />

Home Delivery .......... 18<br />

Take-Out. .............. 19<br />

Fine Dining RESTAURANTS<br />

Any Visit ............... 20<br />

OTHER RESTAURANTS<br />

Any Visit ............... 21<br />

RESTAURANT<br />

EXPENDITURES<br />

61Z<br />

How much did you spend at the following types<br />

of restaurants in the last 6 months? (Write in<br />

amount)<br />

Fast Food & Drive-In Restaurants.. $ 01<br />

Family Restaurants<br />

& Steak Houses .. . . . . . . . . . . $ 02<br />

Fine Dining Restaurants.......... $ 03<br />

Other Restaurants.. . . . . . . . . . . . $ 04

DOMESTIC TRAVEL<br />

Page 34<br />

Have you person<strong>all</strong>y made any trips of more<br />

DOMESTIC TRAVEL than one day’s duration in the past 12<br />

months, within the continental U.S., including<br />

business, vacation and weekend travel?<br />

Yes 1 No 2 404-0<br />

If yes, how many such trips have you made in the last<br />

12 months. _________________ 405-0<br />

Answer for each trip:<br />

Last Second Other<br />

Trip Last Trip Trips<br />

Number of nights away on each trip:<br />

406-0 419-0 432-0<br />

1 ............................. 1 1 1<br />

2 ............................. 2 2 2<br />

3-4 ........................... 3 3 3<br />

5-6 ........................... 4 4 4<br />

7-8 ........................... 5 5 5<br />

9-14 .......................... 6 6 6<br />

15 + .......................... 7 7 7<br />

Number of household members,<br />

including yourself, on each trip:<br />

Which states did you visit on each trip?<br />

Write in # Write in # Write in #<br />

407-0 420-0 433-0<br />

408-0 421-0 434-0<br />

Maine, New Hampshire, Vermont. ... 1 1 1<br />

Massachusetts, Connecticut,<br />

Rhode Island ................. 2 2 2<br />

New York, Pennsylvania, New Jersey . 3 3 3<br />

Delaware, Maryland, District of<br />

Columbia .................... 4 4 4<br />

Michigan, Wisconsin. ............. 5 5 5<br />

Ohio, Indiana, Illinois ............. 6 6 6<br />

Nebraska, Kansas ............... 7 7 7<br />

N. Dakota, S. Dakota, Minnesota . . . . 8 8 8<br />

Iowa, Missouri .................. 9 9 9<br />

N. Carolina, S. Carolina ........... 0 0 0<br />

Alabama, Georgia ............... X X X<br />

409-0 422-0 435-0<br />

Florida ........................ 1 1 1<br />

Kentucky, Tennessee ............. 2 2 2<br />

Mississippi, Louisiana ............ 3 3 3<br />

Texas ......................... 4 4 4<br />

Arkansas, Oklahoma ............. 5 5 5<br />

Virginia, West Virginia. ............ 6 6 6<br />

Montana, Idaho, Wyoming ......... 7 7 7<br />

Washington, Oregon ............. 8 8 8<br />

California ...................... 9 9 9<br />

Utah, Colorado .................. 0 0 0<br />

Arizona, New Mexico ............. X X X<br />

Nevada ....................... Y Y Y<br />

Reason for each trip: 410-0 423-0 436-0<br />

Business (paid for by company) ..... 1 1 1<br />

Business (paid for by self) ......... 2 2 2<br />

Honeymoon .................... 3 3 3<br />

Vacation . . . . . . . . . . . . . . . . . . . . . . . 4 4 4<br />

Personal (not vacation). ........... 5 5 5<br />

Part business/Part vacation ........ 6 6 6<br />

Number of miles traveled from home (round trip) for each trip:<br />

411-0 424-0 437-0<br />

Under 500 ..................... 1 1 1<br />

500-999 ....................... 2 2 2<br />

1000 + ........................ 3 3 3<br />

When was each trip taken?<br />

412-0 425-0 438-0<br />

January – March ................ 1 1 1<br />

April – June .................... 2 2 2<br />

July – September ................ 3 3 3<br />

October – December ............. 4 4 4<br />

Who decided upon the destination of each trip?<br />

Yourself (alone or with someone else) 5 5 5<br />

Travel Agent .................... 6 6 6<br />

Spouse or Mate ................. 7 7 7<br />

Continued in next Column<br />

DOMESTIC TRAVEL<br />

(Continued)<br />

Last Second Other<br />

Trip Last Trip Trips<br />

Did you use the service of a Travel Agent or Internet travel site for each trip?<br />

413-0 426-0 439-0<br />

Yes, used travel agent ............ 1 1 1<br />

Yes, used airline-specific Internet site 2 2 2<br />

Yes, used general Internet travel site . 3 3 3<br />

No. ........................... 4 4 4<br />

If yes, for what purpose:<br />

Flight Reservations .............. 5 5 5<br />

Hotel Reservations. .............. 6 6 6<br />

Entire Trip ...................... 7 7 7<br />

Means of Travel for each trip: 414-0 427-0 440-0<br />

Plane (charter) .................. 1 1 1<br />

Plane (scheduled) ............... 2 2 2<br />

Rental Vehicle. .................. 3 3 3<br />

Personal Vehicle. ................ 4 4 4<br />

Bus (charter or tour). ............. 5 5 5<br />

Bus (scheduled) ................. 6 6 6<br />

Railroad/Train ................... 7 7 7<br />

Motor Home/RV ................. 8 8 8<br />

If by plane, which airlines did you use during each trip?<br />

415-0 428-0 441-0<br />

AirTran Airways ................. 1 1 1<br />

Alaska Airlines .................. 2 2 2<br />

American ...................... 3 3 3<br />

Continental ..................... 4 4 4<br />

Delta. ......................... 5 5 5<br />

Frontier ........................ 6 6 6<br />

JetBlue ........................ 7 7 7<br />

Midwest Airlines ................. 8 8 8<br />

416-0 429-0 442-0<br />

Northwest. ..................... 1 1 1<br />

Southwest ..................... 2 2 2<br />

United. ........................ 3 3 3<br />

US Airways. .................... 4 4 4<br />

Other__________________________ 5 5 5<br />

(Write In)<br />

For each airplane trip, what did you fly?<br />

First Class ..................... 6 6 6<br />

Business. ...................... 7 7 7<br />

Coach. ........................ 8 8 8<br />

For each trip, did you use any in-flight entertainment on the plane?<br />

Listened to radio. ................ 9 9 9<br />

Watched movie. ................. 0 0 0<br />

Watched in-flight video/Used in-flight<br />

video equipment ............... X X X<br />

Read in-flight publication .......... Y Y Y<br />

For vacation or honeymoon trips only:<br />

What activities did you do on each vacation trip?<br />

417-0 430-0 443-0<br />

Go to beach .................... 1 1 1<br />

General sightseeing .............. 2 2 2<br />

Attend a specific event ............ 3 3 3<br />

Shopping ...................... 4 4 4<br />

Fine dining ..................... 5 5 5<br />

Play tennis ..................... 6 6 6<br />

Visit National Park ............... 7 7 7<br />

418-0 431-0 444-0<br />

Play golf ....................... 1 1 1<br />

Backpacking/Hiking .............. 2 2 2<br />

Bicycle riding ................... 3 3 3<br />

Fishing ........................ 4 4 4<br />

Hunting. ....................... 5 5 5<br />

Running/Jogging ................ 6 6 6<br />

Skiing (cross country/downhill). ..... 7 7 7<br />

Other outdoor sports or recreation. .. 8 8 8<br />

Visit relatives or friends ........... 9 9 9<br />

Visit a health spa/retreat .......... 0 0 0<br />

How many round trips BY PLANE have you made in the last<br />

12 months?_____________________ 445-0<br />

Number<br />

How many of those plane trips were for Business<br />

reasons?_______________________ 446-0<br />

Number<br />

How many of those plane trips were for Vacation/Personal/Honeymoon<br />

reasons?_______________________ 447-0<br />

Number

Page 37<br />

BANKING &<br />

FINANCIAL<br />

SERVICES<br />

You Person<strong>all</strong>y or Jointly:<br />

Acquired<br />

last 12<br />

Have months<br />

Bank Accounts/Services: 481<br />

Savings Account ......................... 01<br />

Certificate of Deposit (CD) ................. 02<br />

Interest Checking Account ................. 03<br />

Non-Interest Checking Account. ............. 04<br />

Money Market Account .................... 05<br />

Overdraft Protection ...................... 06<br />

Other Banking Services ................... 07<br />

Business Checking Account ................ 08<br />

Other Sm<strong>all</strong> Business Banking Services. ...... 09<br />

1 2<br />

Banks or Financial Institutions you person<strong>all</strong>y used, last 12 months:<br />

664-0<br />

Bank of America ......................... 1<br />

BB&T (Branch Banking & Trust) ............. 2<br />

Capital One ............................. 3<br />

Chase/Washington Mutual (WaMu). .......... 4<br />

Citibank ................................ 5<br />

Citizens ................................ 6<br />

Fifth Third Bank .......................... 7<br />

HSBC ................................. 8<br />

ING Direct .............................. 9<br />

PNC/National City ........................ 0<br />

Regions Bank ...........................<br />

Sun Trust ...............................<br />

X<br />

Y<br />

64J-0<br />

TD Bank ............................... 1<br />

U.S. Bank. .............................. 2<br />

Wells Fargo/ Wachovia .................... 3<br />

Other National Bank ...................... 4<br />

Local/Community Bank .................... 5<br />

Credit Union ............................ 6<br />

Mutual Funds Co. ........................ 7<br />

Internet Bank. ........................... 8<br />

Banking methods you person<strong>all</strong>y used, last 12 months:<br />

482-0<br />

Bank in person .......................... 1<br />

ATM/Cash Machine ....................... 2<br />

Bank by Mail ............................ 3<br />

Direct Deposit (payroll check) ............... 4<br />

Bank by Phone .......................... 5<br />

Banking Online/Internet. ................... 6<br />

Banking on Mobile Device. ................. 7<br />

Paperless Statements ..................... 8<br />

In the last 6 months have you done any of the following?<br />

Wired or sent money with: 61B-0<br />

MoneyGram ......................... 1<br />

Western Union ....................... 2<br />

PayPal .............................. 3<br />

Bank Wire Transfer .................... 4<br />

U.S. Postal Service .................... 5<br />

Overnight Courier ..................... 6<br />

Another Way ......................... 7<br />

Purchased a money order .................. 8<br />

Used a check cashing service. .............. 9<br />

Which, if any, of the following do you consider very<br />

important when choosing a bank or financial institution?<br />

63R-0<br />

Customer Service ........................ 1<br />

Financial Stability of Company .............. 2<br />

Friend’s/Relative’s Recommendation ......... 3<br />

Interest Rates ........................... 4<br />

Location of Branch ....................... 5<br />

Reputation of Company. ................... 6<br />

Reward Programs ........................ 7<br />

Size of Company ......................... 8<br />

Years in Business ........................ 9<br />

Other .................................. 0<br />

Did you choose to change from one bank to another in the last 12<br />

months? Yes X<br />

INVESTMENT<br />

ACTIVITY<br />

FINANCIAL<br />

Have you used any of the following for<br />

financial services or advice in the last<br />

12 months?<br />

492-0<br />

Stock Rating Service. ............................. 1<br />

Financial Planner/Certified Financial Planner (CFP). ....... 2<br />

Personal Money Manager .......................... 3<br />

Financial Advisor/Broker ............................ 4<br />

Newspaper/Magazine .............................. 5<br />

TV or Radio show ................................. 6<br />

Internet site ..................................... 7<br />

Friends/Family ................................... 8<br />

Other Source .................................... 9<br />

If you contacted a brokerage firm in the last 12 months, what was the<br />

reason for the contact?<br />

Discount Full Service Online<br />

Brokerage Brokerage Brokerage<br />

493 Firm Firm Firm<br />

Advice or Price Quotes . . . . . . . . . . . . . . . 01<br />

Purchased or Sold Bonds ............. 02<br />

Purchased or Sold Stocks ............. 03<br />

Purchased or Sold Mutual Funds ....... 04<br />

1 2 3<br />

Brokerage Firms or other financial institutions, used in last 12 months:<br />

494-0<br />

Banc of America Investment Services. ........ 1<br />

Charles Schwab ......................... 2<br />

Chase Investment Services. ................ 3<br />

Edward Jones ........................... 4<br />

E*Trade ................................ 5<br />

Fidelity. ................................ 6<br />

Merrill Lynch ............................ 7<br />

Morgan Stanley Smith Barney. .............. 8<br />

Raymond James . . . . . . . . . . . . . . . . . . . . . . . . . . 9<br />

495-0<br />

Scottrade. .............................. 1<br />

ShareBuilder/ING Direct ................... 2<br />

TD Ameritrade. .......................... 3<br />

TIAA-CREF ............................. 4<br />

T. Rowe Price ........................... 5<br />

UBS. .................................. 6<br />

USAA. ................................. 7<br />

Van Kampen ............................ 8<br />

Vanguard ............................... 9<br />

Wells Fargo Advisors/Wachovia Securities ..... 0<br />

64T-0<br />

Other full service firm ..................... 1<br />

Other discount brokerage firm. .............. 2<br />

Other online brokerage firm. ................ 3<br />

Other bank. ............................. 4<br />

Other .................................. 5<br />

Investment transactions (stocks, bonds, mutual funds) executed<br />

in the past 12 months: (Please count each buy and sell separately.)<br />

216-0<br />

None. .......... 1 3-9 ........... 3 20-49 ......... 5<br />

1-2 ............ 2 10-19 ......... 4 50+. .......... 6<br />

MUTUAL FUNDS<br />

Do you invest in a mutual fund managed<br />

by any of these mutual fund families/companies?<br />

Own<br />

Acquired or<br />

added to<br />

in last<br />

12 months<br />

1 700 2<br />

American Century ........................ 01<br />

American Funds ......................... 02<br />

Charles Schwab/Schwab .................. 03<br />

Dreyfus ................................ 04<br />

DWS Investments ........................ 05<br />

Fidelity Investments. ...................... 06<br />

Franklin Templeton ....................... 07<br />

The Hartford ............................ 08<br />

ING ................................... 09<br />

Invesco Aim/AIM . . . . . . . . . . . . . . . . . . . . . . . . . . 10<br />

Janus. ................................. 11<br />

Lord Abbett ............................. 12<br />

Merrill Lynch ............................ 13<br />

Morgan Stanley Smith Barney. .............. 14<br />

Oppenheimer. ........................... 15<br />

Prudential JennisonDryden ................. 16<br />

Putnam ................................ 17<br />

SSgA (State Street Global Advisors). ......... 18<br />

T. Rowe Price ........................... 19<br />

UBS. .................................. 20<br />

USAA. ................................. 21<br />

Vanguard Group ......................... 22<br />

Other .................................. 23

FINANCIAL & INSURANCE Page 38<br />

LIFE INSURANCE<br />

Do you currently carry any life<br />

insurance? Yes 1 504-0<br />

Which kind(s) do you carry? 508-0<br />

Separate term policy ............... 1<br />

Separate whole life policy ........... 2<br />

Combination term/whole life policy .... 3<br />

Universal/Adjustable life ............ 4<br />

Variable life ...................... 5<br />

Credit life ........................ 6<br />

How many different life insurance<br />

policies do you carry? 507-0<br />

Number of policies<br />

How acquired: 505-0<br />

From a union ..................... 1<br />

From a place of work. .............. 2<br />

From a fraternal or other membership<br />

group ......................... 3<br />

Veterans life insurance ............. 4<br />

From a bank ..................... 5<br />

With loan, mortgage or inst<strong>all</strong>ment<br />

payments ...................... 6<br />

Through an agent representing one<br />

company ...................... 7<br />

Through an agent (broker) representing<br />

more than one company .......... 8<br />

In response to mail advertising<br />

(no agent) ..................... 9<br />

Direct from insurance company via phone<br />

(no agent) ....................... 0<br />

Direct from insurance company via website<br />

(no agent). ....................... X<br />

Total face value of <strong>all</strong> the life insurance<br />

you currently carry: 506-0<br />

Less than $20,000. ................ 1<br />

$ 20,000 - $ 49,999 ............... 2<br />

$ 50,000 - $ 99,999 ............... 3<br />

$100,000 - $149,999 ............... 4<br />

$150,000 - $249,999 ............... 5<br />

$250,000 - $499,999 ............... 6<br />

$500,000 or more ................. 7<br />

Continued in next Column<br />

LIFE INSURANCE<br />

(Continued)<br />

Acquired<br />

Have Last 12<br />

Policy Months<br />

With which company:<br />

1 509 2<br />

Aetna. ................. 01<br />

AFLAC. ................ 02<br />

AIG American General .... 03<br />

Allstate. ................ 04<br />

American Family ......... 05<br />

Aviva .................. 06<br />

AXA Equitable ........... 07<br />

Bankers Life & Casualty .... 08<br />

Cigna. ................. 09<br />

Colonial Penn ........... 10<br />

Farm Bureau ............ 11<br />

Farmers Insurance Group .. 12<br />

Genworth. .............. 13<br />

Gerber Life ............. 14<br />

Guardian ............... 15<br />

The Hartford ............ 16<br />

ING ................... 17<br />

John Hancock ........... 18<br />

Lincoln Financial Group. ... 19<br />

MassMutual. ............ 20<br />

MetLife. ................ 21<br />

Mutual of Omaha. ........ 22<br />

Nationwide. ............. 23<br />

New York Life. ........... 24<br />

Northwestern Mutual. ..... 25<br />

Pacific Life .............. 26<br />

Principal Financial ........ 27<br />

Prudential .............. 28<br />

SBLI. .................. 29<br />

State Farm. ............. 30<br />

TIAA-CREF ............. 31<br />

Unum Group ............ 32<br />

USAA. ................. 33<br />

Veterans Group Life<br />

(VGLI) ................ 34<br />

Western & Southern ...... 35<br />

Zurich ................. 36<br />

Other .................. 37<br />

PAYING BILLS<br />

Bill-paying methods you person<strong>all</strong>y used,<br />

last 12 months: 64M-0<br />

Pay in person...................... 1<br />

Pay by mail. ...................... 2<br />

Pay by Internet/Online.. . . . . . . . . . . . . . 3<br />

Pay by phone using credit card.. . . . . . . 4<br />

Pay by mobile phone.. . . . . . . . . . . . . . . 5<br />

Bills automatic<strong>all</strong>y charged to credit card. 6<br />

Bills automatic<strong>all</strong>y deducted from bank<br />

account......................... 7<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . 8<br />

TRAVELERS<br />

CHEQUES<br />

Have you person<strong>all</strong>y bought travelers cheques<br />

in the last 12 months?<br />

Yes 1 No 2 483-0<br />

Total amount bought in past 12 months: 484-0<br />

$ 1-$ 249 .. . . . . . . . . . . . . . . . . . . . . 1<br />

$ 250-$ 499 .. . . . . . . . . . . . . . . . . . . . . 2<br />

$ 500-$ 999 .. . . . . . . . . . . . . . . . . . . . . 3<br />

$1000 or more.. . . . . . . . . . . . . . . . . . . . 4<br />

Companies: 485-0<br />

American Express .. . . . . . . . . . . . . . . . . 1<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . 2<br />

Where purchased:<br />

AAA.............................. 3<br />

Bank .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />

Other............................. 5<br />

SECURITIES<br />

Please mark the securities you person<strong>all</strong>y own. For each type owned,<br />

what is the approximate current market value and was any part<br />

acquired in the last 12 months?<br />

TOTAL VALUE OF HOLDINGS<br />

Acquired<br />

or added to<br />

Under $10,000- $50,000- $150,000 in last 12<br />

500 Own $10,000 $49,999 $149,999 or more months<br />

1 2 3 4 5 6<br />

Securities you person<strong>all</strong>y own:<br />

U.S. Savings Bonds .............................................. 01<br />

U.S. Treasury Notes .............................................. 02<br />

Other U.S. Government Bonds ...................................... 03<br />

<strong>Common</strong> or Preferred Stock in Company you work for ................... 04<br />

<strong>Common</strong> Stock in any other Company ................................ 05<br />

Preferred Stock in any other Company ............................... 06<br />

Privately held shares of Companies or Partnerships ..................... 07<br />

City/Municipal or State Bonds ...................................... 08<br />

Corporate Bonds or Debentures .................................... 09<br />

Money Market Funds ............................................. 10<br />

Mutual Funds (Bonds) ............................................ 11<br />

Mutual Funds (Stocks) ............................................ 12<br />

Tax Exempt Funds ............................................... 13<br />

Exchange Traded Funds (ETFs) ..................................... 14<br />

Annuities ....................................................... 15<br />

Savings Certificates .............................................. 16<br />

Insured Money Market Accounts (Bank) .............................. 17<br />

CD (Certificate(s) of Deposit)—6 months or less ........................ 18<br />

CD (Certificate(s) of Deposit)—more than 6 months ..................... 19<br />

Investments in Gold or other Precious Metals or Gems ................... 20<br />

Investment Collections of Antiques, Books, Stamps, etc. .................. 21<br />

Other investments (Commodities/Puts/C<strong>all</strong>s, etc.) ....................... 22<br />

