Dear Participants,

Greetings!

We are conducting a study entitled A Cross-Sectional Study on Household Financial Anxiety Among
Residents in District 6 Barangay Baesa, Quezon City. In line with this, we invite you to participate in this
endeavor by answering questions regarding your financial anxiety level. We ask that you answer them with
utmost honesty and sincerity. Rest assured, your personal data and responses shall be kept confidential. Your
participation is greatly appreciated, and the successful completion of this study is attributed to the time and
input that you have provided.

Thank you, and we are hoping for a favorable response.

John Jayvee B. Acaso Victor M. Dazal Jr.

Jenifer A. Arellano Mary Jane Dhokie B. Dolauta
Harold James C. Bontuyan Noralden L. Kiram
Gregea U. Brunidor Stephanie A. Laiwoo
Janilyn A. Candelaria Angela L. Luces

Data Privacy Consent (R.A. 10173)

All information will remain secured and confidential within the Bureau and only authorized personnel shall
have access to them. This is guided and in compliance with the Data Privacy Act of 2012. The act includes
the right to object to the processing of your data, the right to access your data, the right to correct any
inaccurate data, and the right to erasure or blocking of data.

( ) I agree
( ) I disagree

_______________________ ___________________
Signature over Printed Name Date
(Optional)

Income (Monthly):
( ) Rich (At least ₱219,140 and up)
( ) High income (but not rich) (Between P131,484 to P219,140)
( ) Upper middle income (Between P76,669 in P131,484)
( ) Middle class (Between 143,828 to 176,669)
( ) Lower middle class income (Between P21,194 to P43,828)
( ) Low income (but not poor) (Between P9 520 to P21,194)
( ) Poor (Less than 10,957)
Work Status:
( ) Employed
( ) Self Employed
( ) Unemployed

Age Group:
( ) Child (0-16)
( ) Young Adult (17-30)
( ) Middle Aged Adult (31-45)
( ) Old Age (45 and above)

Household Size (Ilan kayo sa bahay niyo?): __________________

Questions 4 3 2 1 (very 0 (never)

(always) (occaasion (rarely) rarely)
ally)

AFFECTIVE REACTION (AR)

1. I feel depressed because of my

financial situation.
(Nakakaramdam ako ng
depresyon dahil sa aking
kalagayan sa pinansyal.)

2. I feel sad because of my

financial situation.
(Nakakaradam ako ng
kalungkutan dahil sa aking
kalagayan sa pinansyal.)

3. I am fearful because of my
financial situation. (Natatakot
ako dahil sa aking kalagayan sa
pinansyal.)

4. I feel anxious because of my

financial situation.
(Nakakaramdam ako ng
pag-aalala dahil sa aking
kalagayan sa pinansyal.)

5. I worry a lot because of my

financial situation. (Ako ay
maraming nag-aalala dahil sa
aking kalagayan sa pinansyal.)

6. I am easily irritated because of

my financial situation. (Madaling
ako ma-irita dahil sa aking
kalagayan sa pinansyal.)

7. I feel emotionally drained

because of my financial
situation. (Nakakaramdam ako
ng pagkawala sa mood dahil sa
aking kalagayan sa pinansyal.)
8. I feel frustrated because of my
financial situation.
(Nakakaramdam ako ng
pagkapagod dahil sa aking
kalagayan sa pinansyal.)

RELATIONAL/INTERPERSONAL BEHAVIOR (RB)

9. My financial situation interferes

with my daily job performance.
(Ang aking kalagayan sa
pinansyal ay nakikialam sa aking
araw-araw na pagganap sa
trabaho.)

10. I frequently pass on social

events at work due to my
financial situation. (Madalas
akong magpasa ng mga
okasyon sa trabaho dahil sa
aking kalagayan sa pinansyal.)

11. I often get into trouble at work

because of my financial
situation. (Madalas akong
masangkot sa problema sa
trabaho dahil sa aking kalagayan
sa pinansyal.)

12. My financial situation frequently

interferes with my relationship
with co-workers/colleagues.
(Madalas na nakakaistorbo ang
aking kalagayan sa pinansyal sa
akingmga katrabaho.)

13. I often argue with my

spouse/significant other
because of financial matters.
(Madalas akong mag-away ng
aking asawa/mahal sa buhay
dahil sa mga bagay na may
kinalaman sa pinansya.)

14. I find it difficult to talk about

money with my
spouse/significant other.
(Madalas akong mag-away ng
aking asawa/mahal sa buhay
dahil sa mga bagay na may
kinalaman sa pinansya.)

15. I frequently avoid attending

family events because of my
financial situation. (Madalas
kong iwasan ang pagdalo sa
mga pamilyaang okasyon dahil
sa aking kalagayan sa
pinansyal.)

16. My financial situation frequently

interferes with my family
 relationship. (Madalas na
nakikialam ang aking kalagayan
sa pinansyal sa aking ugnayan
sa pamilya.)

PHYSIOLOGICAL RESPONSES (PR)

17. I have stomach aches

frequently because of my
financial situation. (Madalas
akong magkaroon ng sakit ng
tiyan dahil sa aking kalagayan
sa pinansyal.)

18. My heartbeat increases

because of my financial
situation. (Tumataas ang tibok
ng aking puso dahil sa aking
kalagayan sa pinansyal.)

19. I feel cold because of my

financial situation.
(Nararamdaman ko ang lamig
dahil sa aking kalagayan sa
pinansyal.)

20. I sweat more because of my

financial situation. (Mas marami
akong pawis dahil sa aking
kalagayan sa pinansyal.)

21. I have more frequent muscle

pain because of my financial
situation. (Mas madalas akong
magkaroon ng pananakit ng
kalamnan dahil sa aking
kalagayan sa pinansyal.)

22. I fatigue frequently because of

my financial situation. (Madalas
akong napapagod dahil sa aking
kalagayan sa pinansyal.)

23. I am sensitive to noise because

of my financial situation.
(Sensitibo ako sa ingay dahil sa
aking kalagayan sa pinansyal.)

24. I find flaws/cracks/chips of

general objects more frequently
than before because of my
financial situation. (Mas
madalas kong napapansin ang
mga depekto/tarak/chips sa
pangkalahatang mga bagay
kaysa dati dahil sa aking
kalagayan sa pinansyal.)