Question bank

How identifiers work

A question id is a short lowercase token with a two-letter instrument prefix: cn_ for the Community Needs Survey, cs_ for the Consumer Satisfaction Survey. Shared questions keep the prefix of the instrument that introduced them.
Answer values are lowercase tokens in brackets in the tables below. They are what is stored and exported; labels are what respondents see and may be translated freely.
A write-in that appears when an option is chosen has its own id ending in _more.
Checkbox answers export as the values joined with a vertical bar, in instrument order.
A change to meaning gets a new id. A change to spelling or translation does not.

The machine-readable source is the JSON for each instrument in the repository, and the export columns are described in the response data format.

Community Needs Survey (version 1.0.0)

Questions in the Community Needs SurveyIdentifier, type, text, and answer values. Required questions are marked.
Id	Type	Question	Answer values
`cn_role` required	radio	Who are you filling out this survey for?	Myself `[self]` A family member or person I care for `[family]` Someone I advocate for or support `[advocate]` People I serve `[provider]`
`cn_unmet`	checkbox	Which services do you need but are not getting? Check all that apply. A box appears under each one you check, in case you want to say more.	Rights `[rights]`; write-in `cn_unmet_rights_more` Emergencies `[emergencies]`; write-in `cn_unmet_emergencies_more` Benefits `[benefits]`; write-in `cn_unmet_benefits_more` Social `[social]`; write-in `cn_unmet_social_more` Work `[work]`; write-in `cn_unmet_work_more` School `[school]`; write-in `cn_unmet_school_more` Housing `[housing]`; write-in `cn_unmet_housing_more` Transportation `[transportation]`; write-in `cn_unmet_transportation_more` Something else `[other]`; write-in `cn_unmet_other_more` None `[none]` (clears the others)
`cn_difficulty`	radio	How hard is it to get the help you need?	Very hard `[very_hard]` Hard `[hard]` Somewhat hard `[somewhat_hard]` Not too hard `[not_too_hard]`
`cn_county` required	county	Which county in [state] do you live in? If you are answering for someone else, choose their county.	County FIPS code, or `[outside]` for "I do not live in [state]"
`cn_contact`	contact	Your contact information Optional. Only fill this in if you would like someone to follow up with you. Your contact details are stored separately from your answers.	`cn_contact.name`, `cn_contact.email`, `cn_contact.phone`; stored and exported separately
`cn_comments`	textarea	Is there anything else you want us to know?	Free text, up to 4,000 characters

Consumer Satisfaction Survey (version 1.0.0)

Questions in the Consumer Satisfaction SurveyIdentifier, type, text, and answer values. Required questions are marked.
Id	Type	Question	Answer values
`cs_services` required	checkbox	Which services did you receive from the center in the past 12 months? Check all that apply.	Information and referral `[info_referral]` Independent living skills training `[il_skills]` Peer support `[peer_support]` Help with my own advocacy `[advocacy_individual]` Systems advocacy `[advocacy_systems]` Moving out of a nursing home or institution `[transition_institution]` Youth transition `[transition_youth]` Assistive technology `[assistive_tech]` Housing `[housing]` Employment `[employment]` Benefits `[benefits]` Personal assistance services `[personal_assistance]` Transportation `[transportation]` Something else `[other]`; write-in `cs_services_other_more` I am not sure `[unsure]` (clears the others)
`cs_duration`	radio	How long have you been receiving services from the center?	Less than 3 months `[lt_3m]` 3 to 12 months `[3_12m]` 1 to 3 years `[1_3y]` More than 3 years `[gt_3y]` I am not sure `[unsure]`
`cs_mode`	checkbox	How did you work with the center? Check all that apply.	In person at the center `[in_person_office]` In person at my home or in my community `[in_person_home]` By phone `[phone]` By video call `[video]` By email or text `[email_text]`
`cs_agree_respect`	scale (agree5)	Staff treated me with respect.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_listened`	scale (agree5)	Staff listened to what I wanted.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_goals`	scale (agree5)	I set my own goals, and the center worked toward them.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_format`	scale (agree5)	I got information in a format I can use. For example large print, braille, plain language, my language, or a format my screen reader can read.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_timely`	scale (agree5)	Help was available when I needed it.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_access`	scale (agree5)	The center's office, phone line and website were accessible to me.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_agree_reach`	scale (agree5)	I know how to reach the center if I need help again.	Strongly agree `[strongly_agree]` Agree `[agree]` Neither agree nor disagree `[neutral]` Disagree `[disagree]` Strongly disagree `[strongly_disagree]` Does not apply `[not_applicable]`
`cs_helped`	radio	Did the center's services help you reach what you wanted?	Yes, a lot `[a_lot]` Yes, somewhat `[somewhat]` Not yet `[not_yet]` No `[no]`
`cs_changes`	checkbox	What changed for you because of the center? Check all that apply.	I do more for myself at home `[more_independent]` I take part in my community more `[more_involved]` I found or kept a place to live `[housing]` I found or kept a job, or started school or training `[job]` I got benefits or health coverage I did not have `[benefits]` I moved out of a nursing home or institution, or stayed out of one `[left_facility]` I learned a skill I use `[skills]` I know my rights and how to use them `[rights]` I have equipment or technology that helps me `[tech]` I feel less alone `[connected]` Something else `[other]`; write-in `cs_changes_other_more` Nothing has changed yet `[nothing]` (clears the others)
`cs_overall`	radio	Overall, how satisfied are you with the center?	Very satisfied `[very_satisfied]` Satisfied `[satisfied]` Neither satisfied nor dissatisfied `[neutral]` Dissatisfied `[dissatisfied]` Very dissatisfied `[very_dissatisfied]`
`cs_recommend`	radio	Would you recommend the center to another person with a disability?	Yes `[yes]` Maybe `[maybe]` No `[no]`
`cs_unmet`	textarea	Was there anything you needed that the center could not help with?	Free text, up to 4,000 characters
`cs_improve`	textarea	What could the center do better?	Free text, up to 4,000 characters
`cs_praise`	textarea	Is there anything the center did especially well?	Free text, up to 4,000 characters
`cs_county`	county	Which county in [state] do you live in?	County FIPS code, or `[outside]` for "I do not live in [state]"
`cs_age`	radio	What is your age?	Under 18 `[under_18]` 18 to 24 `[18_24]` 25 to 59 `[25_59]` 60 or older `[60_plus]` Prefer not to say `[prefer_not]`
`cs_followup`	contact	Would you like someone from the center to contact you? Optional. Fill this in only if you want a call or an email about something you said here. Your contact details are stored separately from your answers.	`cs_followup.name`, `cs_followup.email`, `cs_followup.phone`; stored and exported separately

Shared scales

A scale is defined once and reused so respondents learn one ladder. Scales are versioned with the instrument that introduced them.

agree5: Strongly agree, Agree, Neither agree nor disagree, Disagree, Strongly disagree, plus Does not apply. Values: strongly_agree, agree, neutral, disagree, strongly_disagree, not_applicable.
Difficulty (in cn_difficulty): Very hard, Hard, Somewhat hard, Not too hard. The anchors describe what help the person gets, not how they feel, so they translate without drift.