<div class="radio-group" role="radiogroup" aria-label="label">
<p class="radio-block margin-bottom">
<input type="radio" name="homeless" value="homeless-rent" id="homeless-rent" aria-describedby="ariaDescribedby">
<label class="radio-block_label" for="homeless-rent">
<strong>I’m renting a room, apartment, or house.</strong>
<span class="radio-block_note">This includes living in a supportive housing unit or SRO that you pay for.</span>
</label>
</p>
<p class="radio-block margin-bottom">
<input type="radio" name="homeless" value="homeless-own" id="homeless-own" aria-describedby="ariaDescribedby">
<label class="radio-block_label" for="homeless-own">
<strong>I live in an apartment or house that I own or a member of my household owns.</strong>
</label>
</p>
<p class="radio-block margin-bottom">
<input type="radio" name="homeless" value="homeless-temporary" id="homeless-temporary" aria-describedby="ariaDescribedby">
<label class="radio-block_label" for="homeless-temporary">
<strong>I have somewhere to stay but it isn’t permanent.</strong>
<span class="radio-block_note">This includes couchsurfing, or living in a motel/hotel that you pay for. It also includes people who have recieved an eviction notice, are living in a medical facility, a substance use treatment facility, or a jail.</span>
</label>
</p>
<p class="radio-block margin-bottom">
<input type="radio" name="homeless" value="homeless-homeless" id="homeless-homeless" aria-describedby="ariaDescribedby">
<label class="radio-block_label" for="homeless-homeless">
<strong>I’m homeless.</strong>
<span class="radio-block_note">This includes living outside, living in your car, staying in a shelter or motel/hotel that is paid for by an emergency voucher.</span>
</label>
</p>
</div>
<div class="radio-group" role="radiogroup" aria-label="label">
{{#each inputs.homeless}}
<p class="radio-block margin-bottom">
<input type="radio" name="homeless" value="homeless-{{value}}" id="homeless-{{value}}" aria-describedby="ariaDescribedby">
<label class="radio-block_label" for="homeless-{{value}}">
<strong>{{name}}</strong>
{{#if note}}
<span class="radio-block_note">{{note}}</span>
{{/if}}
</label>
</p>
{{/each}}
</div>
{
"inputs": {
"homeless": [
{
"name": "I’m renting a room, apartment, or house.",
"note": "This includes living in a supportive housing unit or SRO that you pay for.",
"value": "rent"
},
{
"name": "I live in an apartment or house that I own or a member of my household owns.",
"value": "own"
},
{
"name": "I have somewhere to stay but it isn’t permanent.",
"note": "This includes couchsurfing, or living in a motel/hotel that you pay for. It also includes people who have recieved an eviction notice, are living in a medical facility, a substance use treatment facility, or a jail.",
"value": "temporary"
},
{
"name": "I’m homeless.",
"note": "This includes living outside, living in your car, staying in a shelter or motel/hotel that is paid for by an emergency voucher.",
"value": "homeless"
}
],
"contacts": [
{
"name": "Family member",
"value": "family"
},
{
"name": "Friend",
"value": "friend"
},
{
"name": "Social worker or housing counselor",
"value": "social"
},
{
"name": "I don’t have an alternate contact",
"value": "not"
}
],
"income": [
{
"name": "per month",
"value": "month"
},
{
"name": "per year",
"value": "year"
}
],
"yesno": [
{
"name": "Yes",
"value": "yes"
},
{
"name": "No",
"value": "no"
}
]
}
}
There are no notes for this item.