1 2 3 4 5 6<br />

Which of the following retirement or college savings plans do you have?<br />

501-0<br />

IRA ................................... 1<br />

Keogh ................................. 2<br />

401K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3<br />

529 Plan (College Savings Plan) ............ 4

Page 39<br />

FINANCIAL & INSURANCE<br />

HOMEOWNERS OR<br />

PERSONAL PROPERTY<br />

INSURANCE<br />

own name) and check<br />

which cards you<br />

MEDICAL INSURANCE in the last 12 months:<br />

OTHER INSURANCE<br />

Do you currently carry fire, theft or other type<br />

of loss insurance on either your home or your<br />

personal belongings?<br />

Your Household<br />

Acquired<br />

Currently Last 12<br />

511 Carries Months<br />

1 2<br />

Homeowner .. . . . . . . . . . . . . 01<br />

Renter. ................. 02<br />

Condominium/Co-op .. . . . . . 03<br />

With what company? 513-0<br />

AAA .. . . . . . . . . . . . . . . . . . . 1<br />

AIG..................... 2<br />

Allstate.. . . . . . . . . . . . . . . . . 3<br />

American Family. ......... 4<br />

Chubb. ................. 5<br />

CNA.. . . . . . . . . . . . . . . . . . . 6<br />

Country. ................ 7<br />

Farmers Insurance Group .. . 8<br />

Foremost .. . . . . . . . . . . . . . . 9<br />

The Hartford.............. 0<br />

514-0<br />

Liberty Mutual. ........... 1<br />

MetLife.. . . . . . . . . . . . . . . . . 2<br />

Nationwide.. . . . . . . . . . . . . . 3<br />

New York Life.. . . . . . . . . . . . 4<br />

Safeco .. . . . . . . . . . . . . . . . . 5<br />

State Farm.. . . . . . . . . . . . . . 6<br />

Travelers................. 7<br />

USAA.. . . . . . . . . . . . . . . . . . 8<br />

Other .. . . . . . . . . . . . . . . . . . 9<br />

How was it acquired?<br />

515-0<br />

From an agent .. . . . . . . . . . . 1<br />

In response to direct mail<br />

advertising.............. 2<br />

Direct from insurance<br />

company via phone.. . . . . . 3<br />

Direct from insurance<br />

company via website...... 4<br />

Who decided which company to use?<br />

Yourself (alone or with<br />

516-0<br />

someone else) .. . . . . . . . . 1<br />

Someone else .. . . . . . . . . . . 2<br />

Total value for loss covered by policies:<br />

518-0<br />

Less than $10,000.. . . . . . . . 1<br />

$110,000 - $224,999 .. . . . . . 2<br />

$125,000 - $239,999 .. . . . . . 3<br />

$140,000 - $249,999 .. . . . . . 4<br />

$150,000 - $274,999 .. . . . . . 5<br />

$175,000 - $299,999 .. . . . . . 6<br />

$100,000 - $299,999 .. . . . . . 7<br />

$300,000 - $499,999 .. . . . . . 8<br />

$500,000 or more.......... 9<br />

Floater policy(s) or additional coverage carried:<br />

519-0<br />

Floater for jewelry or furs.. . . 1<br />

Floater for collections (antiques,<br />

coins, etc.).............. 2<br />

Floater for other personal<br />

items .. . . . . . . . . . . . . . . . . 3<br />

Coverage for earthquakes or<br />

floods .. . . . . . . . . . . . . . . 4<br />

Other additional coverage ... 5<br />

Do you have a combined home and auto policy?<br />

Yes.. . . . . . . . . . . . . . . . . . . . 6<br />

Do you person<strong>all</strong>y carry any medical, hospital or<br />

accident insurance?<br />

520-0<br />

Yes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1<br />

Who is covered?<br />

You and other household members.. . . . 2<br />

You alone.. . . . . . . . . . . . . . . . . . . . . . . . 3<br />

With which company?<br />

523-0<br />

Aetna.. . . . . . . . . . . . . . . . . . . . . . . . . . . 1<br />

AFLAC.. . . . . . . . . . . . . . . . . . . . . . . . . . 2<br />

Bankers Life & Casualty.............. 3<br />

BlueCross BlueShield. .............. 4<br />

Cigna.. . . . . . . . . . . . . . . . . . . . . . . . . . . 5<br />

Delta Dental.. . . . . . . . . . . . . . . . . . . . . . 6<br />

Great-West Healthcare. ............. 7<br />

Group Health Cooperative.. . . . . . . . . . . 8<br />

Health Net .. . . . . . . . . . . . . . . . . . . . . . . 9<br />

524-0<br />

Humana.. . . . . . . . . . . . . . . . . . . . . . . . . 1<br />

Kaiser Permanente .. . . . . . . . . . . . . . . . 2<br />

Mutual of Omaha.. . . . . . . . . . . . . . . . . . 3<br />

Oxford. .......................... 4<br />

PacifiCare. ....................... 5<br />

State Farm........................ 6<br />

Unicare........................... 7<br />

United Healthcare. ................. 8<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . 9<br />

How was policy obtained?<br />

521-0<br />

From a union .. . . . . . . . . . . . . . . . . . . . . 1<br />

From a place of work.. . . . . . . . . . . . . . . 2<br />

From a fraternal or other membership<br />

group........................... 3<br />

Medicaid.......................... 4<br />

Medicare. ........................ 5<br />

Other government source. ........... 6<br />

Through an agent representing one<br />

company .. . . . . . . . . . . . . . . . . . . . . . . 7<br />

Through an agent (broker) representing<br />

more than one company.. . . . . . . . . . . 8<br />

In response to mail advertising or phone<br />

contact (no agent).. . . . . . . . . . . . . . . . 9<br />

Through the Internet. ............... 0<br />

What kind of policy is it? 64K-0<br />

EPO (Exclusive Provider Organization).. 1<br />

HMO (Health Maintenance<br />

Organization)..................... 2<br />

POS (Point-of-Service). ............. 3<br />

PPO (Preferred Provider Organization).. 4<br />

Traditional Indemnity/Fee-for-Service. .. 5<br />

Catastrophic/High Deductible. ........ 6<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . 7<br />

MORE ABOUT<br />

INSURANCE<br />

Which of the following types of insurance do<br />

you person<strong>all</strong>y carry?<br />

526-0<br />

Dental............................ 1<br />

Disability/Loss of income through<br />

medical causes.. . . . . . . . . . . . . . . . . . 2<br />

Prescription drugs .. . . . . . . . . . . . . . . . . 3<br />

Vision care.. . . . . . . . . . . . . . . . . . . . . . . 4<br />

Accidental death and dismemberment. . 5<br />

Boat owners....................... 6<br />

Identity theft.. . . . . . . . . . . . . . . . . . . . . . 7<br />

Long term care..................... 8<br />

Mortgage .. . . . . . . . . . . . . . . . . . . . . . . . 9<br />

Personal liability (not Automotive or<br />

Homeowners) .. . . . . . . . . . . . . . . . . . . 0<br />

Sm<strong>all</strong> business..................... X<br />

Travel.. . . . . . . . . . . . . . . . . . . . . . . . . . . Y<br />

TAX PREPARATION<br />

How were your personal federal income taxes<br />

prepared in the last 12 months?<br />

Prepared by: 64A-0<br />

You, person<strong>all</strong>y, manu<strong>all</strong>y............. 1<br />

You, person<strong>all</strong>y, using a computer software<br />

program:<br />

H&R Block TaxCut. ............. 2<br />

TaxAct....................... 3<br />

TurboTax.. . . . . . . . . . . . . . . . . . . . . 4<br />

Other software .. . . . . . . . . . . . . . . . 5<br />

You, person<strong>all</strong>y, using an Internet/online tax<br />

preparation program or service:<br />

H&R Block TaxCut. ............. 6<br />

TaxAct....................... 7<br />

TurboTax.. . . . . . . . . . . . . . . . . . . . . 8<br />

Other online program/service...... 9<br />

H&R Block (on-site).. . . . . . . . . . . . . . . . 0<br />

Jackson Hewitt (on-site). ............ X<br />

Other tax preparation service, on-site.... Y<br />

64N-0<br />

CPA or other tax professional. ........ 1<br />

Friend or family member.............. 2<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . 3<br />

When filed, last 12 months:<br />

Before IRS deadline.. . . . . . . . . . . . . . . . 4<br />

Same day of the IRS deadline .. . . . . . . . 5<br />

After the IRS deadline. .............. 6<br />

Which of the following, if any, are very important to you when choosing an Insurance provider?<br />

(Check <strong>all</strong> that apply)<br />

VERY IMPORTANT WHEN CHOOSING<br />

Homeowners/<br />

Auto Personal Property Life<br />

64Z Insurance Insurance Insurance<br />

Agent Recommendation. ....................... 01<br />

Customer Service .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 02<br />

Financial Stability of Company. .................. 03<br />

Location.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04<br />

Rates.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05<br />

Reputation of Company......................... 06<br />

Simplicity of Application......................... 07<br />

Size of Company.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08<br />

Years in Business. ............................ 09<br />

Other .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10<br />

1 2 3

APPAREL Page 40<br />

AMOUNT SPENT<br />

ATHLETIC SHOES<br />

Pairs<br />

IN TOTAL IN THE<br />

purchased<br />

LAST 12 MONTHS:<br />

in last 12 Under $50- $75-<br />

530 months $50 $74 $149 $150 +<br />

Aerobic/Fitness shoes. .. 01 02<br />

Baseb<strong>all</strong>/Softb<strong>all</strong> shoes. . 03 04<br />

Basketb<strong>all</strong> shoes........ 05 06<br />

Boat/Deck shoes........ 07 08<br />

Bowling shoes.......... 09 10<br />

Cross Training shoes. ... 11 12<br />

Golf shoes............. 13 14<br />

Hiking/Backpacking boots. 15 16<br />

Rock Climbing shoes. . . . 17 18<br />

Running/Jogging shoes. . 19 20<br />

Soccer shoes .. . . . . . . . . 21 22<br />

Sports Sandals.. . . . . . . . 23 24<br />

Tennis shoes........... 25 26<br />

Walking shoes.......... 27 28<br />

Weight Lifting/Training shoes 29 30<br />

1 2 3 4<br />

BRANDS PURCHASED LAST 12 MONTHS:<br />

531-0 532-0<br />

Adidas ................. 1 Merrell ................. 1<br />

Airwalk ................. 2 New Balance ............ 2<br />

Asics. .................. 3 Nike ................... 3<br />

Avia ................... 4 Puma .................. 4<br />

Brooks ................. 5 Reebok. ................ 5<br />

AMOUNT SPENT<br />

SHOES<br />

Pairs<br />

IN TOTAL IN THE<br />

purchased<br />

LAST 12 MONTHS:<br />

in last 12 Under $50- $100-<br />

529 months $50 $99 $249 $250 +<br />

Canvas .. . . . . . . . . . . . . . 01 02<br />

Casual/Leisure .. . . . . . . . 03 04<br />

Dress Boots. .......... 05 06<br />

Dress Shoes.. . . . . . . . . . 07 08<br />

Sandals............... 09 10<br />

Slippers............... 11 12<br />

Western Boots. ........ 13 14<br />

Work Boots............ 15 16<br />

Other Work Shoes. ..... 17 18<br />

Other................. 19 20<br />

1 2 3 4<br />

BRANDS PURCHASED LAST 12 MONTHS:<br />

62A-0<br />

Aerosoles ............ 1<br />

Allen-Edmonds. ....... 2<br />

Børn ................ 3<br />

Coach. .............. 4<br />

Cole Haan ........... 5<br />

Crocs ............... 6<br />

Keen ................ 7<br />

Kenneth Cole ......... 8<br />

Michelle K. ........... 9<br />

Naturalizer ........... 0<br />

62B-0<br />

Nina .................... 1<br />

Nine West ................ 2<br />

Rockport ................. 3<br />

Skechers. ................ 4<br />

Sperry. .................. 5<br />

Steve Madden. ............ 6<br />

UGG .................... 7<br />

Other. ................... 8<br />

Converse ............... 6 Rockport ............... 6<br />

Easy Spirit .............. 7 Saucony ................ 7<br />

Fila .................... 8 Skechers ............... 8<br />

Jordan ................. 9 Timberland. ............. 9<br />

Keds ................... 0 Vans ................... 0<br />

K-Swiss ................ X<br />

LA Gear ................ Y<br />

Wolverine ............... X<br />

Other .................. Y<br />

Please indicate how much you AGREE or DISAGREE with each of<br />

DISAGREE<br />

AGREE<br />

FASHION &<br />

STYLE ATTITUDES the following statements by checking the box that comes closest<br />

62C Completely Somewhat Somewhat Completely<br />

to how you feel.<br />

1 2 3 4<br />

1. Being able to customize an item makes me more willing to purchase it. ............................. 01<br />

2. Comfort is one of the most important factors when selecting fashion products to purchase. ............. 02<br />

3. I prefer fashion that is classic and timeless as opposed to trendy. ................................. 03<br />

4. I rely on magazines to keep me up to date on fashion. .......................................... 04<br />

5. I am loyal to only a few fashion brands and stick with them. ...................................... 05<br />

6. I only buy shoes and clothing when I have to replace something. .................................. 06<br />

7. I often spend more money than I expected to on my fashion purchases. ............................ 07<br />

8. When buying fashion products, the over<strong>all</strong> look is more important than the brand. ..................... 08<br />

9. When I find a haircut that suits me, I stick with it. .............................................. 09<br />

10. I follow a strict skin-care routine. ........................................................... 10<br />

11. I am content with my appearance. .......................................................... 11<br />

12. I must admit I wear designer brands parti<strong>all</strong>y to impress other people. ............................. 12<br />

13. When a celebrity designs a product, I am more likely to buy it. ................................... 13<br />

14. I consider my fashion style to be trendy. ..................................................... 14<br />

15. I often use natural or organic beauty products. ................................................ 15<br />

16. I buy new clothes at the beginning of each season. ............................................ 16<br />

17. I only spend what I budget on fashion items. ................................................. 17<br />

18. I often try different ways to style my hair. .................................................... 18<br />

19. I love to mix and match high and low end designers when putting together an outfit. .................. 19<br />

20. I’ll buy trendy clothes even if they’re not the highest quality. ...................................... 20<br />

21. I am more likely to buy a brand that I know supports a charity. ................................... 21<br />

22. You can tell a lot about a person by the clothes they wear. ....................................... 22<br />

23. Clothes made by fashion designers are more appealing. ........................................ 23<br />

24. I’m willing to use the Internet to shop for fashion products. ....................................... 24<br />

25. I gener<strong>all</strong>y wear sunscreen. ............................................................... 25<br />

26. I prefer to shop for fashion products on my own, rather than with friends. . ........................... 26<br />

27. I dress more to please myself than to please others. ............................................ 27<br />

28. I would consider having a cosmetic surgery or procedure to improve my appearance. .................. 28

ACCESSORIES, WRITING INSTRUMENTS, TOOLS<br />

Page 42<br />

FINE<br />

JEWELRY<br />

You Person<strong>all</strong>y:<br />

Number<br />

Bought/ Bought<br />

last 12 last 12<br />

538 months months<br />

KINDS:<br />

Bracelet 01<br />

Brooch/Pin 02<br />

Earrings 03<br />

Necklace 04<br />

Engagement Ring 05<br />

Other Ring 06<br />

TYPES:<br />

Diamond 07<br />

Gold 08<br />

Platinum 09<br />

Sterling 10<br />

Other 11<br />

Total amount spent on fine jewelry<br />

in the last 12 months:<br />

539-0<br />

Under $100 1<br />

$100-$399 2<br />

$400-$749 3<br />

$750-$999 4<br />

$1,000-$1,499 5<br />

$1,500+ 6<br />

Where Purchased: 64B-0<br />

Independent Jeweler 1<br />

Department Store 2<br />

Jared 3<br />

Kay Jewelers 4<br />

Zales 5<br />

Other Retail Chain 6<br />

Other 7<br />

Purchased for:<br />

Yourself 8<br />

Someone else (gift) 9<br />

WATCHES<br />

541<br />

You Person<strong>all</strong>y:<br />

Bought/<br />

last 12<br />

Own months<br />

KINDS: 1 2<br />

Sport 01<br />

Dress 02<br />

Casual 03<br />

BRANDS:<br />

Bulova 04<br />

Casio 05<br />

Citizen 06<br />

Fossil 07<br />

Gucci 08<br />

Guess 09<br />

Movado 10<br />

Nike 11<br />

Omega 12<br />

Rolex 13<br />

Seiko 14<br />

Swatch . . . . . . . . . . . . . . . . . 15<br />

Tag Heuer 16<br />

Tiffany 17<br />

Timex 18<br />

Tommy Hilfiger 19<br />

Victorinox Swiss Army 20<br />

Other 21<br />

Total amount spent on watches<br />

in the last 12 months: 542-0<br />

$1-$49 1 $100-$299 3 $500+ 5<br />

$50-$99 2 $300-$499 4<br />

If purchased in last 12 months, purchased for:<br />

Yourself 6<br />

Gift for a man 7<br />

Gift for a woman 8<br />

STOCKINGS &<br />

PANTYHOSE<br />

545<br />

You Person<strong>all</strong>y:<br />

Number<br />

Bought Bought<br />

last last 30<br />

6 months days<br />

TOTAL: 00<br />

STYLE:<br />

Knee-highs 01<br />

Leggings 02<br />

Pantyhose 03<br />

Panty Pantyhose<br />

Combination 04<br />

Stockings 05<br />

Tights/Opaques 06<br />

TYPES:<br />

Control Top 07<br />

Regular 08<br />

SIZE:<br />

Queen/Proportional 09<br />

Regular 10<br />

BRANDS:<br />

Calvin Klein/CK 11<br />

Donna Karan/DKNY 12<br />

Hanes Silk Reflections 13<br />

Hanes Too 14<br />

Other Hanes 15<br />

Hue 16<br />

Just My Size 17<br />

L’eggs Sheer Energy 18<br />

L’eggs Silken Mist 19<br />

Other L’eggs 20<br />

No Nonsense 21<br />

Victoria’s Secret 22<br />

999<br />

OTHER (Write In)<br />

You Person<strong>all</strong>y:<br />

COSTUME JEWELRY<br />

Number<br />

Bought/ Bought<br />

last 12 last 12<br />

540 months months<br />

KINDS:<br />

Bracelet 01<br />

Pin 02<br />

Earrings 03<br />

Necklace 04<br />

Ring 05<br />

Total amount spent on costume jewelry<br />

in the last 12 months: 277-0<br />

$1-$24 1 $50-$99 3 $200+ 5<br />

$25-$49 2 $100-$199 4<br />

You Person<strong>all</strong>y:<br />

WRITING<br />

Bought in Bought<br />

INSTRUMENTS last 12 as<br />

months gift<br />

TYPES: 546-0 548-0<br />

Matched Set 1 1<br />

B<strong>all</strong> Point 2 2<br />

Mechanical Lead Pencil 3 3<br />

Rollerb<strong>all</strong> 4 4<br />

Marker 5 5<br />

BRANDS:<br />

Bic 6 6<br />

Crayola 7 7<br />

Cross 8 8<br />

Expo 9 9<br />

Flair 0 0<br />

Montblanc X X<br />

Paper Mate Y Y<br />

547-0 549-0<br />

Parker 1 1<br />

Pentel 2 2<br />

Pilot 3 3<br />

Scripto 4 4<br />

Sharpie 5 5<br />

Uni-b<strong>all</strong> 6 6<br />

Waterman 7 7<br />

Other 8 8<br />

NEEDLECRAFT AND<br />

SEWING<br />

543<br />

You Person<strong>all</strong>y:<br />

Number<br />

Stitched of times/<br />

in last last 6<br />

6 months months<br />

TYPES:<br />

Sewing – General Mending 01<br />

Sewing – Garments from<br />

Patterns 02<br />

Knitting 03<br />

Crocheting 04<br />

Cross-stitch 05<br />

Needlepoint 06<br />

Quilting 07<br />

TOOLS<br />

225<br />

Your Household:<br />

Acquired/<br />

last 12<br />

Owns months<br />

1 2<br />

Air compressor (not 12 volt<br />

inflator) 01<br />

Automotive tools 02<br />

Car vacuum 03<br />

Chain saw (gas) 04<br />

Chain saw (electric) 05<br />

Chipper/Shredder 06<br />

Circular saw (portable) 07<br />

Decorative paint tools/kits 08<br />

Drive bits 09<br />

Electric car polisher 10<br />

Electric drill – cordless 11<br />

Electric drill – corded 12<br />

Electric router 13<br />

Electric sander 14<br />

Electric screwdriver<br />

(cordless) 15<br />

Glue gun 16<br />

Hand tools 17<br />

Jig/sabre saw (portable) 18<br />

Lawn mower – riding 19<br />

Lawn mower (non-power) 20<br />

Lawn mower, walk behind<br />

(electric) 21<br />

Lawn mower, walk behind<br />

(gas) 22<br />

Lawn or garden tractor 23<br />

Lawn sprinkler 24<br />

Leaf shredder 25<br />

Outdoor blower (gas) 26<br />

Outdoor blower (electric) 27<br />

Pliers 28<br />

Pneumatic tools 29<br />

Power ratchet; cordless 30<br />

Paint sprayer 31<br />

Saw blades 32<br />

Shears (non-electric) 33<br />

Shovel 34<br />

Snowblower 35<br />

Staple gun 36<br />

Stationary band saw 37<br />

Stationary drill press 38<br />

Stationary table saw 39<br />

Stationary radial arm saw 40<br />

Tiller (garden) 41<br />

Trimmer/edger (electric) 42<br />

Trimmer/edger (gas) 43<br />

W<strong>all</strong>paper stripper 44<br />

Welder 45<br />

Wet-dry shop vacuum 46<br />

Workbench (portable) 47<br />

Other 48<br />

Who decided to make these purchases?<br />

227-0<br />

Yourself (alone or with<br />

someone else) 1<br />

Someone else 2

Page 45<br />

HOME IMPROVEMENTS & REMODELING,<br />

bedding, SHOPPING<br />

Your<br />

Household: Who did the work: Amount Spent<br />

HOME REMODELING<br />

Had done Yourself or $3000<br />

last 12 Other Household Outside Under $1000- or<br />

573 months Member Contractor $1000 $2999 more<br />

Conversion of garage/attic/ 1 2 3 4 5 6<br />

basement into living space .... 01<br />

Remodel bathroom. ........... 02<br />

Remodel kitchen ............. 03<br />

Remodel bedroom ............ 04<br />

Convert room to home office .... 05<br />

Convert room to home theater ... 06<br />

Remodel other rooms. ......... 07<br />

Add bathroom. ............... 08<br />

Add/extend garage ............ 09<br />

Add other rooms – exterior addition 10<br />

Add deck/porch/patio ......... 11<br />

Roofing. .................... 12<br />

Siding – vinyl/metal ........... 13<br />

Aluminum windows. ........... 14<br />

Clad-wood/Wood windows. ..... 15<br />

Vinyl windows. ............... 16<br />

Ceramic tile floors. ............ 17<br />

Hardwood floors .............. 18<br />

Laminate flooring ............. 19<br />

Vinyl flooring. ................ 20<br />

Carpeting ................... 21<br />

Kitchen cabinets. ............. 22<br />

Kitchen counter tops .......... 23<br />

Skylights. ................... 24<br />

Exterior doors. ............... 25<br />

Interior doors ................ 26<br />

Garage doors ................ 27<br />

Concrete or masonry work. ..... 28<br />

Swimming pool – in ground ..... 29<br />

W<strong>all</strong> paneling ................ 30<br />

Ceramic w<strong>all</strong> tile .............. 31<br />

Did you use any environment<strong>all</strong>y friendly/“green” products in any of the above remodeling jobs?<br />

63C-0 Yes 1<br />

How many of the above remodeling jobs did you person<strong>all</strong>y do?<br />

(Write in number) 574-0<br />

HOME<br />

IMPROVEMENTS<br />

Your<br />

Household: Who did the work: Amount Spent<br />

Purchased Yourself or $500<br />

last 12 Other Household Outside Under $100- or<br />

months Member Contractor $100 $499 more<br />

575 1 2 3 4 5 6<br />

Bathroom or kitchen faucets. .... 01<br />

Other bathroom or kitchen<br />

plumbing fixtures ........... 02<br />

Insulation for ceiling, floor, and/or<br />

w<strong>all</strong>s ..................... 03<br />

Exterior light fixtures. .......... 04<br />

Interior light fixtures ........... 05<br />

Clean-air filter. ............... 06<br />

Down spouts/gutters .......... 07<br />

Yard fence .................. 08<br />

W<strong>all</strong>paper/covering ........... 09<br />

Exterior painting .............. 10<br />

Interior painting .............. 11<br />

Has your household used a home decorating service in the last 12 months? 576-0 Yes 1<br />

Did you use any environment<strong>all</strong>y friendly/“green” products in any of the above home<br />

improvements? 63D-0 Yes 1<br />

How many of the above improvements did you person<strong>all</strong>y do? (Write in number) 577-0<br />

