North Central Human Services Plan Public Survey Question Title * 1. Please provide your city/town and zip code City/Town Zip Code Question Title * 2. What is your age? Under 16 years 16 to 20 years 21 to 34 years 35 to 44 years 45 to 59 years 60 to 64 years 65 to 74 years 75 years and over Question Title * 3. What is the highest level of education you have completed? Some high school Graduated from high school Some college Technical School Bachelor's degree Master's degree Doctoral degree Question Title * 4. What is your annual household income? Less than $15,000 Between $15,000 and $24,999 Between $25,000 and $34,999 Between $35,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $149,999 $150,000 or more Question Title * 5. Are you a military veteran? Yes No Question Title * 6. Do you have any type of disability? Yes No Question Title * 7. How many children under 18 live with you? No Children One Child Two Children Three Children More than three Children Question Title * 8. Do you have access to a car? Yes, I own a car and drive myself Yes, a family member or friend has a car and drives me Yes, I borrow a car and drive myself No, I do not have access to a car Question Title * 9. What are the top 3 destinations you want to go to but cannot due to lack of transportation? Destination 1 Destination 2 Destination 3 Question Title * 10. For the majority of your local trips, how do you travel? (Check all that apply) I drive myself Use public transportation (ATA, etc.) Ride in family / friend's vehicle Ride with volunteers / carpool Take a taxi Walk / bike Use a human service agency (Health-ride, nursing home, etc.) Other, please list: Question Title * 11. Based on your experiences, please tell us which of the following challenges you have encountered using transportation services. (Check all that apply) Understanding program requirements Knowing what’s available Unable to travel to transportation facilities Cost of transportation Difficulty connecting to other services Limited geographic coverage Operating hours of service Question Title * 12. Please list the local services that you use. (ATA, senior center shuttle, etc.) Question Title * 13. Please indicate your reasons if you have never used or no longer use publictransportation. Check all that apply. Service is not frequent enough Travel takes too long Service is not offered to the sites I need Service is not reliable Fares are expensive Too far to walk to a bus stop I prefer to drive I am not aware of the services available Not applicable Other (please specify) Question Title * 14. Have you considered relocating to an area with better transportation services? (i.e. move closer to town, hospitals, or a location that has more options to better suit your needs) Yes No Question Title * 15. How do you find transportation services available to you? (Check all that apply) Senior Center Word of Mouth Internet Search Program Contact County Assistance Office PA211 Other (please specify) Question Title * 16. During the past year, what portion of your transportation did you drive yourself? 0% 50% 100% Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 17. During the past year, what portion of your transportation did your friends/family drive you? 0% 50% 100% Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 18. During the past year, what portion of your transportation did local services drive you? (ATA, health provider, etc.) 0% 50% 100% Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 19. What portion of your transportation would you like local services (ATA, health provider, etc.) to drive you? 0% 50% 100% Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 20. How much do you currently pay per one-way trip for public transportation? (This does not include rideshare trips) Nothing Less than $1.00 $1.00 - $1.50 $1.50 - $2.00 More than $2.00 Question Title * 21. How much are you willing to spend on a one-way trip for public transportation? (This does not include rideshare trips) Nothing Less than $1.00 $1.00 - $1.50 $2.00 - $2.50 More than $2.50 Question Title * 22. If you already use or were going to use public transportation, what is you main reason for traveling? Please check one. Work Medical appointments Shopping Family / friend visits Entertainment Social service Education Religious Not Applicable Other (please specify) Question Title * 23. When you travel, how long does it typically take you to get to your destination? 0 Minutes 50 Minutes 100 Minutes Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 24. How long do you wait for transportation when returning home? 0 Minutes 50 Minutes 100 Minutes Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 25. Please indicate the hours you most frequently travel or need to travel. Monday Tuesday Wednesday Thursday Friday Saturday Sunday 12 A.M - 6 A.M. 12 A.M - 6 A.M. Monday 12 A.M - 6 A.M. Tuesday 12 A.M - 6 A.M. Wednesday 12 A.M - 6 A.M. Thursday 12 A.M - 6 A.M. Friday 12 A.M - 6 A.M. Saturday 12 A.M - 6 A.M. Sunday 6 A.M - 8 A.M. 6 A.M - 8 A.M. Monday 6 A.M - 8 A.M. Tuesday 6 A.M - 8 A.M. Wednesday 6 A.M - 8 A.M. Thursday 6 A.M - 8 A.M. Friday 6 A.M - 8 A.M. Saturday 6 A.M - 8 A.M. Sunday 8 A.M. - 12 P.M. 8 A.M. - 12 P.M. Monday 8 A.M. - 12 P.M. Tuesday 8 A.M. - 12 P.M. Wednesday 8 A.M. - 12 P.M. Thursday 8 A.M. - 12 P.M. Friday 8 A.M. - 12 P.M. Saturday 8 A.M. - 12 P.M. Sunday 12 P.M. - 3 P.M. 12 P.M. - 3 P.M. Monday 12 P.M. - 3 P.M. Tuesday 12 P.M. - 3 P.M. Wednesday 12 P.M. - 3 P.M. Thursday 12 P.M. - 3 P.M. Friday 12 P.M. - 3 P.M. Saturday 12 P.M. - 3 P.M. Sunday 3 P.M - 6 P.M. 3 P.M - 6 P.M. Monday 3 P.M - 6 P.M. Tuesday 3 P.M - 6 P.M. Wednesday 3 P.M - 6 P.M. Thursday 3 P.M - 6 P.M. Friday 3 P.M - 6 P.M. Saturday 3 P.M - 6 P.M. Sunday 6 P.M. - 9 P.M. 6 P.M. - 9 P.M. Monday 6 P.M. - 9 P.M. Tuesday 6 P.M. - 9 P.M. Wednesday 6 P.M. - 9 P.M. Thursday 6 P.M. - 9 P.M. Friday 6 P.M. - 9 P.M. Saturday 6 P.M. - 9 P.M. Sunday 9 P.M. - 12 A.M. 9 P.M. - 12 A.M. Monday 9 P.M. - 12 A.M. Tuesday 9 P.M. - 12 A.M. Wednesday 9 P.M. - 12 A.M. Thursday 9 P.M. - 12 A.M. Friday 9 P.M. - 12 A.M. Saturday 9 P.M. - 12 A.M. Sunday Other (please specify) Question Title * 26. In the last six months, have any household members missed any of the following due to a lack of transportation? Please check all that apply. Work Medical appointments Shopping Family / friend visits Entertainment Social service Education Religious Not Applicable Other (please specify) Question Title * 27. What government services do you participate in? (Check all that apply) Medicaid (Medical Assistance) Medicare Supplemental Nutritional Assistance Program (SNAP) Area Agency on Aging (AAA) Housing Assistance (HUD) Temporary Assistance for Needy Families (TANF) Childcare Subsidy (CCIS) Veterans Affairs (VA) Head Start CareerLink or other employment program None Other (please specify) Question Title * 28. Which of the following would be the best way to inform you about transportation services in your community? Check all that apply. Direct mailings to your home Newspaper Radio Television Websites Social media Inserts with your municipal bills Not interested Other (please specify) Question Title * 29. What are some of your suggestions to improve transportation services? Question Title * 30. 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