1. If you are currently employed, list all employer(s).

2. How long have you worked with your current employer?

3. Do you feel as though it is important for companies to offer supplemental disability pay to employees who are unable to work due to a medical condition

4. Does your current employer offer supplemental disability pay to employees who are disabled from work due to a medical condition? Ex: short term disability. If more than one employer, do one/both offer supplemental pay?

5. If answered yes to question 4, are all employees eligible to receive this benefit starting date of hire?

6. If there are requirement to qualify for disability pay select all that apply

7. If your employer offers short/long term disability does your employer administer those benefits or an outsourcing client/company?

8. Have you ever been on a medical leave of absence? (Do not feel obligated to reveal and personal information)

9. If you answered yes to question 8, was the handling of your claim a good and/or simple process? Or were you unhappy with your experience?

10. If you have been on any medical leaves of absences, what were the duration of the leave(s)?