In the past 12 months how often did you have your home cleaned by:<br />

HOUSEKEEPING<br />

SERVICES Maid or Professional<br />

Housekeeper Cleaning Service<br />

578-0 579-0<br />

More than once a week ............................... 1 1<br />

Once a week ....................................... 2 2<br />

2-3 times a month ................................... 3 3<br />

Once a month. ...................................... 4 4<br />

Less than once a month. .............................. 5 5<br />

In the last 12 months, have you used the following: 580-0<br />

Professional carpet cleaning service .......... 1<br />

Professional furniture cleaning service. ........ 2<br />

BEDDING AND<br />

BATH GOODS<br />

Your Household:<br />

bought<br />

last 12<br />

months<br />

557-0<br />

Bathmat (in tub) .................. 1<br />

Shower Curtain .................. 2<br />

Towels ......................... 3<br />

Pillowcases. ..................... 4<br />

Sheets ......................... 5<br />

Electric blankets .................. 6<br />

Other blankets ................... 7<br />

Bedspreads ..................... 8<br />

Pillows ......................... 9<br />

Pillow shams .................... 0<br />

Comforters/quilts ................. X<br />

Dust ruffles ...................... Y<br />

Total amount spent in last 12 months:<br />

558-0<br />

Less than $50. .......... 1<br />

$50-$149 .............. 2<br />

$150+ ................. 3<br />

Who decided to make these purchases?<br />

559-0 1 Yourself (alone or with someone else)<br />

2 Someone else<br />

559-0 2 Someone else You Person<strong>all</strong>y:<br />

CONVENIENCE Shopped Times/<br />

STORES<br />

in last 6 last 30<br />

months days<br />

584<br />

1. STORES:<br />

AM/PM ................ 01<br />

BP/Amoco Food Mart .... 02<br />

Circle K ............... 03<br />

Citgo Quik Mart ......... 04<br />

Cumberland Farms ...... 05<br />

Exxon/Mobil On the Run .. 06<br />

7-Eleven. .............. 07<br />

Stop-N-Go ............. 08<br />

SuperAmerica/Speedway . 09<br />

Wawa ................. 10<br />

White Hen ............. 11<br />

Other ................. 12<br />

2. What time of day do you usu<strong>all</strong>y shop at<br />

convenience stores? 585-0<br />

Morning (5 am-10 am) ........... 1<br />

Mid Day (10 am-2 pm) ........... 2<br />

Afternoon (2 pm-7 pm). .......... 3<br />

Evening (7 pm-midnight) ......... 4<br />

3. Which of the following items have you bought/<br />

used in a convenience store in the last 30 days?<br />

586-0<br />

Breakfast sandwich ...... 1<br />

Lunch sandwich ......... 2<br />

Hot dogs .............. 3<br />

Other grill food .......... 4<br />

Ice cream .............. 5<br />

Candy ................ 6<br />

Snack foods ............ 7<br />

Dairy products . . . . . . . . . . . 8<br />

Bread ................. 9<br />

Other bakery items ...... 0<br />

Coffee-Brewed .......... X<br />

Milk .................. Y<br />

704-0<br />

Soft drinks – bottle/can ... 1<br />

Soft drinks – fountain ..... 2<br />

Juice drinks ............ 3<br />

Beer .................. 4<br />

Frozen beverage ........ 5<br />

Cigarettes ............. 6<br />

Lottery tickets. .......... 7<br />

Non-prescription drug/OTC 8<br />

ATM/Financial services ... 9<br />

Gas .................. 0<br />

Other (non-food) ........ X<br />

4. How much money did you person<strong>all</strong>y spend<br />

in convenience stores in the last 30 days?<br />

Amount Spent $_ _______________ 587-0

CAMERAS, FILM, SHOPPING, GIFT & PREPAID CARDS<br />

Page 46<br />

SHOPPING<br />

In the last 6 months, where did you purchase the following items?<br />

502<br />

Department Discount Drug Grocery<br />

Store Store Store Store<br />

Cosmetics ......................... 01<br />

Perfume/Cologne .................... 02<br />

Toiletries ........................... 03<br />

Non-prescription drugs/OTC ........................... 04<br />

Prescription drugs ................................... 05<br />

Clothing ........................... 06<br />

Shoes ............................. 07<br />

1 2 3 4<br />

In the last 6 months, where did you purchase the following alcoholic beverages?<br />

