Anonymous Benefits and Income Survey for Lived Experience Advocates
This is an anonymous survey to assist with data necessary for federal advocacy efforts for a bill that will address how benefits of lived experience advocates are affected when they receive payments (i.e., gift cards and stipends) for their advocacy.

Thank you for your participation in this national effort! Your help and the accuracy of the data you provide is critical in removing current and future barriers to compensation. Thank you for using your life experiences to advocate as you continue to advise the homelessness response system.


Sign in to Google to save your progress. Learn more
About:


We are gathering data to try and understand whether individuals are likely to be affected by something known as a "Benefits Cliff."

A "Benefits Cliff" is what happens when public benefit programs taper off or phase out quickly when earnings increase. The abrupt reduction or loss of benefits can be very disruptive because even though earnings have increased, they usually have not increased enough for self-sufficiency.

The questions below will ask you about the different kinds of benefits and income you receive.  Select as many of the choices that apply to your situation.

We would also like to acknowledge the groundwork laid by Susan Kolkowicz in developing this survey. Susan is a lived experience advocate in Los Angeles who has also been sounding the alarm on the Benefits Cliff issue. We are grateful for her contributions to this work.

This survey is anonymous.

Do you have lived experience in homelessness? *
In what month and year were you born? 
Example: September 1970
 *
In what city and state do you live? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms