Community Needs Survey
A short survey, about five minutes, that asks people with disabilities, their families and the people who support them which Independent Living services they need but are not getting, how hard help is to find, and where they live. It gives a Statewide Independent Living Council or a Center for Independent Living a county-level picture of unmet need for a State Plan for Independent Living.
At a glance
- 5minutes, about
- 4sections
- 6questions3 required
- 1.0.0version
The preview saves nothing. Hosted copies are reached by a coded link for your state.
Who it is for
People with disabilities, family members, caregivers, advocates, and disability service providers. If you are filling this out for someone else, please answer based on your experience with them.
What respondents are told first
- It takes about 5 minutes.
- You may skip any question except the first one and the county question.
- Your answers are confidential. They are reported only as counts, never with your name.
- Giving your contact details is optional, and they are kept apart from your answers.
- You can stop at any time. What you have answered so far still counts.
The questions
Every question has a stable identifier, shown in brackets, that stays the same across versions and matches the question bank. Hints appear under the labels on screen and are read as descriptions.
About this survey
-
Who are you filling out this survey for? [cn_role], required
- Myself: I have a disability [self]
- A family member or person I care for [family]
- Someone I advocate for or support [advocate]
- People I serve: as an agency or disability service provider [provider]
Services you need
-
Which services do you need but are not getting? [cn_unmet]
Check all that apply. A box appears under each one you check, in case you want to say more.- Rights: Help knowing and speaking up for my rights [rights] (write-in follows)
- Emergencies: Help getting ready for emergencies or disasters [emergencies] (write-in follows)
- Benefits: Help getting SSI, SSDI, food assistance, or other benefits [benefits] (write-in follows)
- Social: Help meeting people and staying connected [social] (write-in follows)
- Work: Help finding or keeping a job [work] (write-in follows)
- School: Help with education or job training [school] (write-in follows)
- Housing: Help finding a safe, affordable, accessible place to live [housing] (write-in follows)
- Transportation: Help getting around [transportation] (write-in follows)
- Something else [other] (write-in follows)
- None: I am getting the services I need [none]
-
How hard is it to get the help you need? [cn_difficulty]
- Very hard: I cannot get help at all [very_hard]
- Hard: I get some help, but not enough [hard]
- Somewhat hard: I get help sometimes [somewhat_hard]
- Not too hard: I usually get the help I need [not_too_hard]
Where you live
-
Which county in your state do you live in? [cn_county], required
If you are answering for someone else, choose their county.A list of your state's counties, plus "I do not live in your state".
Stay in touch (optional)
-
Your contact information [cn_contact]
Optional. Only fill this in if you would like someone to follow up with you. Your contact details are stored separately from your answers.Name, Email, Phone. Stored separately from the answers.
-
Is there anything else you want us to know? [cn_comments]
Free text.
What you get back
Counts by county of who answered, which services people need but are not getting, and how hard help is to find, with the write-in comments for each service. That is the core of a needs assessment table for a State Plan: a ranked list of unmet needs that can be split by county and compared with the county's disability population from the Census page.
Because the question identifiers and answer values are fixed, results from two networks, or two years, can be laid side by side. The survey asks nothing about disability type, race, age or income on purpose. It is short enough to complete at a resource fair, and the deeper questions belong in a longer instrument with its own consent.
Testing status
- Automated structure and axe-core checks: pass on every built page.
- Browser pass for contrast, focus and reflow at 320 pixels: done for the preview, repeated for each hosted state page before a channel opens.
- Screen reader pass by a daily screen reader user with a task list: not yet. The first network to field it gates its channel on this pass.
If you find something a screen reader reads badly, tell us which screen reader and browser you used and what you heard.
Versions
Version 1.0.0 is the first published version. A new version adds question identifiers and never reuses one. Changes are listed in the repository.