1. What is today's date?  Tuesday, August 29, 2006 04:22:17 PM

2. What county do you live in?  . Butts County Carroll County Coweta County Heard County Lamar County Meriwether County Pike County Spalding County Troup County Upson County Other Georgia County Other County Outside Georgia

3. What state do you live in?  . Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

4. When you are 70, or when you retire, what will need other than money? 

5. Is it likely, after you retire, you will be supporting/caring for someone else such as grandchildren, elderly parents, or family members with disabilities?  Yes No

If yes to #5, briefly comment on your anticipated situation.

6. If you had a disability and were unable to walk or bathe yourself, would you have anyone to help you with your daily needs?  Yes No

If No to #6, how would you obtain assistance?

7. What other services do you imagine you might need?

8. Please indicate your age category.  50+ 40-50 30-40 20-30

9. List any additional comments you may have here.