Self-Employed Coverage Survey

Thank you for agreeing to participate in this important survey on Self-Employed Coverage at the NIS. This survey would only take five (5) minutes to complete. Be assured that all answers you provide will be kept in the strictest confidence.
In addition, If you choose to complete Contact Information section, you will be eligible for one of three monetary prizes. [ $500, $300 or $100]

Section A

If ‘Yes’, Section B will be shown for completion.

If ‘No’, Section C will be shown for completion.


Section D

Fill out your contact information for a chance to win a prize (optional):