Thank you for being willing to participate in our In-Home Supportive Services (IHSS) consumer and provider survey! This survey will help guide our organizing efforts as we work collectively to organize for positive change within the IHSS program statewide.

Your personal and contact information is optional, but we encourage everyone to share your information.

If you need help filling out this this survey, email Disabilityorganizing@cfilc.org with "IHSS Survey Help" in the title. 

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* 1. Name

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* 2. Email

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* 3. Phone Number

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* 4. Zip Code

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* 5. Your Gender Pronouns

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* 6. Choose one Ethnic Identity

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* 7. Choose one or more Racial Identities (regardless of ethnicity)

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* 8. I am an IHSS:

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* 9. I receive IHSS support from: (check all that apply)

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* 10. I look for providers via the IHSS provider registry and am successful:

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* 11. Where do you look for providers?

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* 12. I have tried to access the backup IHSS provider system in my county:

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* 13. Please explain your response here:

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* 14. I have needed backup providers since the beginning of the COVID-19 pandemic:

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* 15. What do you see as being the top issues/challenges facing IHSS consumers? (Rank from 1 to 6, with 1 being the most important and 7 being the least important.)

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* 16. If you checked other, please list the issue here:

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* 17. Please rank (from 1-12 with 1 being your highest priority and 12 being the lowest) the improvements to IHSS you think are most needed or most important:

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* 18. Are there any other solutions or improvements you’d like to see that are not listed above?  (Another way to think of this: If you could wave a magic wand and make one or two improvements to the IHSS, what would those be?)

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* 19. Also, what services/supports do you think need to be covered by IHSS that currently are not?

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* 20. Can we follow up with you later? (If so, please complete your contact info above!)

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* 21. What sort of support or accommodations would you need to participate? (For example: American Sign Language interpretation, Closed Captioning, Revoicing, Language Interpretation, documents in accessible formats, or any other access needs)

Thank you for completing our survey!

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