The Northeast Flood-Affected Region, through Carlton County Public Health & Human Services, has received a grant from the State of Minnesota - Minnesota Recovers Task Force to make sure that the long-term recovery needs of residents in Carlton, Aitkin, Pine, and St. Louis Counties who were affected by the flooding in June 2012 are taken care of. Please help us by answering these questions about the ways that you might have been affected. Included are questions about your home, your possessions, your yard, stress, your finances and your health. Thank you.

1. Who will you be answering for?

2. Do you have friends and/or family affected by the June 2012 floods?

3. Did you have to move because of damage caused by the June 2012 floods?

Living Space and Structure:

4. Was your living space or building structure damaged in the June 2012 floods? (Include damage to key systems including electrical, heating, and water).

5. Is part of your home/apartment that you use as living space, or its structure still not repaired or returned to pre-flood conditions?

6. Did the flood destroy or damage your possessions?

Other Indoor Space:

7. Is part of your home/apartment that you don't use as a living space (storage or utility space) still not repaired or returned to pre-flood conditions?

The Rest of Your Home and Yard:

8. What is the condition of your outside space? (Yard or common outside space at an apartment building).

Moisture and/or Mold:

9. Is moisture and/or mold more of a problem in your home due to the June 2012 floods? (check all that apply).

Stress and Emotional Health:

10. Have you felt stress because of the June 2012 floods?

11. Do you have any emotional health concerns caused or made worse by the June 2012 floods?

Since the June 2012 Floods, Have You Noticed a Change in:

12. Concentration

13. Feeling nervous and/or anxious

14. Sleeping habits

15. Frustrated and/or angry

16. Since the June 2012 floods, have you seen relatives and/or friends:

17. Since the June 2012 floods, how much are you able to get exercise?

Physical Stress:

18. Since the June 2012 floods, how is your physical health? (back pain, shoulders, heart, etc.).

Finances:

19. How did the June 2012 floods affect your debts and the amounts you owe to others?

Savings and Retirement:

20. Due to the June 2012 floods did you have to spend money from your savings and/or retirement?

Assistance:

21. Did you receive financial assistance from federal, state, local government, private, or non-profit agencies to help recover from the June 2012 floods?

22. If you received assistance, what kind was it? (Check all that apply).

Services:

23. Did you receive any services to help make repairs to your home in additional to financial assistance? What kind? (Check all that apply).

24. Did you receive any stress management services?

25. If yes, what kind? (Check all that apply).

Finally, please answer some demographic questions to help us understand future needs across the region:

26. What is your housing status now?

27. Which county do you live in?

28. What is your gender?

29. Are you a veteran?

30. How old are you?

31. How many people are in your household? (Including yourself).

32. How many people are in your household who are under the age of 18?

33. There are two reasons you might want us to contact you.

Please include contact information if you would like us to contact you about your current situation and/or talk about your needs. (Please include name, phone number and/or email address, and the best time to contact you).

34. The other reason:

Please include your contact information here if you'd like to share your story of rebuilding after the June 2012 floods. (Please include name, phone number and/or email address, and the best time to contact you).

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