The following questions are taken from the NGISC's survey. The questionnaire was created by the National Opinion Research Center of the University of Chicago and was used to collect data for a report that was submitted to the NGISC in 1999.

The assessment consists of at most 34 questions. The first 17 questions deal with lifetime problems, while the last 17 deal with previous year problems. A negative response on some questions will cause other questions to be skipped. The questionnaire should only be taken by people who have lost $100 or been down $100 at some time in their life.

For simplicity, not answering a question is the same as answering "No". However, any question denoted with a '*' is mandatory, as the question is used to determine which questions will be asked next.

This is an anonymous questionnaire and you will not be asked for your name or e-mail address.

For more information about NGISC, NORC, or details of the NORC questionnaire, visit the NORC's website.