589 Convenience Super- Liquor Drug Wholesale<br />

Store market Store Store Club Other<br />

Beer ............. 01<br />

Wine ............. 02<br />

Liquor ............ 03<br />

1 2 3 4 5 6<br />

CAMERAS<br />

You Person<strong>all</strong>y:<br />

Bought<br />

last 12<br />

590 Own months<br />

TYPES: 1 2<br />

APS (Point & Shoot or SLR). .. 01<br />

APS Disposable .................. 02<br />

Cartridge ................. 03<br />

Digital Disposable. ................ 04<br />

Digital Point & Shoot ........ 05<br />

Digital SLR ................ 06<br />

Instant developing camera .... 07<br />

35mm Auto Focus Point & Shoot . 08<br />

35mm Auto Focus SLR ...... 09<br />

35mm Auto Focus Zoom Camera 10<br />

35mm Disposable. ................ 11<br />

35mm SLR (Single Lens Reflex). 12<br />

Video Still Camera . . . . . . . . . . . 13<br />

BRANDS:<br />

Canon. ................... 14<br />

Casio .................... 15<br />

Fujifilm ................... 16<br />

Kodak .................... 17<br />

Nikon .................... 18<br />

Olympus .................. 19<br />

Panasonic. ................ 20<br />

Pentax ................... 21<br />

Polaroid .................. 22<br />

Samsung ................. 23<br />

Sigma .................... 24<br />

Sony ..................... 25<br />

Vivitar .................... 26<br />

Other .................... 27<br />

Amount spent on cameras,<br />

last 12 months: 63T-0<br />

$1-$99 ................ 1<br />

$100-$199 ............. 2<br />

$200-$299 ............. 3<br />

$300+ ................. 4<br />

CAMERA &<br />

DEVELOPING<br />

ACCESSORIES<br />

You Person<strong>all</strong>y:<br />

Bought<br />

last 12<br />

Own months<br />

591<br />

Albums ................ 01<br />

Automatic winder ........ 02<br />

Batteries ............... 03<br />

Camera case ........... 04<br />

Flash unit .............. 05<br />

Frames ................ 06<br />

Gadget bags. ........... 07<br />

Lens filter(s) ............ 08<br />

Memory cards .......... 09<br />

Photo paper ............ 10<br />

Photo printer. ........... 11<br />

Telephoto/zoom lens ..... 12<br />

Tripod ................. 13<br />

Wideangle lens. ......... 14<br />

Other accessory lens(es) .. 15<br />

1 2<br />

How much did you spend on camera<br />

accessories in the last 12 months?<br />

592-0<br />

$1-$19 ................ 1<br />

$20-$99 ............... 2<br />

$100+ ................. 3<br />

You Person<strong>all</strong>y:<br />

GIFT CARDS &<br />

Number<br />

PREPAID CARDS Bought of cards<br />

ofof last 6 bought/last<br />

months 6 months<br />

61N<br />

TOTAL: .................. 00<br />

TYPES:<br />

American Express......... 01<br />

Discover .. . . . . . . . . . . . . . . 02<br />

MasterCard.............. 03<br />

VISA .. . . . . . . . . . . . . . . . . . 04<br />

Book Store .. . . . . . . . . . . . . 05<br />

Coffee Shop/Store. ....... 06<br />

Department Store.. . . . . . . . 07<br />

Discount Store. .......... 08<br />

Electronics Store.......... 09<br />

M<strong>all</strong>.. . . . . . . . . . . . . . . . . . . 10<br />

Restaurant. ............. 11<br />

Other................... 12<br />

Bought for/Gave to: 61R-0<br />

Family—Adult .. . . . . . . . . . . . . . . . . . . . . . . 1<br />

Family—Child .. . . . . . . . . . . . . . . . . . . . . . . 2<br />

Friend .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3<br />

Yourself.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />

Other............................... 5<br />

Where purchased: 63S-0<br />

Bank .............................. 1<br />

Department Store. ................... 2<br />

Discount Store ...................... 3<br />

M<strong>all</strong> .............................. 4<br />

Supermarket. ....................... 5<br />

Drugstore/Pharmacy ................. 6<br />

Other Store. ........................ 7<br />

Internet/Online ...................... 8<br />

Other ............................. 9<br />

Amount spent in total, last 6 months:<br />

$ 61S-0<br />

(Write in Amount)<br />

Have you received a gift or prepaid card<br />

(from someone other than yourself) in the<br />

last 6 months? 61T-0 Yes M 1<br />

Received from: 63V-0<br />

Family—Adult .. . . . . . . . . . . . . . . . . 1<br />

Family—Child .. . . . . . . . . . . . . . . . . 2<br />

Friend .. . . . . . . . . . . . . . . . . . . . . . . 3<br />

Other......................... 4<br />

After receiving, how long do you usu<strong>all</strong>y<br />

wait before redeeming gift or prepaid cards?<br />

61W-0<br />

Less than one month.. . . . . . . . . . . . 1<br />

1 month to less than 6 months...... 2<br />

6 months to less than 12 months.... 3<br />

12 months or more............... 4<br />

Do not usu<strong>all</strong>y redeem............ 5<br />

When redeeming a gift or prepaid card do<br />

you typic<strong>all</strong>y spend:<br />

Less than the total amount on the<br />

card. ....................... 6<br />

About the same amount on the card. . 7<br />

More than the amount on the card.. . 8<br />

EXPENDITURES<br />

You Person<strong>all</strong>y:<br />

Used in Amount<br />

last 6 spent last<br />

months 6 months<br />

593<br />

Barber Shop ............ $ 01<br />

Beauty Parlor ........... $ 02<br />

Dry Cleaning ........... $ 03<br />

Flowers by Phone/Internet . $ 04<br />

Flower Shop ............ $ 05<br />

Laundry/Laundromats .... $ 06<br />

Quick Service Copy/Printing $ 07<br />

FILM & PHOTO<br />

PROCESSING<br />

594<br />

You Person<strong>all</strong>y:<br />

Purchased Rolls or<br />

last 12 packs last<br />

months 12 months<br />

TOTAL: ................ 00<br />

TYPES:<br />

APS (Color Prints) ....... 01<br />

35mm (black & white). .... 02<br />

35mm (color slides) ...... 03<br />

35mm (color prints) ...... 04<br />

Instant developing film .... 05<br />

Other still (color). ........ 06<br />

Movie ................. 07<br />

Other ................. 08<br />

BRANDS:<br />

Fujifilm ................ 09<br />

Kodak ................. 10<br />

Store Brands (No Label). .. 11<br />

999<br />

OTHER (Write In)<br />

Where did you Where was<br />

buy the film? film processed?<br />

595-0 596-0<br />

Camera store ........ 1 1<br />

Department store ..... 2 2<br />

Discount store ....... 3 3<br />

Drug store .......... 4 4<br />

Grocery store ........ 5 5<br />

1 hour service. ....... 6 6<br />

Internet/Online ....... 7 7<br />

Warehouse clubs ..... 8 8<br />

Develop film yourself .............. 9<br />

Other .............. 0 0<br />

Have you printed digital photos in the last<br />

12 months? 600-0 Yes M 1<br />

If yes, where printed?<br />

Kodak Picture Maker .. ............... 2<br />

Other digital photo kiosk ............... 3<br />

In-store photo center .. ............... 4<br />

Internet/Online ....... ............... 5<br />

Home/personal photo printer ......... 6<br />

Other . . . . . . . . . . . . . . . . . . . . . . . . . . 7<br />

Your Household:<br />

CAMCORDERS<br />

Bought<br />

ofof last 12<br />

Owns months<br />

619<br />

KINDS: 1 2<br />

Camcorder – Digital (DVD) . . 01<br />

Camcorder – Digital<br />

(Hard Drive) ............ 02<br />

Camcorder – Digital (MiniDV) 03<br />

Camcorder – VHS-C ....... 04<br />

Camcorder – HI-8 ......... 05<br />

BRANDS:<br />

Canon .................. 06<br />

Flip Video. ............... 07<br />

Hitachi .................. 08<br />

JVC .................... 09<br />

Panasonic ............... 10<br />

Samsung ................ 11<br />

Sony ................... 12<br />

13<br />

OTHER (Write In)<br />

Total amount spent last<br />

12 months: $ 620-0<br />

Write in amount

VIDEO GAMES, MUSIC & OTHER AUDIO,<br />

BLANK RECORDABLE CDs/DVDs<br />

Page 48<br />

VIDEO GAMES<br />

(HOUSEHOLD)<br />

Your Household:<br />

Bought<br />

last 12<br />

Owns months<br />

616<br />

Systems: 1 2<br />

Game Boy ............... 01<br />

Game Boy Advance/<br />

Advance SP. ............ 02<br />

Game Boy Micro .......... 03<br />

Nintendo DS. ............. 04<br />

Nintendo DSi ............. 05<br />

Nintendo GameCube ....... 06<br />

Nintendo Wii. ............. 07<br />

Sony PlayStation/PS One ... 08<br />

PlayStation 2 (PS 2). ....... 09<br />

PlayStation 3 (PS 3). ....... 10<br />

Sony PSP. ............... 11<br />

PSP go. ................. 12<br />

Xbox. ................... 13<br />

Xbox 360 ................ 14<br />

Other Video Game Systems . 15<br />

Who is/are the principal user(s)? 617-0<br />

Yourself ................. 1<br />

Other Adult . . . . . . . . . . . . . . 2<br />

Teen (12-17) . . . . . . . . . . . . . 3<br />

Child (under 12) .......... 4<br />

Video Video Game<br />

63E Games Systems<br />

Where purchased: 1 2<br />

Video Store. ............. 01<br />

Electronics Store ......... 02<br />

Gaming Store ............ 03<br />

Discount Dept. Store ...... 04<br />

Toy Store ............... 05<br />

Internet/Online ........... 06<br />

Other .................. 07<br />

Total amount spent, last 12 months: 618<br />

Video Games $ 01<br />

(Write in amount)<br />

Video Game Systems $ 02<br />

(hardware)<br />

(Write in amount)<br />

Number of video games: 63W<br />

Purchased in the last 12 months 01<br />

Rented in the last 30 days 02<br />

VIDEO GAMES<br />

(PERSONAL)<br />

You Person<strong>all</strong>y:<br />

Played in Hours<br />

last 30 played/last<br />

days 7 days<br />

63F<br />

TOTAL: .................. 00<br />

Systems:<br />

Game Boy ............... 01<br />

Game Boy Advance/<br />

Advance SP. ............ 02<br />

Game Boy Micro .......... 03<br />

Nintendo DS ............. 04<br />

Nintendo DSi ............. 05<br />

Nintendo GameCube. ...... 06<br />

Nintendo Wii ............. 07<br />

Sony PlayStation/PS One ... 08<br />

PlayStation 2 (PS 2) ....... 09<br />

PlayStation 3 (PS 3) ....... 10<br />

Sony PSP ............... 11<br />

PSP go ................. 12<br />

Xbox. ................... 13<br />

Xbox 360 . . . . . . . . . . . . . . . . 14<br />

Other Video Game Systems . 15<br />

Games on Computer – PC. .. 16<br />

Games on Computer – Mac. . 17<br />

Games on Apple iPhone or<br />

iPod touch. ............. 18<br />

Games on other mobile phone<br />

or device. .............. 19<br />

Game Types: 63X<br />

Action/Adventure .......... 01<br />

Arcade/Puzzle ............ 02<br />

Card/Board Games ........ 03<br />

Educational .............. 04<br />

Exercise/Fitness .......... 05<br />

Extreme Sports ........... 06<br />

Fantasy ................. 07<br />

Fighting ................. 08<br />

Music/Dance ............. 09<br />

Racing .................. 10<br />

Role-Playing ............. 11<br />

Shooter ................. 12<br />

Simulation ............... 13<br />

Sports .................. 14<br />

Strategy ................. 15<br />

War .................... 16<br />

Other ................... 17<br />

FORMS: 63G-0<br />

Disc/Card/Cartridge ....... 1<br />

Online Download ......... 2<br />

Other. .................. 3<br />

Have you used any of the following services in<br />

the last 30 days? 63H-0 Yes<br />

Nintendo Wi-Fi Connection. . 1<br />

PlayStation Network ....... 2<br />

WiiConnect24 ............ 3<br />

Xbox LIVE. .............. 4<br />

In the last 30 days, have you played a<br />

multiplayer game online? 63J-0<br />

Using a video game system . 1<br />

Using a computer . . . . . . . . . 2<br />

Another way ............. 3<br />

In the last 30 days, have you played a MMO<br />

(Massive Multi-player Online) game?<br />

Yes 4<br />

How do you find out about new video games?<br />

63K-0<br />

Friends ................. 1<br />

Family .................. 2<br />

Radio .................. 3<br />

TV ..................... 4<br />

Magazines .............. 5<br />

Newspapers ............. 6<br />

Internet ................. 7<br />

Other. .................. 8<br />

Which, if any, of the following things do you do<br />

after you play a new video game? 63L-0<br />

Tell friends. .............. 1<br />

Tell family ............... 2<br />

Write about it on the Internet 3<br />

Other. .................. 4<br />

MUSIC & Other Audio<br />

(Downloads, CDs, Tapes)<br />

You Person<strong>all</strong>y:<br />

Acquired Number<br />

last 6 acquired/last<br />

months 6 months<br />

632<br />

FORMS:<br />

Downloaded individual<br />

song(s) ............... 01<br />

Downloaded album(s) ..... 02<br />

Other audio download .... 03<br />

Compact Disc (CD) ...... 04<br />

Pre-recorded tape (cassette) 05<br />

You Person<strong>all</strong>y:<br />

Listened to/ Purchased/<br />

64F last 6 last 6<br />

months months<br />

TYPES: 1 2<br />

Alternative ............. 01<br />

Audiobooks. ............ 02<br />

Blues ................. 03<br />

Classic Rock. ........... 04<br />

Classical. .............. 05<br />

Contemporary Christian ... 06<br />

Country. ............... 07<br />

Dance Music ........... 08<br />

Easy Listening .......... 09<br />

80’s Pop ............... 10<br />

Faith & Inspiration ....... 11<br />

Folk. .................. 12<br />

Foreign Language<br />

Instructional .......... 13<br />

Gospel ................ 14<br />

Hard Rock ............. 15<br />

Hip Hop ............... 16<br />

Jazz .................. 17<br />

Light Classical .......... 18<br />

New Age. .............. 19<br />

Oldies (50’s & 60’s) ...... 20<br />

Pop/Top 40 ............. 21<br />

R&B .................. 22<br />

Rap. .................. 23<br />

Reggae. ............... 24<br />

Self-improvement ........ 25<br />

Soft Rock .............. 26<br />

Soundtracks ............ 27<br />

Spanish/Latin ........... 28<br />

29<br />

OTHER (Write In)<br />

Where purchased: 65X-0<br />

Electronics Store ......... 1<br />

Discount Dept. Store ...... 2<br />

Music Store ............. 3<br />

Mail Order .............. 4<br />

iTunes.com .............. 5<br />

Other Internet/Online Site .. 6<br />

Other .................. 7<br />

BLANK<br />

You Person<strong>all</strong>y:<br />

RECORDABLE Bought Number<br />

last 6 bought last<br />

CDs/DVDs months 6 months<br />

65F<br />

TOTAL: ................ 00<br />

KINDS:<br />

CD ................... 01<br />

DVD .................. 02<br />

BRANDS:<br />

Fuji ................... 03<br />

HP ................... 04<br />

Imation ................ 05<br />

Maxell. ................ 06<br />

Memorex .............. 07<br />

Panasonic. ............. 08<br />

Sony .................. 09<br />

TDK .................. 10<br />

Verbatim ............... 11<br />

Store’s Own Brand ....... 12<br />

999<br />

OTHER (Write In)<br />

Used for: 64G-0<br />

Recording music .................. 1<br />

Recording video. .................. 2<br />

Recording photos ................. 3<br />

Backing up data/software ........... 4<br />

Other ........................... 5

Page 49<br />

COMPUTERS, printers/FAX & Pre-recordED DVDs<br />

PERSONAL<br />

COMPUTERS<br />

AT HOME OR AT WORK<br />

Do you or does anyone else in your household<br />

own a personal computer?<br />

621-0<br />

Yes 1 No 2<br />

Do you person<strong>all</strong>y use a personal computer at<br />

work?<br />

Yes 3 No 4<br />

For each computer owned at home or used at<br />

work, is the computer a:<br />

Own Use<br />

at Home at Work<br />

622<br />

1 2<br />

Desktop. ................. 01<br />

Laptop/Notebook/Tablet ..... 02<br />

Netbook. ................. 03<br />

Which brands does your household own and<br />

which brands do you person<strong>all</strong>y use at work?<br />

Own Use<br />

Computer at Home at Work<br />

1 2<br />

Acer .................. 04<br />

Alienware . . . . . . . . . . . . . . . 05<br />

Asus .................. 06<br />

Compaq ............... 07<br />

Dell ................... 08<br />

e Machines. ............ 09<br />

Fujitsu. ................ 10<br />

Gateway ............... 11<br />

Hewlett-Packard (HP). .... 12<br />

Lenovo/IBM ............ 13<br />

Panasonic. ............. 14<br />

Samsung .............. 15<br />

Sony Vaio .............. 16<br />

Toshiba ................ 17<br />

Other ................. 18<br />

Apple/Mac<br />

Apple iMac ............. 19<br />

MacBook .............. 20<br />

MacBook Pro ........... 21<br />

Mac mini. .............. 22<br />

Mac Pro ............... 23<br />

Other Apple/Mac ........ 24<br />

Own Use<br />

Computer Peripherals at Home at Work<br />

623<br />

1 2<br />

CD ROM Drive ........... 01<br />

CD-RW Drive (CD Burner) . 02<br />

DVD Drive. .............. 03<br />

DVD-RW Drive (DVD Burner) 04<br />

External Hard Drive ....... 05<br />

Flash Drive .............. 06<br />

Modem/Fax Modem ....... 07<br />

LAN/Network Interface Cards 08<br />

Microphone ............. 09<br />

Monitor - LCD/Flat Panel ... 10<br />

Monitor - Standard/Tube ... 11<br />

Removable Cartridge Storage<br />

Device. ............... 12<br />

Scanner ................ 13<br />

Speakers ............... 14<br />

Surge Protector .......... 15<br />

Tape Backup. ............ 16<br />

Webcam ................ 17<br />

Wireless Router .......... 18<br />

Other .................. 19<br />

Computer Own Use<br />

Operating Systems at Home at Work<br />

624<br />

1 2<br />

Apple/Mac OS 9.x ....... 01<br />

Apple/Mac OS X (10.x) ... 02<br />

Linux. ................. 03<br />

MS DOS ............... 04<br />

MS Windows NT. ........ 05<br />

MS Windows ’95. ........ 06<br />

MS Windows ’98. ........ 07<br />

MS Windows 2000 ....... 08<br />

MS Windows XP. ........ 09<br />

MS Windows XP/Pentablet. 10<br />

MS Windows Vista ....... 11<br />

MS Windows 7 .......... 12<br />

Unix .................. 13<br />

Other ................. 14<br />

Continued in next Column<br />

PERSONAL<br />

COMPUTERS AT HOME<br />

OR AT WORK (Continued)<br />

Own<br />

at Home<br />

Use<br />

at Work<br />

625<br />

Computer Software 1 2<br />

Accounting ............. 01<br />

CAD/CAM ............. 02<br />

Communications/Fax ..... 03<br />

Database/filing. ......... 04<br />

Desktop Publishing. ...... 05<br />

Education/training ....... 06<br />

Entertainment/Games .... 07<br />

Personal finance/Tax prep . 08<br />

Presentation graphics. .... 09<br />

Multimedia ............. 10<br />

Networking ............. 11<br />

Online Meeting/Conference 12<br />

Security/Anti-virus ....... 13<br />

Spreadsheet. ........... 14<br />

Utility ................. 15<br />

Web Authoring .......... 16<br />

Word Processing ........ 17<br />

Other ................. 18<br />

Amount spent for software in the past 12 months<br />

for home:<br />

626-0<br />

$001 - $099 ............ 1<br />

$100 - $199 ............ 2<br />

$200 - $299 ............ 3<br />

$300 - $499 ............ 4<br />

$500 + ................ 5<br />

Have you bought any computer books in the<br />

last 12 months? Yes 1 627-0<br />

Who decided what system to buy for your home?<br />

628-0<br />

Yourself (alone or with<br />

someone else) ......... 1<br />

Someone else ........... 2<br />

Who uses the computer at home?<br />

Yourself. ................ 3<br />

Other adult .............. 4<br />

Child (under 18) .......... 5<br />

Have you had your home computer profession<strong>all</strong>y<br />

serviced or upgraded in the last 12 months?<br />

Yes 6 No 7<br />

Total cost of home Most Recent<br />

computer system: Purchase Other(s)<br />

629<br />

1 2<br />

$0,001 - $0,499 ......... 01<br />

$0,500 - $0,999 ......... 02<br />

$1,000 - $1,499 ......... 03<br />

$1,500 - $1,999 ......... 04<br />

$2,000 - $2,999 ......... 05<br />

$3,000 - $4,999 ......... 06<br />

$5,000 + ............... 07<br />

630<br />

How Purchased: 1 2<br />

In-store ................ 01<br />

Mail Order ............. 02<br />

Online/Internet .......... 03<br />

Phone. ................ 04<br />

Purchased from:<br />

Computer Superstore. .... 05<br />

Department/Discount<br />

Store ................ 06<br />

Direct from Manufacturer . . 07<br />

Electronics Store ........ 08<br />

Warehouse/Club Store .... 09<br />

Online-only retailer ....... 10<br />

Other ................. 11<br />

When acquired:<br />

Within the last 12 months .. 12<br />

1 - 2 years ago .......... 13<br />

3 - 4 years ago .......... 14<br />

5 years ago or more ...... 15<br />

COMPUTER<br />

PRINTERS AND FAX<br />

Your Household:<br />

Bought<br />

last 12<br />

MACHINES Owns months<br />

631<br />

1 2<br />

All-in-one Printer<br />

(Printer, Copier, Scanner) .. . 01<br />

All-in-one Printer with Fax<br />

(Printer, Copier, Scanner,<br />

Fax)...................... 02<br />

Computer Printer Only. ..... 03<br />

Fax Machine Only........... 04<br />

Other ................... 05<br />

TYPES:<br />

Laser ................. 06<br />

Ink Jet. ................ 07<br />

Other ................. 08<br />

KINDS:<br />

Color. ................. 09<br />

Black and White ......... 10<br />

BRANDS:<br />

Brother ................ 11<br />

Canon. ................ 12<br />

Epson ................. 13<br />

HP ................... 14<br />

Kodak ................. 15<br />

Lexmark . . . . . . . . . . . . . . . . 16<br />

Other ................. 17<br />

You Person<strong>all</strong>y:<br />

DVDs/VIDEO TAPES Rented/ Purchased/<br />

(Pre-Recorded) last 30 last 30<br />

days days<br />

615<br />

Types rented/<br />

purchased: 1 2<br />

Action/Adventure. ......... 01<br />

Classics ................. 02<br />

Comedy ................. 03<br />

Drama .................. 04<br />

Exercise/Fitness .......... 05<br />

Family/Children Oriented ... 06<br />

Foreign. ................. 07<br />

Horror .................. 08<br />

Musical ................. 09<br />

News/Information/<br />

Documentary ........... 10<br />

Romance ................ 11<br />

Science Fiction ........... 12<br />

TV Shows ............... 13<br />

Westerns ................ 14<br />

Other ................... 15<br />

Where rented/purchased:<br />

Blockbuster Video Store. ... 16<br />

f.y.e. ................... 17<br />

Hollywood Video. ......... 18<br />

Movie G<strong>all</strong>ery ............ 19<br />

Redbox. ................ 20<br />

Other Video Store. ........ 21<br />

Blockbuster.com. ......... 22<br />

Netflix.com .............. 23<br />

Other Internet/Online ...... 24<br />

Discount Dept. Store ...... 25<br />

Electronics Store ......... 26<br />

Grocery Store. ........... 27<br />

Mail Order .............. 28<br />

Other .................. 29<br />

Number of DVDs you have:<br />

Rented in the last 30 days 701-0<br />

Number<br />

Purchased in the last 30 days 702-0<br />

Number<br />

How many times have you gone<br />

to the video store in the last<br />

30 days? 612-0<br />

Number

SPORTS EQUIPMENT/CLUBS/POLITICAL OUTLOOK/LOTTERY<br />

Page 50<br />

SPORT &<br />

You Person<strong>all</strong>y: Amount spent in last 12 months<br />

RECREATION<br />

667 Bought last $1- $25-<br />

EQUIPMENT Own 12 months $24 $49 $50+<br />

PHYSICAL FITNESS<br />

656-0<br />

Baseb<strong>all</strong> gloves ..................... 01<br />

Basketb<strong>all</strong>. ......................... 02<br />

Bicycle helmet ...................... 03<br />

Bow .............................. 04<br />

Bowling b<strong>all</strong>s ....................... 05<br />

Cross country ski boots ............... 06<br />

Cross country skis ................... 07<br />

Elbow/knee pads (In-line skating protective gear) . 08<br />

Factory loaded ammunition ............ 09<br />

Fishing reel. ........................ 10<br />

Fishing rod ......................... 11<br />

Fishing lures or hooks ................ 12<br />

Other fishing equipment ............... 13<br />

Footb<strong>all</strong>. ........................... 14<br />

Golf b<strong>all</strong>s .......................... 15<br />

Outdoor or pocket knife ............... 16<br />

Racquetb<strong>all</strong> b<strong>all</strong>s .................... 17<br />

Racquetb<strong>all</strong> racquet .................. 18<br />

Soccer b<strong>all</strong> ......................... 19<br />

Softb<strong>all</strong>/baseb<strong>all</strong> bats. ................ 20<br />

Sportswatch/Chronograph ............. 21<br />

Tennis b<strong>all</strong>s ........................ 22<br />

Tennis racquet ...................... 23<br />

Other ............................. 24<br />

1 2 3 4 5<br />

You Person<strong>all</strong>y: Amount spent last 12 months<br />

668 Bought last $1- $100-<br />

Own 12 months $99 $249 $250+<br />

Binoculars ......................... 01<br />

Mountain bicycle .................... 02<br />

Road bicycle. ....................... 03<br />

Stationary bicycle. ................... 04<br />

Downhill ski boots. ................... 05<br />

Downhill skis. ....................... 06<br />

Roller blades/In-line skates ............ 07<br />

Elliptical ........................... 08<br />

Treadmill. .......................... 09<br />

Other exercise equipment ............. 10<br />

Golf clubs .......................... 11<br />

Hand gun .......................... 12<br />

Hockey equipment ................... 13<br />

Rifle .............................. 14<br />

Shotgun ........................... 15<br />

Weight lifting equipment. .............. 16<br />

Other ............................. 17<br />

1 2 3 4 5<br />

CONTRIBUTIONS<br />

You Person<strong>all</strong>y:<br />

Contributed to,<br />

last 12 months<br />

Types of Organizations: 655-0<br />

Public Broadcasting Service (PBS) . 1<br />

National Public Radio (NPR) ..... 2<br />

Religious .................... 3<br />

Arts/Cultural .................. 4<br />

Educational .................. 5<br />

Environmental ................ 6<br />

Health. ...................... 7<br />

Political ...................... 8<br />

Social Services. ............... 9<br />

Other Non-Religious Organization . 0<br />

63M-0 Amount<br />

How much did you $1-$49.. . . . . . . . . . 1<br />

contribute in total? $50-$99.. . . . . . . . . 2<br />

$100-$249.. . . . . . . 3<br />

$250-$499.. . . . . . . 4<br />

$500 or more.. . . . . 5<br />

In the past 12 months, have you volunteered<br />

for a charitable organization? Yes 6<br />

CASINO<br />

GAMBLING<br />

659<br />

You Person<strong>all</strong>y:<br />

Participated Times<br />

in last last 12<br />

12 months months<br />

PLACES:<br />

Atlantic City ............ 01<br />

Caribbean. ............. 02<br />

Connecticut ............ 03<br />

Las Vegas. ............. 04<br />

Mississippi Gulf Coast .... 05<br />

Reno. ................. 06<br />

Other ................. 07<br />

You Person<strong>all</strong>y:<br />

LOTTERY<br />

Bought Times<br />

in last last 30<br />

12 months days<br />

658<br />

Any lottery tickets: ....... 00<br />

KINDS:<br />

Instant game ........... 01<br />

Daily drawing ........... 02<br />

Lotto drawing ........... 03<br />

999<br />

OTHER (Write In)<br />

Have you engaged in a regular exercise<br />

program in the last 12 months where you<br />

exercised at least twice a week?<br />

At At At other<br />

home club facility<br />

Yes .............. 01<br />

1 2 3<br />

GREETING CARDS<br />

657<br />

You Person<strong>all</strong>y:<br />

Bought Number of<br />

in last cards last<br />

6 months 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Anniversary ............ 01<br />

Birthday ............... 02<br />

Friendship/Love ......... 03<br />

Get Well ............... 04<br />

Sympathy .............. 05<br />

Thinking of You .......... 06<br />

Wedding ............... 07<br />

Baby .................. 08<br />

Christmas/Hanukkah/<br />

Kwanzaa ............. 09<br />

Mother’s Day ........... 10<br />

Father’s Day ............ 11<br />

Valentine’s Day. ......... 12<br />

Other Holiday ........... 13<br />

999<br />

OTHER (Write In)<br />

Where Purchased: 63N-0<br />

Card Store ....................... 1<br />

Discount Store .................... 2<br />

Drug Store ....................... 3<br />

Grocery Store. .................... 4<br />

Internet/Online. ................... 5<br />

Other ........................... 6<br />

ORGANIZATIONS/<br />

CLUBS<br />

Organizations or clubs you are a<br />

member of: 653-0<br />

AARP ............................ 1<br />

Fraternal Orders ................... 2<br />

Religious Clubs .................... 3<br />

Civic Clubs. ....................... 4<br />

Veterans Clubs. .................... 5<br />

A body of local government ........... 6<br />

654-0<br />

Country Clubs ..................... 1<br />

Business Club ..................... 2<br />

Collector’s Clubs ................... 3<br />

Union ............................ 4<br />

School or College Board ............. 5<br />

Church Board. ..................... 6<br />

Charitable Organizations ............. 7<br />

None of the above .................. 8<br />

POLITICAL<br />

OUTLOOK /<br />

AFFILIATION<br />

652-0<br />

POLOTICAL OUTLOOK<br />

In terms of your political outlook, do you<br />

usu<strong>all</strong>y think of yourself as:<br />

Very Conservative .................. 1<br />

Somewhat Conservative ............. 2<br />

Middle of The Road ................. 3<br />

Somewhat Liberal .................. 4<br />

Very Liberal ....................... 5<br />

Which political party, if any, are you affiliated<br />

with?<br />

Democratic. ....................... 6<br />

Republican. ....................... 7<br />

Other party. ....................... 8<br />

Independent. ...................... 9

SPORTS<br />

Page 52<br />

You Person<strong>all</strong>y:<br />

HOW OFTEN DO YOU ENGAGE IN THESE:<br />

SPORTS Participated 2 or more 2-3 Less than<br />

in last times a Once a times a Once a once a<br />

12 months week week month month month<br />

666<br />

1 2 3 4 5 6<br />

Aerobics...................................................................................................... 01<br />

Archery....................................................................................................... 02<br />

Auto racing.................................................................................................. 03<br />

Backpacking................................................................................................ 04<br />

Baseb<strong>all</strong>...................................................................................................... 05<br />

Basketb<strong>all</strong>................................................................................................... 06<br />

Bicycling – Mountain................................................................................... 07<br />

Bicycling – Road......................................................................................... 08<br />

Boating (power)........................................................................................... 09<br />

Bowling....................................................................................................... 10<br />

Canoeing/kayaking..................................................................................... 11<br />

Fishing – fresh water.................................................................................. 12<br />

Fishing – salt water..................................................................................... 13<br />

Footb<strong>all</strong>....................................................................................................... 14<br />

Frisbee........................................................................................................ 15<br />

Golf............................................................................................................. 16<br />

Hiking.......................................................................................................... 17<br />

Hockey........................................................................................................ 18<br />

Horseback riding......................................................................................... 19<br />

Hunting with bow & arrow........................................................................... 20<br />

Hunting with handgun................................................................................. 21<br />

Hunting with rifle......................................................................................... 22<br />

Hunting with shotgun.................................................................................. 23<br />

Ice skating................................................................................................... 24<br />

Jet skiing..................................................................................................... 25<br />

Jogging/running.......................................................................................... 26<br />

Karate......................................................................................................... 27<br />

Kick Boxing................................................................................................. 28<br />

Lacrosse..................................................................................................... 29<br />

Marathon/Triathlon (training and events) ................................................... 30<br />

Martial Arts................................................................................................. 31<br />

Motocross................................................................................................... 32<br />

Motorcycling................................................................................................ 33<br />

Paddle Tennis.............................................................................................. 34<br />

Pilates......................................................................................................... 35<br />

Ping Pong/Table Tennis............................................................................... 36<br />

Racquetb<strong>all</strong>................................................................................................. 37<br />

Rock climbing............................................................................................. 38<br />

Roller blading/in-line skating....................................................................... 39<br />

Roller skating.............................................................................................. 40<br />

Rowing: stationary/outdoor......................................................................... 41<br />

Sailing......................................................................................................... 42<br />

Scuba diving............................................................................................... 43<br />

Skateboarding............................................................................................. 44<br />

Skiing – Cross country................................................................................ 45<br />

Skiing – Downhill........................................................................................ 46<br />

Snorkeling/skin diving................................................................................. 47<br />

Snowboarding............................................................................................. 48<br />

Snowmobiling............................................................................................. 49<br />

Soccer......................................................................................................... 50<br />

Softb<strong>all</strong>........................................................................................................ 51<br />

Surfing/windsurfing..................................................................................... 52<br />

Swimming................................................................................................... 53<br />

Target shooting........................................................................................... 54<br />

Tennis......................................................................................................... 55<br />

Volleyb<strong>all</strong>..................................................................................................... 56<br />

Walking for exercise.................................................................................... 57<br />

Water skiing................................................................................................ 58<br />

Weight lifting............................................................................................... 59<br />

Whitewater rafting....................................................................................... 60<br />

Yoga............................................................................................................ 61<br />

Other........................................................................................................... 62

cellular/mobile PHONES<br />

Page 54<br />

CELLULAR/<br />

MOBILE PHONES/<br />

SMARTPHONES<br />

You Person<strong>all</strong>y: 705-0<br />

Have a working cellular/mobile phone. ... M 1<br />

Purchased/obtained last 12 months ..... M 2<br />

Working cell phones<br />

you person<strong>all</strong>y:<br />

Use most Other working<br />

often cell phone(s)<br />

709 (choose one)<br />

Handset Brands: 1 2<br />

Apple iPhone .......... M M 01<br />

BlackBerry ............ M M 02<br />

Kyocera .............. M M 03<br />

LG .................. M M 04<br />

Motorola. ............. M M 05<br />

Nokia ................ M M 06<br />

Palm. ................ M M 07<br />

Samsung ............. M M 08<br />

Sanyo. ............... M M 09<br />

Sony Ericsson ......... M M 10<br />

T-Mobile .............. M M 11<br />

Other ................ M M 12<br />

Used For:<br />

Business ............. M M 13<br />

Personal. ............. M M 14<br />

Please answer the following questions about the<br />

one cell phone you person<strong>all</strong>y use most often:<br />

Plan Types: 61G-0<br />

Individual Plan ....................... M 1<br />

Family or Shared Plan ................. M 2<br />

Corporate Plan ...................... M 3<br />

Mobile Service Agreement Types:<br />

Monthly Plan with Contract ............. M 4<br />

Monthly Plan with No Contract .......... M 5<br />

Prepaid ............................ M 6<br />

Average Monthly Bill:<br />

$ 1-$24 ............................ M 7<br />

$25-$49 ............................ M 8<br />

$50-$74 ............................ M 9<br />

$75-$99 ............................ M 0<br />

$100-$199 .......................... M X<br />

$200+ ............................. M Y<br />

CELLULAR/<br />

MOBILE PHONES/<br />

SMARTPHONES<br />

(Continued)<br />

Amount spent on cellular phone<br />

purchase, last 12 months: $ 61F-0<br />

(Write in Amount)<br />

Where Purchased: 707-0<br />

Online/Internet. .................... M 1<br />

Electronics Store ................... M 2<br />

Department Store .................. M 3<br />

Discount Store ..................... M 4<br />

Wholesale/Club Store ............... M 5<br />

Carrier-owned Store ................ M 6<br />

Computer Superstore ................ M 7<br />

Other ............................. M 8<br />

Person<strong>all</strong>y<br />

Cell Phone Used last<br />

Has 30 days<br />

708<br />

Communication Features: 1 2<br />

Phone. ................. M M 01<br />

Voicemail ............... M M 02<br />

Email .................. M M 03<br />

Instant Messenger (IM) .... M M 04<br />

Text Messaging .......... M M 05<br />

Picture Messaging ........ M M 06<br />

Walkie-Talkie/“Push-to-Talk”. M M 07<br />

Media Features:<br />

Camera ................ M M 08<br />

FM Radio ............... M M 09<br />

Games ................. M M 10<br />

MP3 Player. ............. M M 11<br />

Video Player. ............ M M 12<br />

Video Recorder .......... M M 13<br />

Web/Internet Access ...... M M 14<br />

Other Features:<br />

Address Book. ........... M M 15<br />

Bluetooth ............... M M 16<br />

Calendar/Organizer ....... M M 17<br />

GPS/Navigation . . . . . . . . . . . M M 18<br />

Keypad (Full Alphabet/<br />

Qwerty) ............ M M 19<br />

View Spreadsheets/<br />

Text Documents . . . . . . . . . M M 20<br />

Create/Edit Spreadsheets/<br />

Text Documents . . . . . . . . . M M 21<br />

Speakerphone ........... M M 22<br />

Voice Activated Dialing. .... M M 23<br />

WiFi ................... M M 24<br />

CELLULAR/<br />

MOBILE PHONES/<br />

SMARTPHONES<br />

(Continued)<br />

Which, if any, of the following things did you<br />

do using your cellular phone in the last 30<br />

days?<br />

62Z-0<br />

Visited a search engine .............. M 1<br />

Visited a website for News ............ M 2<br />

Visited a website for Sports ........... M 3<br />

Visited a website for Weather. ......... M 4<br />

Visited a website for Entertainment<br />

Information ...................... M 5<br />

Visited a website for Financial Information M 6<br />

Visited a website for Maps/Directions ...... M 7<br />

Visited a website for other Local Information . M 8<br />

Visited a Social Networking website ....... M 9<br />

Searched for information about a product. M 0<br />

Visited any other website . . . . . . . . . . . . . . M X<br />

Used Text Messaging to communicate with<br />

friends or family .................. M Y<br />

61H-0<br />

Used Text Messaging to vote in a contest,<br />

make a choice, or give an opinion .... M 1<br />

Looked at an advertisement sent with<br />

Text Message .................... M 2<br />

Used Text Messaging to respond to an<br />

advertisement .................... M 3<br />

Signed up for a Text Message “alert” service M 4<br />

Received a Text Message “alert” ....... M 5<br />

Redeemed a mobile coupon .......... M 6<br />

Watched a video clip ................ M 7<br />

Watched a downloaded or streamed<br />

TV program. ..................... M 8<br />

Watched live television .............. M 9<br />

Watched a full length movie. .......... M 0<br />

Watched other video ................ M X<br />

Listened to a podcast. ............... M Y<br />

61J-0<br />

Listened to music. .................. M 1<br />

Downloaded a song. ................ M 2<br />

Downloaded a ringtone .............. M 3<br />

Downloaded w<strong>all</strong>paper. .............. M 4<br />

Downloaded a game ................ M 5<br />

Downloaded an application ........... M 6<br />

C<strong>all</strong>ed directory assistance ........... M 7<br />

Please indicate how much you AGREE or DISAGREE with each of<br />

DISAGREE<br />

AGREE<br />

CELLULAR/<br />

the following statements by checking the box that comes closest<br />

MOBILE OPINIONS Completely Somewhat Somewhat Completely<br />

to how you feel.<br />

62H 1 2 3 4<br />

1. I understand how to use most of the features on my cell phone. ................................... 01<br />

2. Having one mobile device that can do everything is very convenient. ............................... 02<br />

3. There are some features on my cell phone I’d like to use, but I don’t know how to use them. ............. 03<br />

4. I just want to use my cell phone to make and receive c<strong>all</strong>s and don’t care about any other features. ....... 04<br />

5. I think of my mobile phone as a source of entertainment. ........................................ 05<br />

6. My cell phone is an extension of my personality. ............................................... 06<br />

7. I enjoy customizing the look and sound of my cell phone. ........................................ 07<br />

8. I would be willing to receive advertisements on my cell phone in exchange for services, like live TV<br />

or Text Messaging.. .................................................................... 08<br />

