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DHS Division of Aging Services Daytime: 6/3/2014 09:41 Food Security Survey Footprint Daytime: 6/3/2014 09:41 AM Page 1 of 1Client ID: Client Name:Date:Staff Name: Score:1. During the last 30 days,
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Start by reading the instructions on the food security survey form.
02
Fill in your personal information such as name, address, contact details, and household size.
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Answer all questions honestly and to the best of your knowledge. This may include questions about your income, expenses, food purchasing habits, and food accessibility.
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Double-check your responses to ensure accuracy before submitting the form.

Who needs food security survey form?

01
Individuals and families who are at risk of food insecurity
02
Researchers and policymakers looking to understand the food security status of a specific population
03
Food banks and aid organizations seeking to provide assistance to those in need
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The food security survey form is a questionnaire designed to assess and monitor the availability, access, and utilization of food at the household level.
Households and individuals who are designated to participate in the survey are required to fill out the food security survey form.
The form can be filled out by providing accurate and honest information about the household's food situation, including sources of food, access to food, and food security challenges.
The purpose of the food security survey form is to gather data on food security issues, identify vulnerable populations, and inform policies and programs aimed at improving food security.
Information such as household size, income sources, food sources, food expenditures, and food consumption patterns must be reported on the food security survey form.
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