In the last 12 months, have you needed to see a doctor, but could not because of cost?
In the last 12 months, have you ever had to go without health care because you didn't have a way to get there?
Are you unemployed or without regular income?
In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food?
In the last 12 months, has the electric, gas, oil, or water company threatened to shut off your services in your home?
Are you worried that in the next 2 months, you may not have stable housing?
Do you feel unsafe in your daily life?