9. I would be willing to pay a monthly subscription fee to receive live TV on my cell phone. ................ 09<br />

10. I would be willing to receive advertisements on my cell phone in exchange for lower monthly costs. . ...... 10<br />

11. I expect the quality of video on my cell phone to be as good as that on my TV. ....................... 11<br />

12. Advertisements on cell phones are annoying. ................................................. 12<br />

13. I am interested in watching video clips on my cell phone. ........................................ 13<br />

14. I am interested in watching live TV on my cell phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14<br />

15. Text messaging is an important part of my daily life. . ........................................... 15<br />

16. I would use Text Messaging if I knew how to do it. . ............................................. 16<br />

17. I would use Text Messaging more often, if it were easier to type the messages. . ...................... 17<br />

18. I would use Text Messaging more often, if it were less expensive. . ................................. 18<br />

19. I would use the Internet on my cell phone more often, if it were less expensive. ....................... 19<br />

20. I would use the Internet on my cell phone more often, if the websites loaded more easily. ............... 20<br />

21. I would use the Internet on my cell phone more often, if the screen were easier to read. ................ 21

Page 55<br />

SPORTS EVENTS, GARDENING, EXTERMINATORS<br />

SPORTS EVENTS:<br />

WATCH, LISTEN &<br />

ATTEND<br />

For each of the sports events you actu<strong>all</strong>y watch on TV, listen to on<br />

the radio or attend in-person (during the sport’s season), please mark<br />

how often you do so:<br />

Watch on TV Listen To Radio AttENd<br />

On On On<br />

682 Regularly Occasion Regularly Occasion Regularly Occasion<br />

Alpine Skiing & Ski Jumping. ....... 01<br />

Auto Racing – NASCAR. .......... 02<br />

Auto Racing – Other. ............. 03<br />

Baseb<strong>all</strong> – College ............... 04<br />

Baseb<strong>all</strong> – MLB Regular Season .... 05<br />

Baseb<strong>all</strong> – MLB Playoffs/World Series . . 06<br />

Basketb<strong>all</strong> – College. ............. 07<br />

Basketb<strong>all</strong> – NBA Regular Season. .. 08<br />

Basketb<strong>all</strong> – NBA Playoffs/Finals .... 09<br />

Basketb<strong>all</strong> – NCAA Basketb<strong>all</strong><br />

Tournament. .................. 10<br />

Basketb<strong>all</strong> – WNBA .............. 11<br />

Bicycle Racing .................. 12<br />

Bowling. ....................... 13<br />

Boxing ........................ 14<br />

Equestrian Events ............... 15<br />

Extreme Sports – Summer. ........ 16<br />

Extreme Sports – Winter .......... 17<br />

Figure Skating .................. 18<br />

Fishing ........................ 19<br />

Footb<strong>all</strong> – College ............... 20<br />

Footb<strong>all</strong> – NFL Monday or<br />

Thursday Night Games. ......... 21<br />

Footb<strong>all</strong> – NFL Weekend Games .... 22<br />

Footb<strong>all</strong> – NFL Playoffs/Super Bowl .. 23<br />

Golf – PGA ..................... 24<br />

Golf – LPGA .................... 25<br />

Other Golf. ..................... 26<br />

Gymnastics .................... 27<br />

High School Sports .............. 28<br />

Horse Racing (flats, runners) ....... 29<br />

Horse Racing (trotters/harness). .... 30<br />

Ice Hockey – NHL Regular Season . . 31<br />

Ice Hockey – NHL Playoffs and<br />

Stanley Cup Finals . . . . . . . . . . . . . 32<br />

Lacrosse – MLL ................. 33<br />

Marathon/Road Running, Triathlon<br />

& Other Endurance Events. ....... 34<br />

Mixed Martial Arts (MMA). ......... 35<br />

Motorcycle Racing ............... 36<br />

Olympics – Summer. ............. 37<br />

Olympics – Winter ............... 38<br />

Poker ......................... 39<br />

Pro Bull Riding .................. 40<br />

Rodeo. ........................ 41<br />

Soccer – MLS. .................. 42<br />

Soccer – World Cup .............. 43<br />

Tennis – Men’s .................. 44<br />

Tennis – Women’s ............... 45<br />

Track & Field. ................... 46<br />

Truck and Tractor Pull/Mud Racing. .. 47<br />

Volleyb<strong>all</strong> – Pro Beach ............ 48<br />

Weightlifting .................... 49<br />

Wrestling – Professional. .......... 50<br />

1 2 3 4 5 6<br />

INTEREST<br />

IN SPORTS<br />

491<br />

Non-Fan Average Fan Super-Fan<br />

0 1 2 3 4 5 6 7 8 9 10<br />

All Sports ............. 01<br />

College Basketb<strong>all</strong> ...... 02<br />

College Footb<strong>all</strong> ........ 03<br />

Other College Sports .... 04<br />

Golf. ................. 05<br />

High School Sports. ..... 06<br />

Major League Baseb<strong>all</strong>. .. 07<br />

Nascar. ............. 08<br />

NBA ................. 09<br />

NFL. ................. 10<br />

NHL ................. 11<br />

Olympics. ............. 12<br />

Professional Wrestling ... 13<br />

Soccer ............... 14<br />

Tennis ................ 15<br />

GARDEN<br />

Do you have a garden?<br />

Yes 1<br />

685-0<br />

What size is your garden?<br />

Under 250 square feet ............ 2<br />

250-499 square feet .............. 3<br />

500-1999 square feet ............. 4<br />

2000 or more square feet .......... 5<br />

Did you participate in outdoor gardening in<br />

the last 12 months?<br />

Yes 6 No 7<br />

On how many days did you person<strong>all</strong>y garden<br />

in the past 12 months?<br />

686-0<br />

(Write in Number)<br />

Which of the following did you engage in<br />

during the last 12 months? 598-0<br />

Flowers/Ornamentals ............. 1<br />

Vegetable Gardening. ............. 2<br />

Herb Growing ................... 3<br />

Fruit (Not Trees) ................. 4<br />

Lawn Care. ..................... 5<br />

Berries & Brambles ............... 6<br />

PROPERTY<br />

AND GARDEN<br />

MAINTENANCE<br />

Your Household:<br />

Bought<br />

last 12<br />

months<br />

687-0<br />

Bulbs ....................... 1<br />

Flower seeds ................. 2<br />

Garden fertilizer ............... 3<br />

Garden insecticides ............ 4<br />

Garden soil. .................. 5<br />

Lawn fertilizer with weed control .. 6<br />

Lawn fertilizer without weed control 7<br />

Lawn insecticides .............. 8<br />

Lawn maintenance service. ...... 9<br />

Lawn seed ................... 0<br />

Organic soil additives ........... X<br />

Plant food (outdoor) ............ Y<br />

588-0<br />

Pool chemicals ................ 1<br />

Potting soil ................... 2<br />

Shrubs & plants (outdoor) ....... 3<br />

Top soil ...................... 4<br />

Trees ....................... 5<br />

Vegetable plants. .............. 6<br />

Vegetable seeds. .............. 7<br />

Weed killer ................... 8<br />

Total amount spent on <strong>all</strong> garden items,<br />

last 12 months<br />

$<br />

688-0<br />

In the last 12 months have you used a<br />

service, or services, for property and garden<br />

maintenance?<br />

689-0<br />

Yes 1 No 2<br />

On a scale from “0” to “10” where “0” means you are not a sports fan<br />

at <strong>all</strong>, “5” means you are an average sports fan and “10” means you<br />

are a super sports fan, where would you place yourself on that scale<br />

for each of the following? (Please “X” one box FOR EACH SPORT.) Your Household:<br />

PROFESSIONAL<br />

EXTERMINATORS<br />

Had<br />

treatment Times/<br />

last 12 last 12<br />

months months<br />

690<br />

TOTAL ................... 00<br />

FOR:<br />

Insects (ants, roaches, etc.).. 01<br />

Pests (mice, rats, etc.). .... 02<br />

Termites. ............... 03<br />

COMPANIES:<br />

Orkin.. . . . . . . . . . . . . . . . . . 04<br />

Terminix. ............... 05<br />

999<br />

OTHER (Write In)

YELLOW PAGES, overnight delivery, NEWSPAPERS,<br />

batteries, Games, books, PDAs<br />

Page 56<br />

YELLOW PAGES<br />

691<br />

In the past 12 months, have you referred to<br />

the yellow pages when considering the<br />

purchase or use of any of these items or<br />

services?<br />

You person<strong>all</strong>y referred to,<br />

past 12 months:<br />

Paper Internet<br />

yellow yellow<br />

pages pages<br />

1 2<br />

Attorneys ................ 01<br />

Auto — Dealers & Sales .... 02<br />

Auto — Parts & Supplies .... 03<br />

Auto — Repair & Services ... 04<br />

Auto — Other. ............ 05<br />

Banking, Finance & Insurance. 06<br />

Beauty Salons ............ 07<br />

Other Personal Care Services . 08<br />

Carpet Cleaning. .......... 09<br />

Department Stores ......... 10<br />

Doctors, Dentists and Other<br />

Medical Services ........ 11<br />

Education/Schools ......... 12<br />

Electronic Equipment,<br />

Supplies & Services. ...... 13<br />

Florists .................. 14<br />

Home Appliance Repairs .... 15<br />

Home Improvement & Repairs 16<br />

Household Furnishings ..... 17<br />

Jewelers/Jewelry .......... 18<br />

Pizza ................... 19<br />

Pharmacies .............. 20<br />

Plumbers & Electricians. .... 21<br />

Real Estate .............. 22<br />

Restaurants .............. 23<br />

Sports & Leisure Activities<br />

& Equipment ............ 24<br />

Supermarkets/Grocers. ..... 25<br />

Theaters. ................ 26<br />

Travel — Airlines/Airline<br />

Tickets ................ 27<br />

Travel — Hotels/Motels ..... 28<br />

Travel — Other Services .... 29<br />

Other ................... 30<br />

You person<strong>all</strong>y referred in the past 7 days to:<br />

63P-0<br />

Paper yellow pages 1<br />

Internet yellow pages 2<br />

OVERNIGHT<br />

PACKAGES/LETTER<br />

DELIVERY SERVICES<br />

Have you used an overnight package/letter<br />

delivery service in the last 12 months?<br />

Yes 1 No 2 660-0<br />

661<br />

Services Used: Business Personal<br />

DHL .................. 01<br />

Federal Express ......... 02<br />

U.P.S. ................. 03<br />

U.S. Postal Service. ...... 04<br />

Other ................. 05<br />

1 2<br />

PDA/HANDHELD<br />

COMPUTERS<br />

(Not a cell phone)<br />

63Y-0<br />

Do you person<strong>all</strong>y have a Handheld Computer/<br />

Organizer or PDA that is not a cell phone?<br />

Yes 1<br />

NEWSPAPER<br />

READING<br />

Which of these sections do you read or look<br />

at when you read your weekday and Sunday/<br />

weekend newspaper?<br />

63Q<br />

Read in<br />

Read in Sunday/<br />

Weekday Weekend<br />

Newspaper Newspaper<br />

1 2<br />

Main News/Front Page. ..... 01<br />

International/National News. . 02<br />

Local News .............. 03<br />

Business/Finance ......... 04<br />

Classified Advertising ...... 05<br />

Comics. ................. 06<br />

Editorial Page. ............ 07<br />

Entertainment/Lifestyle ..... 08<br />

Fashion ................. 09<br />

Food/Cooking. ............ 10<br />

Health. .................. 11<br />

Home/Home Design/<br />

Furnishings/Gardening. .... 12<br />

Movie Listings & Reviews ... 13<br />

Science & Technology ...... 14<br />

Sports .................. 15<br />

Travel ................... 16<br />

TV Listings ............... 17<br />

Weather ................. 18<br />

Advertisements ........... 19<br />

Circulars/Inserts/Fliers. ..... 20<br />

Which of these actions did you take in the past<br />

30 days, as a result of reading or looking into a<br />

newspaper? (Check <strong>all</strong> that apply.) 650-0<br />

Shopped at an advertised store ......... 1<br />

Purchased an advertised product ........ 2<br />

Requested additional information<br />

on an advertised product ............. 3<br />

Cut out an ad for later reference ......... 4<br />

How useful do you find the advertising in your<br />

newspaper? (Check one in each column.)<br />

Sunday/<br />

Weekday Weekend<br />

Newspaper Newspaper<br />

Usefulness of Advertising:<br />

Very ...................... 5 8<br />

Somewhat ................. 6 9<br />

Not at <strong>all</strong> .................. 7 0<br />

BATTERIES<br />

633<br />

You Person<strong>all</strong>y:<br />

Purchased Number/<br />

in last 6 last 6<br />

months months<br />

TOTAL: ................ 00<br />

TYPES:<br />

Rechargeable. .......... 01<br />

Throw-away ............ 02<br />

BRANDS:<br />

Duracell ............... 03<br />

Duracell PowerPix ....... 04<br />

Duracell Ultra . . . . . . . . . . . . 05<br />

eneloop Rechargeables ... 06<br />

Energizer/Energizer Max .. 07<br />

Energizer e 2 ............ 08<br />

Eveready Gold .......... 09<br />

Eveready Super Heavy Duty . 10<br />

Kodak ................. 11<br />

Panasonic. ............. 12<br />

Radio Shack. ........... 13<br />

Rayovac—Alkaline ....... 14<br />

Rayovac—Heavy Duty .... 15<br />

Sony .................. 16<br />

Store’s Own Brand ....... 17<br />

999<br />

OTHER (Write In)<br />

CHILDREN’S<br />

TOYS & GAMES<br />

You Person<strong>all</strong>y:<br />

Bought Number<br />

last 12 bought last<br />

months 12 months<br />

693<br />

Large/baby dolls ........ 01<br />

Boy action figures. ....... 02<br />

Girl action figures ........ 03<br />

Fashion dolls ........... 04<br />

Plush dolls/animals ...... 05<br />

Electronic dolls/animals .. 06<br />

Doll clothing ............ 07<br />

Doll accessories ......... 08<br />

Construction toys . . . . . . . . . 09<br />

Educational toys. ........ 10<br />

Mechanical toys ......... 11<br />

Model kits/Model sets .... 12<br />

Action games ........... 13<br />

Board games ........... 14<br />

Sound games ........... 15<br />

Word games ............ 16<br />

Electronic games ........ 17<br />

Infant toys. ............. 18<br />

Pre-school toys. ......... 19<br />

Builder sets ............ 20<br />

Cars .................. 21<br />

Electric trains ........... 22<br />

Swing sets ............. 23<br />

Bicycles ............... 24<br />

Tricycles ............... 25<br />

Water toys ............. 26<br />

Other toys. ............. 27<br />

Amount spent for toys and games in last 12<br />

months for children:<br />

694<br />

Under 1 year. ........... $ 01<br />

1-2 years old. ........... $ 02<br />

3-5 years old. ........... $ 03<br />

6-11 years old. .......... $ 04<br />

12-17 years old. ......... $ 05<br />

BOOKS<br />

695<br />

You Person<strong>all</strong>y:<br />

Bought Number<br />

last 12 bought last<br />

months 12 months<br />

FORM:<br />

Paperback ............. 01<br />

Hardcover. ............. 02<br />

Digital ................. 03<br />

KINDS:<br />

Fiction. ................ 04<br />

Non-Fiction. ............ 05<br />

TYPES:<br />

Cookbooks. ............. 06<br />

Desk dictionary. ......... 07<br />

Mystery. ............... 08<br />

Novel ................. 09<br />

Biography .............. 10<br />

History ................ 11<br />

Science fiction .......... 12<br />

Children’s books. ........ 13<br />

Romance .............. 14<br />

Personal/business/self-help 15<br />

Religious (not Bibles) ..... 16<br />

Travel ................. 17<br />

999<br />

OTHER (Write In)<br />

Where purchased: 696-0<br />

Barnes & Noble Book store 1<br />

Borders Book store ...... 2<br />

Other Book store ........ 3<br />

amazon.com ........... 4<br />

barnes&noble.com ...... 5<br />

Other Internet/Online. .... 6<br />

Book club. ............. 7<br />

Department store ....... 8<br />

Drug store . . . . . . . . . . . . . . 9<br />

Mail order ............. 0<br />

Supermarket ........... X<br />

Warehouse store ........ Y

CONSUMER ATTITUDES<br />

Page 74<br />

YOUR INTENTIONS<br />

69K<br />

In the next twelve months, how likely are you or someone in your househOld to:<br />

Very Somewhat Not Very Not at <strong>all</strong><br />

Likely Likely Likely Likely<br />

Home:<br />

Buy your first house/residence. ...................................... 01<br />

Buy a second house/or vacation home ................................ 02<br />

Sell your house/residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03<br />

Take out a 2nd Mortgage or Equity Loan. .............................. 04<br />

Remodel your home:<br />

Remodel Kitchen ................................................. 05<br />

Remodel Bathroom ............................................... 06<br />

Convert room to home office ........................................ 07<br />

Add rooms – Exterior Additions ...................................... 08<br />

Other .......................................................... 09<br />

Buy insurance or financial products:<br />

Homeowner or personal property .................................... 10<br />

Life insurance. ................................................... 11<br />

Invest in stocks, bonds, or mutual funds ............................... 12<br />

Travel: Vacation within the U.S.:<br />

Hawaii ......................................................... 13<br />

Florida ......................................................... 14<br />

Theme Park ..................................................... 15<br />

Other .......................................................... 16<br />

Cruise: (for more than 1 day) ....................................... 17<br />

Travel: Vacation abroad:<br />

Europe ......................................................... 18<br />

Caribbean ...................................................... 19<br />

Mexico ......................................................... 20<br />

South America ................................................... 21<br />

Other .......................................................... 22<br />

Vehicle:<br />

Buy a new vehicle ................................................ 23<br />

Buy a used or pre-owned vehicle. .................................... 24<br />

Lease a vehicle .................................................. 25<br />

Buy/lease vehicle type:<br />

2-door car ...................................................... 26<br />

4-door car ...................................................... 27<br />

Van/Mini-van .................................................... 28<br />

Motorcycle ...................................................... 29<br />

Sport Utility Vehicle ............................................... 30<br />

Truck .......................................................... 31<br />

Hybrid/Alternative Fuel Vehicle ...................................... 32<br />

Buy electronics:<br />

Home theater system. ............................................. 33<br />

Large screen TV (27" - 42") ......................................... 34<br />

Big screen projection TV (43" - 65"). .................................. 35<br />

Flat screen/plasma screen TV ....................................... 36<br />

Portable DVD player. .............................................. 37<br />

HDTV (High Definition TV). ......................................... 38<br />

Digital video camera/Digital camera .................................. 39<br />

Desktop computer ................................................ 40<br />

Laptop computer ................................................. 41<br />

Satellite Radio ................................................... 42<br />

Lifestyle (you person<strong>all</strong>y):<br />

Get engaged .................................................... 43<br />

Become a parent ................................................. 44<br />

Become a grandparent ............................................ 45<br />

Have a child go away to college. ..................................... 46<br />

Have a child graduate from college ................................... 47<br />

Have a child get married ........................................... 48<br />

Retire from full-time work. .......................................... 49<br />

Collect lump-sum from pension/IRA/401k .............................. 50<br />

Start or buy a new business. ........................................ 51<br />

Change jobs. .................................................... 52<br />

1 2 3 4<br />

CONSUMER<br />

CONFIDENCE<br />

69M-0<br />

Thinking of the last 12 months, do you believe that you and your household are better off or worse off financi<strong>all</strong>y than you were one year ago?<br />

Better now 1 About the same 2 Worse now 3<br />

Thinking of the next 12 months, do you think you and your household will be better off or worse off financi<strong>all</strong>y one year from now?<br />

Better 4 About the same 5 Worse 6<br />

Thinking of the last 12 months, do you believe that the economy and business conditions in the country as a whole are better or worse now than one year ago?<br />

Better now 7 About the same 8 Worse now 9<br />

Thinking of the next 12 months, do you think that the economy and business conditions in the country as a whole will be better or worse one year from now?<br />

Better 0 About the same X Worse Y

PERSONAL VALUES<br />

Page 76<br />

PERSONAL VALUES<br />

69N<br />

Please rate on a scale of 1 to 7, with ‘1’ meaning not at <strong>all</strong> important and ‘7’ meaning extremely important. For each personal value, please circle the<br />

number that best describes how important, if at <strong>all</strong>, it is to you as a guiding principle in your life. You should mark values that are of average importance<br />

to you towards the middle of the scale.<br />

How Important To You?<br />

Not at <strong>all</strong> Average Extremely<br />

important importance important<br />

1. Wealth: Having material possessions, a lot of money 1 2 3 4 5 6 7<br />

2. Status: Achieving a higher social status 1 2 3 4 5 6 7<br />

3. Ambition: Aspiring to get ahead 1 2 3 4 5 6 7<br />

4. Honesty: Being sincere, having integrity 1 2 3 4 5 6 7<br />

5. Being in tune with nature: Fitting into nature 1 2 3 4 5 6 7<br />

6. Preserving the environment: Helping to preserve nature 1 2 3 4 5 6 7<br />

7. Creativity: Being creative, imaginative 1 2 3 4 5 6 7<br />

8. Freedom: Having freedom of action and thought 1 2 3 4 5 6 7<br />

9. Curiosity: Wanting to explore and learn about new things 1 2 3 4 5 6 7<br />

10. Public image: Protecting my reputation, saving face 1 2 3 4 5 6 7<br />

11. Protecting the family: Having safety for loved ones 1 2 3 4 5 6 7<br />

12. Social responsibility: Working for the welfare of society 1 2 3 4 5 6 7<br />

13. Equality: Desiring equal opportunity for <strong>all</strong> 1 2 3 4 5 6 7<br />

14. Stable personal relationships: Maintaining a long-term commitment to friends<br />

and loved ones 1 2 3 4 5 6 7<br />

15. Romance: Having romance in my life 1 2 3 4 5 6 7<br />

16. Enjoying life: Doing things because I like them 1 2 3 4 5 6 7<br />

17. Having fun: Having a good time 1 2 3 4 5 6 7<br />

18. Adventure: Seeking adventure and risk 1 2 3 4 5 6 7<br />

19. Sex: Achieving a fulfilling sexual life 1 2 3 4 5 6 7<br />

20. Looking good: Seeking the utmost attractive appearance 1 2 3 4 5 6 7<br />

21. Duty: Fulfilling obligations to family, community and country 1 2 3 4 5 6 7<br />

22. Respecting ancestors: Showing respect for those who came before us 1 2 3 4 5 6 7<br />

23. Traditional gender roles: Following traditional roles for men and women 1 2 3 4 5 6 7<br />

24. Faith: Holding to religious faith and belief 1 2 3 4 5 6 7<br />

25. Learning: Continuing to learn throughout my life 1 2 3 4 5 6 7<br />

26. Helpfulness: Making the effort to assist others 1 2 3 4 5 6 7<br />

27. Friendship: Having close, supportive friends 1 2 3 4 5 6 7<br />

28. Power: Having control over people and resources 1 2 3 4 5 6 7<br />

29. Open-mindedness: Being broad-minded 1 2 3 4 5 6 7<br />

30. Social tolerance: Respecting ethnic, religious, and racial differences 1 2 3 4 5 6 7<br />

31. Authenticity: Being true to myself 1 2 3 4 5 6 7<br />

32. Self-reliance: Being self reliant, choosing my own goals 1 2 3 4 5 6 7<br />

33. Tradition: Preserving time-honored customs 1 2 3 4 5 6 7<br />

34. Being youthful: Feeling young 1 2 3 4 5 6 7<br />

35. Excitement: Having stimulating experiences 1 2 3 4 5 6 7<br />

36. Self-interest: Putting my interests ahead of others' 1 2 3 4 5 6 7<br />

37. Knowledge: Being well educated 1 2 3 4 5 6 7<br />

38. Simplicity: Keeping your life and mind as uncluttered as possible 1 2 3 4 5 6 7<br />

39. Cultural purity: Keeping my culture free from outside influences 1 2 3 4 5 6 7<br />

40. Working hard: Always giving my best effort 1 2 3 4 5 6 7<br />

41. Modesty: Being modest, self-effacing 1 2 3 4 5 6 7<br />

42. Thrift: Being economical or careful with money and avoiding excesses 1 2 3 4 5 6 7

Page 77<br />

YOUR ATTITUDES<br />

We are interested in your attitude about a number of issues. There are no right or wrong answers. Please indicate how much you AGREE or<br />

DISAGREE with each of the following statements by checking the box that comes closest to how you feel.<br />

DISAGREE<br />

AGREE<br />

62Y Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. I try to eat dinner with my family almost every night ............................................. 01<br />

2. I am so busy, I often can’t finish everything I need to in a day ..................................... 02<br />

3. I strive to achieve a high social status. ....................................................... 03<br />

4. The government should pay more attention to environmental issues. ............................... 04<br />

5. I like to shower my loved ones with gifts ...................................................... 05<br />

6. I like to give the impression that my life is under control. ......................................... 06<br />

7. Given the choice, I would be my own boss. ................................................... 07<br />

8. Prayer is a part of my daily life ............................................................. 08<br />

9. Marriage should only be legal between a man and a woman. ..................................... 09<br />

10. I am interested in finding out how I can help the environment ..................................... 10<br />

11. I don’t mind giving up my personal time for work ............................................... 11<br />

12. Risk-taking is exciting to me ............................................................... 12<br />

13. I am very interested in the fine arts. ......................................................... 13<br />

14. I purchase products to help organize my life .................................................. 14<br />

15. Religion should be the pillar of our society .................................................... 15<br />

16. I often find myself in a leadership position .................................................... 16<br />

17 I like to live a lifestyle that impresses others. .................................................. 17<br />

18. Spending time with my family is my top priority ................................................ 18<br />

19. I work primarily for the salary .............................................................. 19<br />

20. I prefer a set routine in my daily life ......................................................... 20<br />

21. Global warming is a serious threat .......................................................... 21<br />

22. I enjoy showing off my home to guests. ...................................................... 22<br />

23. I like to learn about foreign cultures ......................................................... 23<br />

24. Keeping a neat, organized home is a top priority for me ......................................... 24<br />

25. I feel I am more environment<strong>all</strong>y conscious than most people ..................................... 25<br />

26. Even if things look messy, I know where everything is ........................................... 26<br />

27. I consider myself sophisticated. ............................................................ 27<br />

28. I must admit, I work most weekends. ........................................................ 28<br />

29. Children have a right to be spoiled .......................................................... 29<br />

30. I attend religious services regularly ......................................................... 30<br />

31. My philosophy is “Life should be as much fun as possible.” ....................................... 31<br />

32. I am typic<strong>all</strong>y willing to pay more for high-quality items .......................................... 32<br />

33. I’d rather prepare a meal than eat in a restaurant. .............................................. 33<br />

34. A company’s environmental record is important to me in my purchasing decisions. .................... 34<br />

35. I consider myself a spiritual person ......................................................... 35<br />

36. My friends are the most important thing in my life .............................................. 36<br />

37. I often feel like my life is slipping out of control ................................................. 37<br />

38. I enjoy being the center of attention ......................................................... 38<br />

39. My goal is to make it to the top of my profession ............................................... 39<br />

40. I seek out variety in my everyday life ........................................................ 40<br />

41. Family is important to me, but I have other interests that are equ<strong>all</strong>y important. ....................... 41<br />

42. I consider myself to be very sociable ........................................................ 42<br />

43. People who are worried about the environment are overreacting. .................................. 43<br />

44. My cultural/ethnic heritage is an important part of who I am ...................................... 44<br />

45. I frequently wish I had more time to spend with my family. ........................................ 45<br />

46. I would continue working even if I won the lottery. .............................................. 46<br />

47. I make sure I take time for myself each day. ................................................... 47<br />

48. Juggling family and work demands is very stressful for me. ....................................... 48<br />

49. I see myself as somewhat of a loner. ........................................................ 49<br />

50. My home is an expression of my personal style ................................................ 50

YOUR OPINION<br />

Page 78<br />

We are interested in your attitude about a number of issues. There are no right or wrong answers. Please indicate how much you AGREE or<br />

DISAGREE with each of the following statements by checking the box that comes closest to how you feel.<br />

AUTOMOTIVE<br />

DISAGREE<br />

AGREE<br />

69F Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. I want a vehicle that has both the comforts of a car and the capabilities of a truck. ..................... 01<br />

2. I plan to buy the vehicle that best meets my needs no matter who makes it or in what country it is produced. 02<br />

3. The vehicle a person owns says a lot about him or her. .......................................... 03<br />

4. I often take the opportunity to discuss my knowledge of automobiles with others. ..................... 04<br />

5. I consider myself to be an automotive enthusiast. .............................................. 05<br />

6. I buy vehicles that reflect my commitment to support the environment. .............................. 06<br />

7. I seek out vehicles with bold, innovative designs that stand apart from others on the road. .............. 07<br />

8. I think of vehicles as basic transportation. .................................................... 08<br />

9. I look forward to technology advances in new vehicles. .......................................... 09<br />

10. The quality of workmanship/construction of a vehicle is more important than anything else.. ............. 10<br />

11. I enjoy learning about automobiles from others. ............................................... 11<br />

12. I research and compare as many vehicles as possible before making my final purchase decision.. ........ 12<br />

13. When I find a vehicle that I like, I typic<strong>all</strong>y recommend it to people I know. . .......................... 13<br />

14. My first consideration in choosing a vehicle is its exterior styling. .................................. 14<br />

15. I look for vehicles that offer spirited performance and powerful acceleration. ......................... 15<br />

16. Having a vehicle that is fun to drive is a top consideration in my purchasing decision. .................. 16<br />

17. I enjoy personalizing my vehicle to reflect my individual tastes. .................................... 17<br />

18. I often ask the advice of others when it comes to automobiles. . ................................... 18<br />

19. I prefer buying models of vehicles that I or people I know have owned and like. ....................... 19<br />

20. I want the cheapest and easiest to maintain vehicle I can find. .................................... 20<br />

21. I gener<strong>all</strong>y purchase the most expensive model with <strong>all</strong> the luxury appointments and options. ............ 21<br />

22. People often ask my advice when it comes to automobiles.. ...................................... 22<br />

23. Having a versatile vehicle to accommodate my busy lifestyle is important to me. ...................... 23<br />

24. Rebates and incentives strongly influence my new vehicle purchase decisions. ....................... 24<br />

25. I consider safety first when shopping for a new vehicle. .......................................... 25<br />

26. I always follow the advice of my mechanic.. ................................................... 26<br />

27. I always maintain my vehicle as recommended by the manufacturer’s manual.. ....................... 27<br />

69H-0<br />

28. If you had to make a decision today, what new (not used) CAR or TRUCK would you buy or lease? Make Model<br />

(Write In)<br />

(Write In)<br />

VACATION TRAVEL<br />

DISAGREE<br />

AGREE<br />

69L Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. On my vacations, I prefer traveling to places I’ve never been. ..................................... 01<br />

2. Concerns about security issues have made me less likely to travel. ................................ 02<br />

3. Travel and hotel discounts have a strong influence on where I choose to travel and where I choose to stay. . 03<br />

4. I often take the opportunity to discuss knowledge of vacation options with others. ..................... 04<br />

5. I’d rather book a trip over the Internet than meet with a travel agent.. ............................... 05<br />

6. Packaged deals are great, because I don’t have to plan out the details too much. ..................... 06<br />

7. I love doing research on a location before I go on vacation.. ...................................... 07<br />

8. When I learn about a great vacation, I typic<strong>all</strong>y recommend it to people I know. . ...................... 08<br />

9. I’d rather travel myself or with just a sm<strong>all</strong> group of people. ....................................... 09<br />

10. I frequently choose active vacations with lots to do. ............................................. 10<br />

11. I’m happy to do very little, if any, sightseeing on my vacations. .................................... 11<br />

12. I enjoy learning about vacation options from others. ............................................ 12<br />

13. When I find a vacation spot I like, I go back whenever I can. ...................................... 13<br />

14. I am willing to pay more for a flight in order to travel on my favorite airline. ........................... 14<br />

15. The best vacation is restful without too much physical exercise. ................................... 15<br />

16. Group tours are fun and a good way to meet people. .. .......................................... 16<br />

17. People often ask my advice when it comes to vacation travel. .................................... 17<br />

18. I’d rather travel in the U.S. than to a foreign location. ............................................ 18<br />

19. The Internet is not a secure way to make travel plans.. .......................................... 19<br />

20. I often ask the advice of others when it comes to vacation travel. . ................................. 20<br />

21. Traveling to foreign places is a great way for me to learn about other cultures. ........................ 21<br />

22. I’d rather take a few weekend vacations than one long vacation. ................................... 22<br />

23. I prefer guided tours to traveling independently. ................................................ 23<br />

24. Planning a vacation is just as much fun as the trip itself. ......................................... 24

Page 79<br />

YOUR OPINION<br />

We are interested in your attitude about a number of issues. There are no right or wrong answers. Please indicate how much you AGREE or<br />

DISAGREE with each of the following statements by checking the box that comes closest to how you feel.<br />

FOOD<br />

DISAGREE<br />

AGREE<br />

69R Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. I try to eat healthy these days and pay attention to my nutrition. ................................... 01<br />

2. I rarely eat frozen dinners ................................................................. 02<br />

3. I typic<strong>all</strong>y celebrate special occasions at restaurants ............................................ 03<br />

4. During a given week, I cook meals frequently ................................................. 04<br />

5. If a food item is on sale, I buy multiple units to stock up .......................................... 05<br />

6. Often, I eat my meals on the run ........................................................... 06<br />

7. I rely on product labels to help me make decisions when food shopping. ............................ 07<br />

8. I try to eat a healthy breakfast every day ..................................................... 08<br />

9. I only buy food items that are name-brand, not generic brands .................................... 09<br />

10. I evaluate the nutrition of menu items when ordering at a restaurant. ............................... 10<br />

11. When I find a food product I like, I typic<strong>all</strong>y recommend it to people I know .. ......................... 11<br />

12. I don’t <strong>all</strong>ow junk food in my home .......................................................... 12<br />

13. When I find a restaurant I like, I stick with it. .................................................. 13<br />

14. Frozen dinners are a convenient alternative for a meal .......................................... 14<br />

15. Eating at a fast food restaurant is fun. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15<br />

16. If generic brands are on sale, I will purchase them over my normal name-brand ...................... 16<br />

17. I don’t have very much interest in cooking .................................................... 17<br />

18. I try to buy foods that are grown or produced loc<strong>all</strong>y (in the region where I live).. ...................... 18<br />

19. I enjoy trying different types of food ......................................................... 19<br />

20. I indulge my cravings for sweets ............................................................ 20<br />

21. Fast food is junk food. ................................................................... 21<br />

22. People often ask my advice when it comes to food ............................................. 22<br />

23. I prefer picking up quick meals to cooking meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23<br />

24. I’m fine with eating at a restaurant by myself. ................................................. 24<br />

25. I don’t pay much attention to my intake of fat .................................................. 25<br />

26. Dinners in my home are usu<strong>all</strong>y planned ahead of time. ......................................... 26<br />

27. I only eat fast food when I’m in a rush ....................................................... 27<br />

28. I prefer cooking with fresh food rather than canned or frozen. ..................................... 28<br />

29. I’m a creature of habit, and stick to the food I know I like ......................................... 29<br />

30. I let my children make their own decisions when ordering at a restaurant. ........................... 30<br />

31. I regularly eat organic foods . .............................................................. 31<br />

DISAGREE<br />

AGREE<br />

FINANCE 69J Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. I regularly read financial news or financial publications .......................................... 01<br />

2. I hate to borrow money; I would much rather save up in advance of a purchase ....................... 02<br />

3. My parents tend/tended to be savers ........................................................ 03<br />

4. I would be happy to use the Internet to carry out day to day banking transactions ..................... 04<br />

5. I often take the opportunity to discuss my knowledge of financial products or services with others ........ 05<br />

6. I always know broadly how much is in my bank account at any one time. ............................ 06<br />

7. There are one or two financial institutions that I always turn to first ................................. 07<br />

8. It is better for me to put my money in a low-risk investment, even if the return may not be as great ........ 08<br />

9. The way I deal with my finances reflects how my parents dealt with theirs ........................... 09<br />

10. When I find a financial product or service that I like, I typic<strong>all</strong>y recommend it to people I know. ........... 10<br />

11. You are better off having what you want now as you never know what tomorrow brings ................. 11<br />

12. I like to take risks when investing for the chance of a high return. .................................. 12<br />

13. I enjoy learning about financial products or services from others. .................................. 13<br />

14. I only save for a specific purpose ........................................................... 14<br />

15. Borrowing money makes me feel uncomfortable ............................................... 15<br />

16. People often ask my advice when it comes to financial matters. ................................... 16<br />

17. I hate having to go to the branch of my bank or savings institution ................................. 17<br />

18. I find the ups and downs of the financial markets exciting ........................................ 18<br />

19. I often ask the advice of others when it comes to financial products or services ...................... 19<br />

20. I’m happy to use the phone to carry out day to day banking transactions ............................ 20<br />

21. Investing in the stock market is too risky for me ................................................ 21<br />

22. The economy has a direct effect on my spending habits.. ........................................ 22<br />

23. I feel overwhelmed by financial burdens. ..................................................... 23

YOUR OPINION<br />

Page 80<br />

We are interested in your attitude about a number of issues. There are no right or wrong answers. Please indicate how much you AGREE or<br />

DISAGREE with each of the following statements by checking the box that comes closest to how you feel.<br />

internet/online<br />

DISAGREE<br />

AGREE<br />

69S Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. The Internet is a great way to gather information on products/services I’m considering purchasing ........ 01<br />

2. The Internet is a great way to actu<strong>all</strong>y buy products ............................................ 02<br />

3. The Internet has <strong>all</strong>owed me to learn things I probably wouldn’t have learned otherwise ................ 03<br />

4. The Internet is a great way to communicate with family/friends .................................... 04<br />

5. The Internet is a main source of entertainment for me. .......................................... 05<br />

6. I would feel disconnected without the Internet ................................................. 06<br />

7. Going online is one of my favorite things to do with my free time .................................. 07<br />

8. The Internet is a good thing, but I worry that too much technology can be a bad thing .................. 08<br />

9. Instant messenger keeps me in touch with my friends ........................................... 09<br />

10. The Internet is a good way to meet new people ................................................ 10<br />

11. The Internet has little impact on my daily life .................................................. 11<br />

TECHNOLOGY<br />

DISAGREE<br />

AGREE<br />

69W Completely Somewhat Somewhat Completely<br />

1 2 3 4<br />

1. I enjoy reading about new technology products ................................................ 01<br />

2. I’m willing to pay more for top quality electronics ............................................... 02<br />

3. I often take the opportunity to discuss my knowledge of technology or electronic products with others . .... 03<br />

4. Computers are too confusing to be of much use to me .......................................... 04<br />

5. I give others advice when they are looking to buy technology or electronic products . . . . . . . . . . . . . . . . . . . 05<br />

6. Computers can be a good source of entertainment ............................................. 06<br />

7. I’m fascinated by new technology ........................................................... 07<br />

8. I enjoy learning about technology or electronic products from others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08<br />

9. Technology helps make my life more organized ................................................ 09<br />

10. Before buying electronics, I do as much research as possible ..................................... 10<br />

11. Technology has little impact on my daily life ................................................... 11<br />

12. When I find a technology or electronic product I like, I typic<strong>all</strong>y recommend it to people I know ........... 12<br />

13. I am among the first of my friends and colleagues to try new technology products ..................... 13<br />

14. At first, I was nervous about using computers, but now I’m much more comfortable .................... 14<br />

15. I often ask the advice of others when it comes to technology or electronic products .................... 15<br />

16. I like to read reviews before buying technology or electronics ..................................... 16<br />

17. I want others to say “wow” when they see my electronics ...................................... 17<br />

ADVERTISING<br />

Here is a list of different places where you might find advertising. We would like to know:<br />

a. Have you seen advertising in these places in the last 6 months or in the last 30 days?<br />

b. If yes, how much interest do you have in the advertising that appears in these places?<br />

A. You Person<strong>all</strong>y B. How much Interest do you have?<br />

Have seen in Have seen in<br />

699 last 6 months last 30 days Considerable Interest Some Interest Not Much Interest<br />

Billboards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01<br />

Ads on buses/trains.. ............................. 02<br />

Ads at bus stops or train stations. ................... 03<br />

Ads inside taxis. ................................. 04<br />

Ads on top of taxis.. .............................. 05<br />

Ads on phone booths . ........................... 06<br />

Ads at sports or entertainment events. ............... 07<br />

Ads on elevators. . ............................... 08<br />

Ads on postcards.. ............................... 09<br />

Ads sent to a cell phone or other mobile device. ........ 10<br />

Ads at the movies. ............................... 11<br />

Ads in stores (not video ads) ....................... 12<br />

Video Ads in stores .............................. 13<br />

Video Ads in shopping m<strong>all</strong>s ....................... 14<br />

Video Ads in bars/pubs ........................... 15<br />

Video Ads in restaurants .......................... 16<br />

Video Ads in gyms/health clubs ..................... 17<br />

Video Ads in medical offices ....................... 18<br />

Video Ads in airports ............................. 19<br />

Infomercials .................................... 20<br />

Offers or Ads sent to your home by mail .............. 21<br />

Product placement in video games .................. 22<br />

Product placement in TV shows. .................... 23<br />

Product placement in movies. ...................... 24<br />

1 2 3 4 5

FOOD<br />

Page 88<br />

COOKIES<br />

(Ready to Eat)<br />

757<br />

Your Household:<br />

Used in Boxes or<br />

last 6 packages/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Butter ................. 01<br />

Chocolate Chip. ......... 02<br />

Chocolate Covered. ...... 03<br />

Figbars ................ 04<br />

Fudge ................. 05<br />

Oatmeal ............... 06<br />

Peanut Butter ........... 07<br />

Sandwich .............. 08<br />

Shortbread ............. 09<br />

Other ................. 10<br />

KINDS:<br />

Regular. ............... 11<br />

Low Fat. ............... 12<br />

Fat Free ............... 13<br />

Sugar Free ............. 14<br />

PACKAGE SIZE:<br />

100 Calorie Pack ........ 15<br />

Other Package Size . . . . . . . 16<br />

BRANDS:<br />

Archway ............... 17<br />

Entenmann’s ............ 18<br />

Famous Amos ........... 19<br />

Kashi TLC. ............. 20<br />

Keebler Chips Deluxe. ..... 21<br />

Keebler E. L. Fudge Sandwich 22<br />

Keebler Fudge Shoppe .... 23<br />

Keebler Pecan Sandies .... 24<br />

Keebler Rainbow Chips Deluxe 25<br />

Keebler Soft Batch. ....... 26<br />

Keebler Vienna Fingers .... 27<br />

Other Keebler ........... 28<br />

Little Debbie Nutty Bars .... 29<br />

Little Debbie Oatmeal<br />

Creme Pies ........... 30<br />

Other Little Debbie ....... 31<br />

LU Biscuits ............. 32<br />

Mother’s ............... 33<br />

Murray. ................ 34<br />

Nabisco Chips Ahoy! ...... 35<br />

Nabisco Chunky Chips Ahoy 36<br />

Nabisco Newtons. ........ 37<br />

Nabisco Nilla Wafers ...... 38<br />

Nabisco Nutter Butter. ..... 39<br />

Nabisco Oreo ........... 40<br />

Nabisco Teddy Grahams ... 41<br />

Other Nabisco ........... 42<br />

Pepperidge Farm Distinctives 43<br />

Other Pepperidge Farm .... 44<br />

Stella D’Oro. ............ 45<br />

Stauffer’s ............... 46<br />

Store’s Own Brand. ....... 47<br />

999<br />

OTHER (Write In)<br />

READY TO EAT<br />

MUFFINS<br />

Your Household:<br />

Used in Packages/<br />

last 6 Boxes last<br />

months 30 days<br />

765<br />

TOTAL: ................ 00<br />

PACKAGE SIZE:<br />

100 Calorie Pack ........ 01<br />

Other Package Size . . . . . . . 02<br />

BRANDS:<br />

Entenmann’s ........... 03<br />

Hostess ............... 04<br />

Little Debbie ............ 05<br />

Otis Spunkmeyer ........ 06<br />

Bakery ................ 07<br />

Store’s Own Bakery ...... 08<br />

999<br />

OTHER (Write In)<br />

GELATIN AND<br />

GELATIN DESSERTS<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

759<br />

TOTAL: ................ 00<br />

TYPES:<br />

Refrigerated/Ready to Eat . 01<br />

Powder/Mix. ............ 02<br />

BRANDS:<br />

Jell-O Gelatin ........... 03<br />

Jell-O Gelatin Snacks .... 04<br />

Jell-O Gelatin Sugar Free<br />

Snacks .............. 05<br />

Jell-O Sugar Free Gelatin. . 06<br />

Knox ................. 07<br />

Kool-Aid Gels .......... 08<br />

Royal ................. 09<br />

Store’s Own Brand ....... 10<br />

999<br />

OTHER (Write In)<br />

SNACK CAKES<br />

753<br />

Your Household:<br />

Used in Boxes or<br />

last 6 Packages/<br />

months last 30 days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Lowfat. ................ 01<br />

Fat Free ............... 02<br />

Regular. ............... 03<br />

PACKAGE SIZE:<br />

100 Calorie Pack ........ 04<br />

Other Package Size . . . . . . . 05<br />

BRANDS:<br />

Dolly Madison. .......... 06<br />

Drake’s ................ 07<br />

Entenmann’s ........... 08<br />

Hostess Cup Cakes . . . . . . . 09<br />

Hostess Twinkies ........ 10<br />

Other Hostess .......... 11<br />

Little Debbie ............ 12<br />

Marinela ............... 13<br />

MoonPie ............... 14<br />

Nabisco Cakesters ....... 15<br />

Tastykake . . . . . . . . . . . . . . . 16<br />

999<br />

OTHER (Write In)<br />

TOASTER<br />

PRODUCTS<br />

Your Household:<br />

Used in Packages<br />

last 6 last 30<br />

months days<br />

761<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Kellogg’s Pop-Tarts ...... 01<br />

Pillsbury Toaster Scrambles 02<br />

Pillsbury Toaster Strudel. .. 03<br />

Toast’em Pop-ups. ....... 04<br />

Store’s Own Brand ....... 05<br />

999<br />

OTHER (Write In)<br />

READY TO EAT<br />

DOUGHNUTS<br />

758<br />

Your Household:<br />

Used in Packages/<br />

last 6 Boxes last<br />

months 30 days<br />

TOTAL .................. 00<br />

BRANDS:<br />

Dolly Madison ........... 01<br />

Entenmann’s ............ 02<br />

Hostess. ............... 03<br />

Krispy Kreme. ........... 04<br />

Little Debbie ............ 05<br />

Tastykake .............. 06<br />

Fresh Doughnut Shop ..... 07<br />

Bakery. ................ 08<br />

Store’s Own Bakery ....... 09<br />

999<br />

OTHER (Write In)<br />

BREAKFAST/<br />

CEREAL/<br />

GRANOLA BARS<br />

Your Household:<br />

Used in Bars/<br />

last 6 last 30<br />

months days<br />

763<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Curves Chewy Granola Bars . 01<br />

Entenmann’s Multi-Grain<br />

Cereal Bar ........... 02<br />

Fiber One Snack Bars .... 03<br />

General Mills Milk ’n<br />

Cereal Bars. .......... 04<br />

Kashi TLC Bars ......... 05<br />

Kellogg’s Nutri-Grain Bar .. 06<br />

Kellogg’s Rice Krispies<br />

Treats Squares ........ 07<br />

Kellogg’s Special K Bar ... 08<br />

Kudos ................. 09<br />

Little Debbie ............ 10<br />

Nabisco Granola Bar ..... 11<br />

Nature V<strong>all</strong>ey Granola Bars . 12<br />

Quaker Cereal Bars . . . . . . . 13<br />

Quaker Oats Chewy<br />

Granola Bars ......... 14<br />

Sunbelt Fruit & Grain Bars . 15<br />

Sunbelt Granola Bars. .... 16<br />

Store’s Own Brand ....... 17<br />

999<br />

OTHER (Write In)<br />

FRUIT SNACKS<br />

Your Household:<br />

Used in Snacks/<br />

last 6 last 30<br />

months days<br />

995<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Betty Crocker Fruit By<br />

