Needs Assessment Survey 2024

Welcome!

Complete a 10-minute survey, and be entered into a
Drawing to Win a Visa Gift Card!

Thank you for taking the time to complete this survey for the Carbon County Action Committee for Human Services. Your needs and opinions are important to us. If you have any questions about the survey, please contact us at info@ccachs.com or call 610-377-6400 (extension 227).

Upon the completion of this survey, you must provide your contact information in order to be entered in our drawing for a Visa gift card. One entry per household; 3 winners will be randomly selected to win a $25 Visa gift card. Survey responses will be accepted until 9/30/24. The drawing will be held on 10/8/24, and winners will be contacted and posted to our website.

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* 1. In what Carbon County city or town do you live?

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* 2. What is your gender?

Female

Male

Other (please specify)

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* 3. In which age group do you belong?

18-24

25-44

45-54

55-59

60-64

65-74

75+

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* 4. What is your race?

Black or African American

White

Asian

Native American or Native Alaskan

Native Hawaiian or Pacific Islander

Multi-Race

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* 5. Ethnicity?

Hispanic/Latino or Spanish Origins

Non-Hispanic/Latino or Spanish Origins

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* 6. What is the highest level of education you have completed?

No High School Diploma

High School Diploma or GED

Vocational or Technical School

Some College

Associates Degree

Bachelors Degree or higher

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* 7. What are your sources of income? (check all that apply)

Wages

TANF (Cash assistance)

Social Security Benefits

Social Security Disability

Supplemental Security Income (SSI)

Child Support

Unemployment

Worker’s Compensation

Veterans Assistance

Pension

No Income

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* 8. How many people are living in your household including all adults, children and yourself?

Adults

Children

Total people residing in your household

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* 9. How many members of your household:

Receive Social Security Disability Benefits

Are Veterans

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* 10. What is the total combined gross household income (before taxes) for all the members in your household?

$0 to $22,590

$22,591 to $30,660

$30,661 to $38,730

$38,731 to $46,800

$46,801 to $54,870

$54,871 to $62,940

$62,941 to $71,010

$71,011 to $79,080

$79,081 to $87,150

$87,151 to $95,220

More than $95,200

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* 11. How many employed adults reside in your household?

Number of Adults Employed Part-Time

Number of Adults Employed Full-Time

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* 12. What is your current housing arrangement?

Homeowner

Renter (Subsidized/Section 8 Housing)

Renter (No Subsidy)

Doubled-Up w/ family or friends

Temporary Homeless Shelter

Homeless

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* 13. Do you currently have health insurance?

Yes, I do

No, I do not

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* 14. How do you find out about community services available to you and your family? (Please select no more than three sources from the list below.)

Newspaper

Internet

Social Media

State Agency

Television

Posters/Flyers

Word of Mouth

Radio

Other (please specify)

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* 15. Please tell us what prevents you or members of your family from receiving needed human/social services? (Please select all that apply.)

Can’t afford fees or costs

Not eligible/do not qualify for assistance

No transportation/too far to travel

Not aware of services in County

Services available during limited hours

Lack of language interpretation services

Other (please specify)