Camden County Health and Well-being Assessment

The Camden County Department of Health and Human Services (CCDHHS)is sponsoring the "Health and Well-being Superstorm Sandy Assessment Survey",to assess the impact of Superstorm Sandy on your health and well-being and to assure that if impacted, that you are connected to needed resources.

All your responses are confidential as your name will not appear with your answers.

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* 1. In what town/municipality do you live?

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* 2. How old are you?

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* 3. Are you male or female?

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* 4. How would you refer to yourself?

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* 5. What is your primary language?

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* 6. What is your current living arrangement?

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* 7. How many people live in your household, including yourself?

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* 8. Were you personally affected by Superstorm Sandy?

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* 9. If YES, how were you affected? (Mark all that apply)

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* 10. *If you did lose power, for how long? (please specify)

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* 11. Did you have any loss of income due to the storm?

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* 12. If YES, was loss of income:

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* 13. As a result of Superstorm Sandy, did you need service provider assistance, such as a visiting nurse, meal delivery, or other home-based care service?

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* 14. If yes, is this service still provided to you?

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* 15. Were you displaced from your home due to Superstorm Sandy?

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* 16. If you were displaced, where did you go?

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* 17. If yes, are you still displaced?

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* 18. Are you aware of the following types of resources?

  Yes No
Case management
Counseling services
Federal Emergency Management Agency (FEMA)
NJ Hope and Healing
NJ 211
NJ Register Ready
Sandy Homeowner and Renter Assistance Program (SHRAP)
United Way/Red Cross/Charity
Other NJ State Programs*
Other Resources*

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* 19. Are you still in need of this type of resource(s)? (Please mark all that apply)

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* 20. What would you say your health was, in general, before and after Superstorm Sandy?

  Very good Good Neither good nor poor Fair Very poor
Before Superstorm Sandy
After Superstorm Sandy

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* 21. As a result of Superstorm Sandy, what are the top five (5) concerns with your health and overall well-being? (Please mark all that apply.)

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* 22. As a result of Superstorm Sandy, have you experienced any of the following: (Please mark all that apply)

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* 23. As a result of Superstorm Sandy, what types of services do you still need? (Please mark all that apply.)

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* 24. What best describes how you are recovering from Superstorm Sandy?

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* 25. Do you have any special conditions that are preventing you from recovering?

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If you feel that you still need assistance because of how you were impacted by Superstorm Sandy, please contact:
UOSS: First Call For Help: "Your Link to Community Services"
(856) 663.2255 or 1.800 .331.7272

If you have any questions regarding the survey, please contact:
Camden County Department of Health and Human Services
Lynn Rosner, M.Ed.
Tel: 856.374.6363
Email: lrosner@camdencounty.com

THANK YOU FOR YOUR TIME AND PARTICIPATION!

If you feel that you still need assistance because of how you were impacted by Superstorm Sandy, please contact:<br>UOSS: First Call For Help: &quot;Your Link to Community Services&quot;<br>(856) 663.2255 or 1.800 .331.7272<br><br>If you have any questions regarding the survey, please contact: <br>Camden County Department of Health and Human Services<br>Lynn Rosner, M.Ed.<br>Tel: 856.374.6363<br>Email: lrosner@camdencounty.com <br><br>THANK YOU FOR YOUR TIME AND PARTICIPATION!<br>

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