The Foot . . . . . . . . . . . . . 01<br />

Betty Crocker Fruit Roll-Ups 02<br />

Betty Crocker Gushers .... 03<br />

Brach’s Fruit Snacks. ..... 04<br />

Farley’s Fruit Snacks .... 05<br />

Kellogg’s Yogos. ......... 06<br />

Ocean Spray Craisins .... 07<br />

Sunkist Fruit Snacks. ..... 08<br />

Sunsweet Fruit Snacks. ... 09<br />

Store’s Own Brand ....... 10<br />

999<br />

OTHER (Write In)<br />

READY TO EAT<br />

SWEET ROLLS &<br />

PASTRIES<br />

770<br />

Your Household:<br />

Used in Packages/<br />

last 6 Boxes last<br />

months 30 days<br />

TOTAL: ................ M 00<br />

TYPES:<br />

Cinnamon Rolls ......... M 01<br />

Coffee Cake ............ M 02<br />

Cupcakes .............. M 03<br />

Danish Rolls ............ M 04<br />

Honey Buns ............ M 05<br />

Pies .................. M 06<br />

Turnovers .............. M 07<br />

BRANDS:<br />

Dolly Madison. .......... M 08<br />

Entenmann’s ........... M 09<br />

Hostess ............... M 10<br />

Little Debbie ............ M 11<br />

Tastykake . . . . . . . . . . . . . . . M 12<br />

Store’s Own Brand ....... M 13<br />

M 999<br />

OTHER (Write In)

Page 91<br />

FOOD<br />

NATURAL OR<br />

IMPORTED CHEESE<br />

779<br />

Your Household:<br />

Used in Pounds/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

FORMS:<br />

Chunk. ................ 01<br />

Loaf .................. 02<br />

Pre-Sliced. ............. 03<br />

Shredded .............. 04<br />

String ................. 05<br />

TYPES:<br />

Fat Free ............... 06<br />

Low Fat/Low Cholesterol .. 07<br />

Low Sodium . . . . . . . . . . . . . 08<br />

Low Calorie ............ 09<br />

Regular. ............... 10<br />

KINDS:<br />

Blue Cheese. ........... 11<br />

Brie. .................. 12<br />

Cheddar ............... 13<br />

Colby ................. 14<br />

Edam ................. 15<br />

Feta .................. 16<br />

Gouda ................ 17<br />

Havarti ................ 18<br />

Jarlsberg .............. 19<br />

Monterey Jack .......... 20<br />

Pepper Jack ............ 21<br />

Mozzarella ............. 22<br />

Muenster .............. 23<br />

Parmesan. ............. 24<br />

Provolone .............. 25<br />

Ricotta ................ 26<br />

Romano ............... 27<br />

Swiss ................. 28<br />

Cheese Blends. ......... 29<br />

BRANDS:<br />

Alpine Lace ............ 30<br />

Babybel ............... 31<br />

Borden ................ 32<br />

Cabot ................. 33<br />

Cacique ............... 34<br />

County Line ............ 35<br />

Cracker Barrel .......... 36<br />

Crystal Farms. .......... 37<br />

Frigo .................. 38<br />

Heluva Good ........... 39<br />

Kraft .................. 40<br />

Kraft LiveActive ......... 41<br />

Land O’ Lakes .......... 42<br />

The Laughing Cow ....... 43<br />

Polly-O ................ 44<br />

Sargento Light .......... 45<br />

Sargento (Regular). ...... 46<br />

Sorrento ............... 47<br />

Tillamook .............. 48<br />

Store’s Own Brand ....... 49<br />

999<br />

OTHER (Write In)<br />

GRATED CHEESE<br />

780<br />

Your Household:<br />

Used in Containers/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Deli — Pre-Packaged. .... 01<br />

Deli — Fresh ........... 02<br />

Dry/Canned ............ 03<br />

KINDS:<br />

Parmesan. ............. 04<br />

Romano ............... 05<br />

Parmesan/Romano Blend . 06<br />

BRANDS:<br />

DiGiorno. .............. 07<br />

4C. ................... 08<br />

Kraft .................. 09<br />

Store’s Own Brand ....... 10<br />

999<br />

OTHER (Write In)<br />

COTTAGE CHEESE<br />

Your Household:<br />

Used in Containers/<br />

last 6 last 30<br />

months days<br />

781<br />

TOTAL: ................ 00<br />

TYPES:<br />

Low Fat. ............... 01<br />

Non Fat/Fat Free ........ 02<br />

Regular. ............... 03<br />

BRANDS:<br />

Axelrod ................ 04<br />

Breakstone’s. ........... 05<br />

Daisy ................. 06<br />

Dean’s ................ 07<br />

Friendship. ............. 08<br />

Hood. ................. 09<br />

Knudsen ............... 10<br />

Light n’ Lively ........... 11<br />

Prairie Farms ........... 12<br />

Store’s Own Brand ....... 13<br />

999<br />

OTHER (Write In)<br />

CREAM CHEESE<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

782<br />

TOTAL: ................ 00<br />

TYPES:<br />

Flavored ............... 01<br />

Regular/Unflavored ...... 02<br />

FORM:<br />

Brick .................. 03<br />

Soft. .................. 04<br />

Whipped ............... 05<br />

KINDS:<br />

Fat Free ............... 06<br />

Reduced Fat. ........... 07<br />

Regular. ............... 08<br />

BRANDS:<br />

Philadelphia Free ........ 09<br />

Philadelphia Light. ....... 10<br />

Philadelphia Regular ..... 11<br />

Temptee ............... 12<br />

Store’s Own Brand ....... 13<br />

999<br />

OTHER (Write In)<br />

Used For: 783-0<br />

Cooking/Baking ......... 1<br />

Spreading ............. 2<br />

SPREAD CHEESE/<br />

CHEESE SAUCE<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

784<br />

TOTAL: ................ 00<br />

TYPES:<br />

Aerosol Can ............ 01<br />

B<strong>all</strong>s/Logs. ............. 02<br />

Crock/Tub .............. 03<br />

Jar/Cup. ............... 04<br />

Squeeze Bottle. ......... 05<br />

KINDS:<br />

Sauce ................. 06<br />

Spread ................ 07<br />

BRANDS:<br />

Alouette ............... 08<br />

Boursin ................ 09<br />

Cheez Whiz (Regular) .... 10<br />

Other Cheez Whiz ....... 11<br />

Kaukauna .............. 12<br />

Kraft Easy Cheese ....... 13<br />

WisPride. .............. 14<br />

Store’s Own Brand ....... 15<br />

999<br />

OTHER (Write In)<br />

CRACKERS<br />

785<br />

Your Household:<br />

Used in Boxes/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Butter-Flavored. ......... 01<br />

Cheese. ............... 02<br />

Crispbread ............. 03<br />

Graham ............... 04<br />

Oat/Oat Bran ........... 05<br />

Saltines ............... 06<br />

Sandwich .............. 07<br />

Sesame ............... 08<br />

Wheat/Rye ............. 09<br />

Other Flavored Snack .... 10<br />

FORMS:<br />

Low Fat. ............... 11<br />

Fat Free ............... 12<br />

Regular. ............... 13<br />

PACKAGE SIZE:<br />

100 Calorie Pack ........ 14<br />

Other Package Size . . . . . . . 15<br />

BRANDS:<br />

Austin Cracker Sandwiches . 16<br />

Back to Nature . . . . . . . . . . . 17<br />

Carr’s ................. 18<br />

Combos (Cracker Varieties) 19<br />

Kashi TLC Crackers ...... 20<br />

Keebler Club. ........... 21<br />

Keebler Club Multi-Grain .. 22<br />

Keebler Grahams ........ 23<br />

Keebler Sandwich Crackers 24<br />

Keebler Town House. ..... 25<br />

Keebler Wheatables ...... 26<br />

Keebler Zesta Saltines .... 27<br />

Other Keebler ........... 28<br />

Kraft Handi-Snacks ...... 29<br />

Kraft Mac and Cheese .... 30<br />

Lance Sandwich Crackers . 31<br />

Lay’s Cracker Crisps ..... 32<br />

Little Debbie ............ 33<br />

Nabisco Better Cheddars .. 34<br />

Nabisco Cheese Nips. .... 35<br />

Nabisco Honey Maid<br />

Grahams. ............ 36<br />

Nabisco Premium Saltines . 37<br />

Nabisco Ritz ............ 38<br />

Nabisco Ritz Bits Cheese<br />

Sandwiches .......... 39<br />

Nabisco Ritz Bits Peanut<br />

Butter Sandwiches ..... 40<br />

Nabisco Ritz Bits (Other) .. 41<br />

Nabisco Ritz Fresh Stacks . 42<br />

Nabisco Triscuits ........ 43<br />

Nabisco Wheatsworth .... 44<br />

Nabisco Wheat Thins ..... 45<br />

Other Nabisco .......... 46<br />

Pepperidge Farm Crackers . 47<br />

Pepperidge Farm Goldfish . 48<br />

Pepperidge Farm Flavor<br />

Blasted Goldfish ........ 49<br />

RyKrisp. ............... 50<br />

Stoned Wheat Thins. ..... 51<br />

Sunshine Cheez-It ....... 52<br />

Sunshine Krispy Saltines . . . 53<br />

Wasa ................. 54<br />

Store’s Own Brand ....... 55<br />

999<br />

OTHER (Write In)

FOOD<br />

Page 92<br />

RICE CAKES<br />

786<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Quaker . . . . . . . . . . . . . . . . . 01<br />

Store’s Own Brand ....... 02<br />

999<br />

OTHER (Write In)<br />

PRETZELS<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

789<br />

TOTAL: ................ 00<br />

PACKAGE SIZE:<br />

100 Calorie Pack. ........ 01<br />

Other Package Size.. ..... 02<br />

TYPES:<br />

Flavored ............... 03<br />

Oat Bran. .............. 04<br />

Sourdough ............. 05<br />

BRANDS:<br />

Bachman .............. 06<br />

Combos (pretzel varieties) . 07<br />

Mr. Salty ............... 08<br />

Rold Gold .............. 09<br />

Snyder’s Pretzels ........ 10<br />

Snyder’s Pretzel<br />

Sandwiches .......... 11<br />

Utz ................... 12<br />

Store’s Own Brand ....... 13<br />

999<br />

OTHER (Write In)<br />

POTATO CHIPS<br />

787<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

PACKAGE SIZE:<br />

100 Calorie Pack. ........ 01<br />

2-5 oz. ................ 02<br />

6-8 oz. ................ 03<br />

10-12 oz. .............. 04<br />

More than 12 oz. ........ 05<br />

Multi/Variety Pack ....... 06<br />

TYPES:<br />

Flavored ............... 07<br />

Regular. ............... 08<br />

KINDS:<br />

No Salt ................ 09<br />

Salted ................. 10<br />

BRANDS:<br />

Cape Cod .............. 11<br />

Herr’s ................. 12<br />

Jays .................. 13<br />

Kettle Chips ............ 14<br />

Lay’s .................. 15<br />

Baked! Lay’s ........... 16<br />

Lay’s Light ............. 17<br />

Lay’s Stax. ............. 18<br />

Lay’s Wavy . . . . . . . . . . . . . . 19<br />

Pringles Light Fat Free .... 20<br />

Pringles Minis. .......... 21<br />

Pringles Regular. ........ 22<br />

Pringles Select .......... 23<br />

Ruffles Light ............ 24<br />

Ruffles Regular ......... 25<br />

Snyder’s ............... 26<br />

Terra .................. 27<br />

Utz ................... 28<br />

Wise .................. 29<br />

Store’s Own Brand ....... 30<br />

999<br />

OTHER (Write In)<br />

POPPING CORN &<br />

POPCORN SNACKS<br />

Your Household:<br />

Packages/<br />

Used in Bowls<br />

last 6 served/<br />

months last 30 days<br />

791<br />

TOTAL: ................ 00<br />

TYPES:<br />

Popped Corn ........... 01<br />

Popcorn Snacks ......... 02<br />

Unpopped Corn ......... 03<br />

BRANDS:<br />

Act II Microwave ......... 04<br />

Cracker Jack. ........... 05<br />

Crunch ’N Munch ........ 06<br />

Fiddle Faddle ........... 07<br />

Jiffy Pop ............... 08<br />

Jolly Time .............. 09<br />

Newman’s Own ......... 10<br />

Orville Redenbacher’s<br />

Kettle Korn ........... 11<br />

Orville Redenbacher’s Butter<br />

(Microwave) .......... 12<br />

Orville Redenbacher’s<br />

SmartPop!. ........... 13<br />

Other Orville Redenbacher’s 14<br />

Pop Secret ............. 15<br />

PopWeaver. ............ 16<br />

Store’s Own Brand ....... 17<br />

999<br />

OTHER (Write In)<br />

CORN, TORTILLA &<br />

OTHER CHIPS &<br />

CHEESE SNACKS<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

790<br />

TOTAL: ................ 00<br />

PACKAGE SIZE:<br />

100 Calorie Pack. ........ 01<br />

2-5 oz. ................ 02<br />

6-8 oz. ................ 03<br />

10-12 oz. .............. 04<br />

More than 12 oz. ........ 05<br />

Multi/Variety Pack. ....... 06<br />

BRANDS:<br />

Bugles ................ 07<br />

Cheez Doodles. ......... 08<br />

Cheetos ............... 09<br />

Cheetos Baked! ......... 10<br />

Cheetos Twisted ......... 11<br />

Chi-Chi’s. .............. 12<br />

Combos ............... 13<br />

Corn Nuts. ............. 14<br />

Doritos Baked! .......... 15<br />

Doritos Nacho Cheese .... 16<br />

Doritos Cool Ranch........ 17<br />

Other Doritos ........... 18<br />

Flat Earth Crisps ........ 19<br />

Fritos Regular. .......... 20<br />

Fritos Bar-B-Q .......... 21<br />

Fritos Chili Cheese. ...... 22<br />

Fritos Scoops! .......... 23<br />

Other Fritos ............ 24<br />

Santitas ............... 25<br />

Stacy’s Pita Chips ....... 26<br />

SunChips .............. 27<br />

Tostitos (Baked) ......... 28<br />

Tostitos Crispy Rounds. ... 29<br />

Tostitos Gold. ........... 30<br />

Tostitos Restaurant Style .. 31<br />

Tostitos Scoops ......... 32<br />

Other Tostitos ........... 33<br />

Store’s Own Brand ....... 34<br />

999<br />

OTHER (Write In)<br />

CANNED OR JARRED<br />

SOUP/BROTH<br />

Your Household:<br />

Used in Cans/jars<br />

last 6 last 30<br />

months days<br />

796<br />

TOTAL: ................ 00<br />

TYPES:<br />

Condensed. ............ 01<br />

Ready to Serve ......... 02<br />

Refrigerated ............ 03<br />

Frozen ................ 04<br />

KINDS:<br />

Low Sodium . . . . . . . . . . . . . 05<br />

Regular. ............... 06<br />

BRANDS:<br />

Campbell’s Chunky ...... 07<br />

Campbell’s Select Harvest . 08<br />

Other Campbell’s Ready<br />

to Serve ............. 09<br />

Campbell’s Condensed<br />

Chicken Noodle Soup ... 10<br />

Campbell’s Condensed<br />

Cream of Mushroom. ... 11<br />

Campbell’s Condensed<br />

Tomato Soup. ......... 12<br />

Other Campbell’s<br />

Condensed Soup ...... 13<br />

Campbell’s Healthy Request . 14<br />

Campbell’s Soup at Hand. . 15<br />

College Inn Broth ........ 16<br />

Healthy Choice. ......... 17<br />

Muir Glen .............. 18<br />

Progresso. ............. 19<br />

Progresso Light .......... 20<br />

Progresso 99% Fat Free .. 21<br />

Swanson Broth. ......... 22<br />

Wolfgang Puck .......... 23<br />

Store’s Own Brand ....... 24<br />

999<br />

OTHER (Write In)<br />

DRY SOUP &<br />

BOUILLON<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

792<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Campbell’s Dry Soup Mix. . 01<br />

Herb-ox Bouillon. ........ 02<br />

Knorr Bouillon. .......... 03<br />

Knorr Recipe Classics<br />

Soup Mix. ............ 04<br />

Lipton Cup-a-Soup ....... 05<br />

Lipton Recipe Secrets .... 06<br />

Lipton Soup Secrets. ..... 07<br />

Maruchan Instant Lunch. .. 08<br />

Maruchan Ramen Soup ... 09<br />

Mrs. Grass Soup & Recipe<br />

Mix ................. 10<br />

Nissin Cup Noodles ...... 11<br />

Nissin Top Ramen ....... 12<br />

Nong Shim Bowl Noodle<br />

Soup ................ 13<br />

Wyler’s Bouillon ......... 14<br />

Store’s Own Brand ....... 15<br />

999<br />

OTHER (Write In)

FOOD<br />

Page 96<br />

Your Household:<br />

FROZEN/<br />

REFRIGERATED Used in Packages/<br />

last 6 last 30<br />

POTATO PRODUCTS months days<br />

818<br />

TOTAL: ................ 00<br />

TYPES:<br />

French Fried Potatoes .... 01<br />

Other Potatoes .......... 02<br />

BRANDS:<br />

Larry’s Mashed Potatoes .. 03<br />

McCain French Fries ..... 04<br />

McCain Roasters ........ 05<br />

Ore-Ida Easy Fries ....... 06<br />

Ore-Ida Frozen French Fries . 07<br />

Ore-Ida Frozen Hash Browns 08<br />

Ore-Ida Frozen Tater Tots. . 09<br />

Ore-Ida Roasted. ........ 10<br />

Ore-Ida Steam n’ Mash ... 11<br />

Other Ore-Ida ........... 12<br />

Simply Potatoes ......... 13<br />

Store’s Own Brand ....... 14<br />

999<br />

OTHER (Write In)<br />

FROZEN<br />

VEGETABLES<br />

819<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Box ................... 01<br />

Plastic Bag ............. 02<br />

KINDS:<br />

Plain .................. 03<br />

With Sauce/Seasoning .... 04<br />

FORMS:<br />

Single Vegetable. ........ 05<br />

Mixed Vegetables ........ 06<br />

BRANDS:<br />

Birds Eye .............. 07<br />

Cascadian Farm. ........ 08<br />

Flav-R-Pac ............. 09<br />

Freshlike. .............. 10<br />

Green Giant ............ 11<br />

Goya. ................. 12<br />

Hanover ............... 13<br />

Libby’s ................ 14<br />

Pictsweet .............. 15<br />

Raley’s ................ 16<br />

Store’s Own Brand ....... 17<br />

999<br />

OTHER (Write In)<br />

FROZEN MAIN<br />

COURSES<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

821<br />

TOTAL: ................ 00<br />

TYPES:<br />

Low Calorie ............ 01<br />

Regular. ............... 02<br />

KINDS:<br />

Single Serving .......... 03<br />

Family Size. ............ 04<br />

BRANDS:<br />

Amy’s ................. 05<br />

Banquet ............... 06<br />

Contessa .............. 07<br />

Gorton’s ............... 08<br />

Healthy Choice. ......... 09<br />

Hot Pockets ............ 10<br />

Hot Pockets Croissant Crust . 11<br />

Lean Cuisine Cafe Classics . 12<br />

Lean Cuisine Entrees. .... 13<br />

Lean Pockets ........... 14<br />

Marie C<strong>all</strong>ender’s ........ 15<br />

Michelina’s ............. 16<br />

On-Cor ................ 17<br />

South Beach Living ...... 18<br />

Stouffer’s Entrees. ....... 19<br />

Swanson Pot Pies ....... 20<br />

Tyson ................. 21<br />

Weight Watchers Smart<br />

Ones ................ 22<br />

Store’s Own Brand ....... 23<br />

999<br />

OTHER (Write In)<br />

FROZEN PIZZA<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

824<br />

TOTAL: ................ 00<br />

BRANDS:<br />

California Pizza Kitchen ... 01<br />

Celeste Pizza For One .... 02<br />

DiGiorno Rising Crust Pizza 03<br />

DiGiorno Stuffed Crust Pizza 04<br />

Freschetta ............. 05<br />

Healthy Choice. ......... 06<br />

Home Run Inn .......... 07<br />

Jack’s Natur<strong>all</strong>y Rising .... 08<br />

Jack’s Original .......... 09<br />

Lean Cuisine ........... 10<br />

McCain Ellio’s .......... 11<br />

Red Baron Deep Dish<br />

Singles .............. 12<br />

Red Baron Classic Crust .. 13<br />

Stouffer’s French Bread Pizza 14<br />

Tombstone Mini Deep Dish . 15<br />

Tombstone Original ...... 16<br />

Tony’s ................. 17<br />

Tony’s Deep Dish ........ 18<br />

Totino’s Party Pizza ...... 19<br />

Store’s Own Brand ....... 20<br />

999<br />

OTHER (Write In)<br />

VEGETARIAN<br />

FROZEN BURGERS<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

984<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Boca Burger ............ 01<br />

Gardenburger. .......... 02<br />

Morningstar Farms ....... 03<br />

999<br />

OTHER (Write In)<br />

FROZEN COMPLETE<br />

DINNERS<br />

Your Household:<br />

Used in Number/<br />

last 6 last 30<br />

months days<br />

823<br />

TOTAL: ................ 00<br />

TYPES:<br />

Low Calorie ............ 01<br />

Regular. ............... 02<br />

KINDS:<br />

Single Serving .......... 03<br />

Family Size. ............ 04<br />

BRANDS:<br />

Banquet Crock-Pot Classics . 05<br />

Other Banquet .......... 06<br />

Bertolli ................ 07<br />

Birds Eye Voila .......... 08<br />

Boston Market Frozen Meal 09<br />

Healthy Choice Complete<br />

Selections ............ 10<br />

Kid Cuisine ............. 11<br />

Lean Cuisine ........... 12<br />

Marie C<strong>all</strong>ender’s ........ 13<br />

Michelina’s ............. 14<br />

Stouffer’s Corner Bistro. ... 15<br />

Stouffer’s Dinners ........ 16<br />

Stouffer’s Skillets ........ 17<br />

Swanson’s Hungry-Man ... 18<br />

Other Swanson. ......... 19<br />

Weight Watchers Smart<br />

Ones ................ 20<br />

999<br />

OTHER (Write In)<br />

FROZEN HOT<br />

SNACKS<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

822<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Asian Sensations ........ 01<br />

Bagel Bites ............. 02<br />

Farm Rich Cheese Sticks. . 03<br />

Farm Rich Onion Petals ... 04<br />

Other Farm Rich Snacks .. 05<br />

La Choy Mini Egg Rolls ... 06<br />

Poppers ............... 07<br />

SuperPretzel. ........... 08<br />

T.G.I. Friday’s ........... 09<br />

Totino’s Pizza Rolls. ...... 10<br />

White Castle Hamburgers . 11<br />

Store’s Own Brand ....... 12<br />

999<br />

OTHER (Write In)<br />

Your Household:<br />

GRAVY/SAUCE<br />

Used in Packages or<br />

MIXES AND<br />

last 6 containers/<br />

COOKING SAUCES months last 30 days<br />

842<br />

TOTAL: ................ 00<br />

TYPES:<br />

Dry gravy mixes ......... 01<br />

Liquid gravy (ready to heat) . 02<br />

Other sauce mixes ....... 03<br />

BRANDS:<br />

Campbell’s ............. 04<br />

Durkee ................ 05<br />

Franco-American ........ 06<br />

French’s ............... 07<br />

Gravy Master ........... 08<br />

Heinz ................. 09<br />

Knorr ................. 10<br />

Lawry’s ................ 11<br />

McCormick ............. 12<br />

Pioneer. ............... 13<br />

Store’s Own Brand ....... 14<br />

999<br />

OTHER (Write In)

Page 99<br />

FOOD<br />

SALAD OR<br />

COOKING OIL<br />

855<br />

Your Household:<br />

Used in Pints/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Canola Oil ............. 01<br />

Corn Oil ............... 02<br />

Olive Oil ............... 03<br />

Peanut Oil. ............. 04<br />

Safflower Oil. ........... 05<br />

Sunflower Oil ........... 06<br />

Vegetable Oil ........... 07<br />

Other ................. 08<br />

BRANDS:<br />

Bertolli ................ 09<br />

Carapelli ............... 10<br />

Colavita ............... 11<br />

Crisco Natural Blend ..... 12<br />

Crisco Pure Canola ...... 13<br />

Crisco Vegetable Oil. ..... 14<br />

Enova Oíl .............. 15<br />

Filippo Berio ............ 16<br />

Goya. ................. 17<br />

LouAna. ............... 18<br />

Mazola ................ 19<br />

Wesson Best Blend ...... 20<br />

Wesson Vegetable Oil .... 21<br />

Store’s Own Brand ....... 22<br />

999<br />

OTHER (Write In)<br />

Used for: 856-0<br />

Baking ................ 1<br />

Frying ................. 2<br />

Salad ................. 3<br />

Sautéing/Stir Frying ...... 4<br />

Other ................. 5<br />

MAYONNAISE AND<br />

MAYONNAISE TYPE<br />

SALAD DRESSING<br />

857<br />

Your Household:<br />

Used in Jars/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Low Fat. ............... 01<br />

Fat Free ............... 02<br />

Regular. ............... 03<br />

KINDS:<br />

Jar ................... 04<br />

Squeeze ............... 05<br />

BRANDS:<br />

Best Foods Light ........ 06<br />

Best Foods Real<br />

Mayonnaise .......... 07<br />

Best Foods Low Fat ...... 08<br />

Blue Plate. ............. 09<br />

Duke’s. ................ 10<br />

Hellmann’s Light. ........ 11<br />

Hellmann’s Real<br />

Mayonnaise .......... 12<br />

Hellmann’s Low Fat ...... 13<br />

Kraft Real Mayonnaise .... 14<br />

Kraft Fat-Free Mayonnaise . 15<br />

Kraft Light Mayonnaise. ... 16<br />

Kraft Miracle Whip Free ... 17<br />

Kraft Miracle Whip Light ... 18<br />

Kraft Miracle Whip (Regular) 19<br />

Store’s Own Brand ....... 20<br />

999<br />

OTHER (Write In)<br />

SALAD DRESSING<br />

Your Household:<br />

Used in Bottles or<br />

last 6 packages/<br />

months last 30 days<br />

858<br />

TOTAL: ................ 00<br />

TYPES:<br />

Fat Free ............... 01<br />

Low Fat/Light ........... 02<br />

Regular. ............... 03<br />

KINDS:<br />

Dry Mix. ............... 04<br />

Liquid ................. 05<br />

Refrigerated ............ 06<br />

FLAVORS:<br />

Bacon ................. 07<br />

Buttermilk .............. 08<br />

Caesar/Creamy Caesar . . . . 09<br />

Creamy Cucumber ....... 10<br />

Dijon/Mustard ........... 11<br />

French ................ 12<br />

Italian/Creamy Italian . . . . . . 13<br />

Oil & Vinegar ........... 14<br />

Ranch. ................ 15<br />

Roquefort/Blue Cheese ... 16<br />

1000 Island/Russian. ..... 17<br />

Vinaigrette ............. 18<br />

Other ................. 19<br />

BRANDS:<br />

Good Seasons Fat Free ... 20<br />

Good Seasons (Regular) .. 21<br />

Hidden V<strong>all</strong>ey Ranch Regular<br />

Bottled .............. 22<br />

Hidden V<strong>all</strong>ey Ranch<br />

Fat Free Bottled ....... 23<br />

Hidden V<strong>all</strong>ey Ranch Light<br />

Bottled .............. 24<br />

Hidden V<strong>all</strong>ey Ranch Dry<br />

Mix ................. 25<br />

Ken’s. ................. 26<br />

Kraft Free .............. 27<br />

Kraft Light Done Right .... 28<br />

Kraft (Regular) .......... 29<br />

Marie’s ................ 30<br />

Marzetti/T. Marzetti ....... 31<br />

Natur<strong>all</strong>y Fresh .......... 32<br />

Newman’s Own ......... 33<br />

Newman’s Own Lighten Up . 34<br />

Seven Seas ............ 35<br />

Western Salad Dressing. .. 36<br />

Wish-Bone Fat Free ...... 37<br />

Wish-Bone Light ......... 38<br />

Wish-Bone (Regular) ..... 39<br />

Wish-Bone Salad Spritzers . 40<br />

Store’s Own Brand ....... 41<br />

999<br />

OTHER (Write In)<br />

SALAD TOPPINGS<br />

Your Household:<br />

Bottles or<br />

Used in packages/<br />

last 6 last<br />

months 30 days<br />

853<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Almond Accents ......... 01<br />

Arnold Croutons ......... 02<br />

Bac˜Os. ............... 03<br />

Brownberry Croutons ..... 04<br />

French’s French Fried<br />

Onions .............. 05<br />

Hormel Real Bacon Bits. .. 06<br />

Hormel Real Bacon Pieces . 07<br />

McCormick Bac’n Pieces .. 08<br />

Mrs. Cubbison’s Croutons . 09<br />

Oscar Mayer Bacon Bits. .. 10<br />

Pepperidge Farm Croutons. 11<br />

Salad Crispins .......... 12<br />

Store’s Own Brand ....... 13<br />

999<br />

OTHER (Write In)<br />

PACKAGED<br />

FRESH SALAD<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

996<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Dole .................. 01<br />

Earthbound Farm ........ 02<br />

Fresh Express .......... 03<br />

Ready Pac ............. 04<br />

Store’s Own Brand ....... 05<br />

999<br />

OTHER (Write In)<br />

FRESH FRUIT &<br />

VEGETABLES<br />

Your Household:<br />

Used in Pounds/<br />

last 6 last 30<br />

months days<br />

861<br />

TOTAL: ................ 00<br />

KINDS:<br />

Organic. ............... 01<br />

Non-organic ............ 02<br />

TYPES:<br />

Apples ................ 03<br />

Apricots ............... 04<br />

Asparagus ............. 05<br />

Avocados .............. 06<br />

Bananas ............... 07<br />

Broccoli ............... 08<br />

Cabbage. .............. 09<br />

Cantaloupes ............ 10<br />

Carrots ................ 11<br />

Cauliflower ............. 12<br />

Cherries ............... 13<br />

Corn .................. 14<br />

Cucumber. ............. 15<br />

Grapefruit .............. 16<br />

Grapes ................ 17<br />

Green Beans ........... 18<br />

Kiwi. .................. 19<br />

Lemons ............... 20<br />

Lettuce ................ 21<br />

Limes ................. 22<br />

Mushrooms ............ 23<br />

Onions ................ 24<br />

Oranges ............... 25<br />

Peaches ............... 26<br />

Pears ................. 27<br />

Peas .................. 28<br />

Peppers ............... 29<br />

Pineapples ............. 30<br />

Plums ................. 31<br />

Potatoes ............... 32<br />

Pumpkin ............... 33<br />

Raspberries ............ 34<br />

Spinach ............... 35<br />

Strawberries ............ 36<br />

Tomatoes .............. 37<br />

Watermelons ........... 38<br />

999<br />

OTHER (Write In)<br />

FROZEN ORANGE<br />

JUICE<br />

Your Household:<br />

Used in Glasses/<br />

last 6 average<br />

months day<br />

862<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Minute Maid Regular ..... 01<br />

Other Minute Maid ....... 02<br />

Old Orchard ............ 03<br />

Tropicana .............. 04<br />

Store’s Own Brand ....... 05<br />

999<br />

OTHER (Write In)

FOOD/GROCERY SHOPPING<br />

Page 102<br />

INSTANT OR<br />

FREEZE-DRIED<br />

COFFEE<br />

Your Household:<br />

Used in Cups or<br />

last 6 glasses/<br />

months average day<br />

876<br />

TOTAL: ................ 00<br />

TYPES:<br />

Freeze-Dried ........... 01<br />

Instant Powdered/Buds ... 02<br />

BRANDS:<br />

Folgers Crystals (Regular) . 03<br />

Folgers Crystals (Decaf) .. 04<br />

Folgers Singles. ......... 05<br />

Maxwell House Coffee<br />

Singles .............. 06<br />

Maxwell House (Regular). . 07<br />

Maxwell House (Decaf) ... 08<br />

Nescafé Classic ......... 09<br />

Nescafé Taster’s Choice<br />

(Regular). ............ 10<br />

Nescafé Taster’s Choice<br />

(Decaf) .............. 11<br />

Sanka ................. 12<br />

Store’s Own Brand ....... 13<br />

999<br />

OTHER (Write In)<br />

FLAVORED INSTANT<br />

COFFEE<br />

Your Household:<br />

Used in Cups or<br />

last 6 glasses/<br />

months last 7 days<br />

877<br />

TOTAL: ................ 00<br />

TYPES:<br />

Decaffeinated ........... 01<br />

Regular. ............... 02<br />

Sugar Free ............. 03<br />

Fat Free ............... 04<br />

BRANDS:<br />

Folgers Cappuccino ...... 05<br />

General Foods International Coffees:<br />

Café Vienna .......... 06<br />

French Vanilla Café. .... 07<br />

French Vanilla Decaf. ... 08<br />

Hazelnut Belgian Café .. 09<br />

Suisse Mocha ......... 10<br />

Other. ............... 11<br />

Hills Bros. Cappuccino .... 12<br />

Nescafé Taster’s Choice. .. 13<br />

999<br />

OTHER (Write In)<br />

ORGANIC FOODS<br />

Your Household:<br />

Used in last<br />

6 months<br />

990-0<br />

TOTAL: ................... 1<br />

ORGANIC FOODS:<br />

Baby Food ............... 2<br />

Bread ................... 3<br />

Breakfast Cereals. ......... 4<br />

Cheese. ................. 5<br />

Chocolate ................ 6<br />

Coffee. .................. 7<br />

Fish/Seafood .............. 8<br />

Frozen Foods ............. 9<br />

Granola ................. 0<br />

Ice Cream. ............... X<br />

Meat ....................<br />

Y<br />

991-0<br />

Pasta ................... 1<br />

Peanut Butter ............. 2<br />

Poultry .................. 3<br />

Soup. ................... 4<br />

Spaghetti/Pasta Sauce. ..... 5<br />

Tea ..................... 6<br />

__________________________ 7<br />

OTHER (Write In)<br />

FOOD PREPARED<br />

FROM SCRATCH<br />

Your Household:<br />

Made in Times/<br />

last 6 last 30<br />

months days<br />

879<br />

TOTAL: ................ 00<br />

FOODS:<br />

Baby Food ............. 01<br />

Biscuits. ............... 02<br />

Bread ................. 03<br />

Cake. ................. 04<br />

Candy. ................ 05<br />

Chili .................. 06<br />

Cookies ............... 07<br />

Dips .................. 08<br />

Frosting ............... 09<br />

Gravies. ............... 10<br />

Ice Cream. ............. 11<br />

Jambalaya ............. 12<br />

Jams. ................. 13<br />

Jellies ................. 14<br />

Macaroni Salad ......... 15<br />

Pancakes .............. 16<br />

Pasta ................. 17<br />

Pies .................. 18<br />

Pizza ................. 19<br />

Potato Salad. ........... 20<br />

Salad Dressing. ......... 21<br />

Soup. ................. 22<br />

Spaghetti Sauce. ........ 23<br />

Stew .................. 24<br />

Tomato Sauce .......... 25<br />

Other Sauces ........... 26<br />

Tuna Casserole ......... 27<br />

Waffles . . . . . . . . . . . . . . . . . 28<br />

999<br />

OTHER (Write In)<br />

MICROWAVE USAGE<br />

Your Household:<br />

Used in Times/<br />

last 6 last 7<br />

months days<br />

880<br />

TOTAL: ................ 00<br />

For Which Meal(s):<br />

Breakfast .............. 01<br />

Lunch ................. 02<br />

Dinner. ................ 03<br />

Snack ................ 04<br />

REASON:<br />

Cook. ................. 05<br />

Defrost/Thaw ........... 06<br />

Reheat leftovers ......... 07<br />

TYPES OF FOOD:<br />

Baking Mixes ........... 08<br />

Food prepared from scratch 09<br />

Fresh vegetables ........ 10<br />

Frozen breakfast foods. ... 11<br />

Frozen desserts . . . . . . . . . . 12<br />

Frozen dinner/dinner<br />

entrees .............. 13<br />

Frozen side dishes ....... 14<br />

Pasta ................. 15<br />

Popcorn ............... 16<br />

Shelf Stable (Non-<br />

Refrigerated). ......... 17<br />

Soup. ................. 18<br />

Take-out food ........... 19<br />

999<br />

OTHER (Write In)<br />

PRODUCT SAMPLES<br />

987-0<br />

In the last 6 months, have you used a product<br />

sample?<br />

Yes ........................... 1<br />

If yes, how did you obtain the product<br />

sample(s) you used?<br />

Delivered in the mail. ............. 2<br />

Included with the newspaper ....... 3<br />

Obtained in-store ................ 4<br />

Other ......................... 5<br />

In the last 6 months, have you purchased a<br />

product after using its sample?<br />

Yes ........................... 6<br />

GROCERY<br />

SHOPPING<br />

How often do you go<br />

grocery shopping<br />

in an average week?<br />

Number of trips _______________881-0<br />

In the past week, what day(s) did you shop for<br />

groceries?<br />

882-0<br />

Sunday ............... 1<br />

Monday. .............. 2<br />

Tuesday .............. 3<br />

Wednesday. ........... 4<br />

Thursday. ............. 5<br />

Friday ................ 6<br />

Saturday. ............. 7<br />

Distance from your home to the store where<br />

you most frequently shop for groceries:<br />

Less than 1 mile ........ 8<br />

1–2 miles ............. 9<br />

3–5 miles ............. 0<br />

6–10 miles ............ X<br />

11+ miles ............. Y<br />

Time of day you usu<strong>all</strong>y shop for groceries<br />

(Check one): 883-0<br />

Morning .............. 1<br />

Afternoon ............. 2<br />

Evening .............. 3<br />

Various Times. ......... 4<br />

Do you prepare a written grocery shopping<br />

list in advance? 884-0<br />

Always ............... 1<br />

Sometimes ............ 2<br />

Never ................ 3<br />

In the past 30 days, have you purchased 989-0<br />

groceries over the Internet/online? Yes 1<br />

In the past 30 days, did you use a 997-0<br />

grocery store loyalty card? Yes 1<br />

CENTS OFF<br />

COUPONS<br />

Your Household:<br />

Used in Times<br />

last 12 used/last<br />

months 3 months<br />

885<br />

TOTAL: ................ 00<br />

Where redeemed:<br />

Discount Store .......... 01<br />

Drug Store ............. 02<br />

Grocery Store/Supermarket . 03<br />

Other ................. 999<br />

Received or clipped from: 886-0<br />

Handed out by person in store ...... 1<br />

In or on packages. ............... 2<br />

Magazine ...................... 3<br />

Mail. .......................... 4<br />

Sunday newspaper/inserts ........ 5<br />

Weekday newspaper/inserts ........ 6<br />

In-store circulars .................. 7<br />

Instant coupon machine/Shelf coupons 8<br />

Preferred customer/loyalty card ..... 9<br />

Coupons at register .............. 0<br />

Internet or E-mail ................ X<br />

Use coupons to: 887-0<br />

Save as much money as I can ...... 1<br />

Save on brands I use now ......... 2<br />

Try new products ................ 3<br />

Other ......................... 4<br />

Types of products used for:<br />

Beverages ..................... 5<br />

Cleaning products ............... 6<br />

Cosmetics ..................... 7<br />

Food products .................. 8<br />

Tobacco ....................... 9<br />

Toiletry items ................... 0<br />

Other ......................... X<br />

Total number of coupons used, last<br />

30 days: 994-0<br />

(Write in number)

Page 103<br />

HOUSEHOLD PRODUCTS<br />

Your Household:<br />

TOILET PAPER Used in Rolls/<br />

last 6 last 30<br />

months days<br />

888<br />

TOTAL: ................ 00<br />

TYPES:<br />

Plain White ............. 01<br />

Print .................. 02<br />

FORM:<br />

Moist. ................. 03<br />

Dry ................... 04<br />

BRANDS:<br />

Angel Soft. ............. 05<br />

Charmin Basic .......... 06<br />

Charmin Fresh Mates<br />

(Moist Wipes) .......... 07<br />

Charmin Plus (w/Lotion). .. 08<br />

Charmin Ultra Soft ....... 09<br />

Charmin Ultra Strong ..... 10<br />

Cottonelle .............. 11<br />

Cottonelle Aloe & E ...... 12<br />

Cottonelle Fresh Moist<br />

Wipes ............... 13<br />

Cottonelle Ultra ......... 14<br />

Marcal/Sofpac .......... 15<br />

Quilted Northern (Regular). 16<br />

Quilted Northern Ultra Plush . 17<br />

Scott 1000 ............. 18<br />

Scott Extra Soft ......... 19<br />

Scott Moist Wipes. ....... 20<br />

Soft ’N Gentle. .......... 21<br />

White Cloud ............ 22<br />

Store’s Own Brand ....... 23<br />

999<br />

OTHER (Write In)<br />

FACIAL TISSUES<br />

Your Household:<br />

Used in Boxes/<br />

last 6 last 30<br />

months days<br />

889<br />

TOTAL: ................ 00<br />

TYPES:<br />

Scented ............... 01<br />

Unscented ............. 02<br />

FORM:<br />

Box ................... 03<br />

Soft Pack .............. 04<br />

BRANDS:<br />

Kleenex Anti-Viral. ....... 05<br />

Kleenex Expressions ..... 06<br />

Kleenex Extra Large. ..... 07<br />

Kleenex Lotion .......... 08<br />

Kleenex Regular. ........ 09<br />

Kleenex Ultra Soft ....... 10<br />

Other Kleenex .......... 11<br />

Marcal ................ 12<br />

Nice ’N Soft ............ 13<br />

Puffs Basic ............. 14<br />

Puffs Plus Lotion ........ 15<br />

Puffs Ultra ............. 16<br />

Scotties ............... 17<br />

White Cloud ............ 18<br />

Store’s Own Brand ....... 19<br />

999<br />

OTHER (Write In)<br />

PLASTIC<br />

Your Household:<br />

DISPOSABLE Used in Number<br />

CONTAINERS last 6 used/last<br />

(not bags) months 30 days<br />

985<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Glad OvenWare ......... 01<br />

GladWare ............. 02<br />

Ziploc Snap ’n Seal ...... 03<br />

Ziploc Twist ’n Loc ....... 04<br />

Store’s Own Brand ....... 05<br />

999<br />

OTHER (Write In)<br />

PAPER TOWELS<br />

Your Household:<br />

Used in Rolls/<br />

last 6 last 30<br />

months days<br />

890<br />

TOTAL: ................ 00<br />

TYPES:<br />

Plain White ............. 01<br />

Print .................. 02<br />

BRANDS:<br />

Bounty ................ 03<br />

Bounty Designer’s Touch .. 04<br />

Bounty Fun Prints. ....... 05<br />

Bounty Home Decor. ..... 06<br />

Bounty Select-a-Size ..... 07<br />

Brawny ................ 08<br />

Brawny Big Roll ......... 09<br />

Marcal ................ 10<br />

Mardi Gras ............. 11<br />

Scott Towels ............ 12<br />

Scott Towels Mega Roll ... 13<br />

Sparkle ................ 14<br />

Viva. .................. 15<br />

Store’s Own Brand ....... 16<br />

999<br />

OTHER (Write In)<br />

PAPER NAPKINS<br />

891<br />

Your Household:<br />

Used in Packs/<br />

last 6 last 30<br />

months days<br />

TOTAL: ................ 00<br />

TYPES:<br />

Dinner. ................ 01<br />

Family. ................ 02<br />

BRANDS:<br />

Bounty ................ 03<br />

Chinet. ................ 04<br />

Dixie .................. 05<br />

Kleenex ............... 06<br />

Marcal ................ 07<br />

Mardi Gras ............. 08<br />

Scott .................. 09<br />

Vanity Fair. ............. 10<br />

Zee ................... 11<br />

Store’s Own Brand ....... 12<br />

999<br />

OTHER (Write In)<br />

RECYCLING<br />

998-0<br />

In the last 30 days, did you or anyone in your<br />

household recycle or re-use any of the<br />

following?<br />

Batteries ....................... 1<br />

Electronic Equipment ............. 2<br />

Aluminum Beverage Cans ......... 3<br />

Other Metal items. ............... 4<br />

Glass Bottles ................... 5<br />

Other Glass items ............... 6<br />

Plastic Bottles. .................. 7<br />

Plastic Bags .................... 8<br />

Other Plastic Items. .............. 9<br />

Newspapers .................... 0<br />

Other Paper .................... X<br />

_______________________________ Y<br />

OTHER (Write In)<br />

PRE-MOISTENED<br />

HOUSEHOLD WIPES<br />

Your Household:<br />

Used in Packages/<br />

last 6 last 30<br />

months days<br />

892<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Clorox Disinfecting Wipes. . 01<br />

Glass Plus Wipes ........ 02<br />

Green Works ........... 03<br />

Lysol Disinfecting Wipes. .. 04<br />

Mr. Clean Wipes ......... 05<br />

Murphy Soft Wipes ....... 06<br />

Old English Furniture Wipes 07<br />

Pledge Wipes ........... 08<br />

Scrubbing Bubbles Wipes . 09<br />

Swiffer Wet ............. 10<br />

Windex Wipes. .......... 11<br />

999<br />

OTHER (Write In)<br />

DRY DISPOSABLE<br />

WIPES & DUSTERS<br />

Your Household:<br />

Used in Packs/<br />

last 6 last 30<br />

months days<br />

893<br />

TOTAL: ................ 00<br />

BRANDS:<br />

Easy-Wipes ............ 01<br />

Endust Dust Cloths ...... 02<br />

Endust Duster .......... 03<br />

Handi-Wipes. ........... 04<br />

Pledge Dust & Allergen ... 05<br />

Pledge Multi-Surface Duster. 06<br />

Swiffer Cloths ........... 07<br />

Swiffer Dusters. ......... 08<br />

Scotch Brite Cloths. ...... 09<br />

Windex Dry Microfiber Cloths 10<br />

999<br />

OTHER (Write In)<br />

DISPOSABLE CUPS<br />

Your Household:<br />

Used in Number<br />

last 6 used/last<br />

months 30 days<br />

894<br />

TOTAL: ................ 00<br />

TYPES:<br />

Foam ................. 01<br />

Paper ................. 02<br />

Plastic. ................ 03<br />

BRANDS:<br />

Dixie .................. 04<br />

Solo .................. 05<br />

Generic (No Label). ...... 06<br />

Store’s Own Brand ....... 07<br />

999<br />

OTHER (Write In)<br />

DISPOSABLE PLATES<br />

Your Household:<br />

Used in Packages/<br />

last 12 last 30<br />

months days<br />

895<br />

TOTAL: ................ 00<br />

TYPES:<br />

Foam ................. 01<br />

Plain Paper. ............ 02<br />

Coated Paper ........... 03<br />

Plastic. ................ 04<br />

BRANDS:<br />

Chinet. ................ 05<br />

Dixie .................. 06<br />

Hefty. ................. 07<br />

Solo .................. 08<br />

Generic (No Label). ...... 09<br />

Store’s Own Brand ....... 10<br />

999<br />

OTHER (Write In)

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