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* 1. How would you rate your community as a place for people to live as they age? (This would be the geographical location where your home is located. A community can be located within a city, town, county or tribal nation.)

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* 2. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 74037)

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* 3. How long have you lived in this community?

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* 4. How important is it for you to remain in your community as you age?

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* 5. Thinking about your retirement years when you do not work at all for pay, how likely is it that you will move to a different home in your community?

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* 6. Thinking about your retirement years when you do not work at all for pay, how likely is it that you will move to a different home outside of your community?

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* 7. If you were to consider moving out of your community during your retirement when you do not work at all, would the following factors impact your decision to move?

  Yes No Not sure
Looking for a different home size that meets your needs
Maintaining your current home will be too expensive
Fearing for your personal safety or security concerns
Looking for a home that will help you live independently as you age
Wanting to move to an area that has better health care facilities
Wanting to be closer to family and/or friends
Needing more access to public transportation
Wanting to live in a different climate
Looking for an area that has a lower cost of living

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* 8. Do you own or rent your primary home — or do you have some other type of living arrangement, such as living with a family member or friend?

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* 9. What type of home is your primary home?

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* 10. How important is it for you to be able to live independently in your own home as you age?

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* 11. People sometimes make modifications to their home so they can stay there as they age. Do you think you will need to make the following types of modifications or improvements to your home to enable you to stay there as you age?

  Yes No Not sure
Easier access into or within your home such as a ramp, chairlift or elevator, or wider doorways
Bathroom modifications such as grab bars, handrails, a higher toilet or non-slip tiles
Putting a bedroom, bathroom and kitchen on the first floor
Improving lighting
Installing a medical emergency response system that notifies others in case of emergency
Installing lever-style handles on doors and cabinets for ease in opening 
Installing light switches and outlets in an accessible location that can easily reached from a seated position

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* 12. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Affordable housing options for adults of varying income levels such as older active adult communities, assisted living and communities with shared facilities and outdoor spaces
Homes that are equipped with features such as a no-step entry, wider doorways, first floor bedroom and bath, grab bars in bathrooms
Well-maintained and safe low-income housing

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* 13. Does the community where you live have the following?

  Yes No Not sure
Affordable housing options for adults of varying income levels, such as older active adult communities, assisted living and communities with shared facilities and outdoor spaces
Homes that are equipped with features such as a no-step entry, wider doorways, first floor bedroom and bath, grab bars in bathrooms
Well-maintained and safe low-income housing

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* 14. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Well-maintained and safe parks that are within walking distance of your home
Public parks with enough benches
Sidewalks that are in good condition, free from obstruction and are safe for pedestrian use and accessible for wheelchairs or other assistive mobility devices
Well-maintained public buildings and facilities that are accessible to people of different physical abilities
Separate pathways for bicyclists and pedestrians
Well-maintained public restrooms that are accessible to people of different physical abilities
Neighborhood watch programs

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* 15. Does the community where you live have the following?

  Yes No Not sure
Well-maintained and safe parks that are within walking distance of your home
Public parks with enough benches
Sidewalks that are in good condition, free from obstruction and are safe for pedestrian use and accessible for wheelchairs or other assistive mobility devices
Well-maintained public buildings and facilities that are accessible to people of different physical abilities
Separate pathways for bicyclists and pedestrians
Well-maintained public restrooms that are accessible to people of different physical abilities
Neighborhood watch programs

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* 16. Do you get around for things like shopping, visiting the doctor, running errands or going to other places in the following ways?

  Yes No
Drive yourself
Have others drive you
Walk
Ride a bike
Use public transportation
Take a taxi/cab (excluding Uber or Lyft)
Take an Uber or Lyft
Use a special transportation service, such as one for seniors or persons with disabilities

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* 17. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Accessible and convenient public transportation
Affordable public transportation
Well-maintained public transportation vehicles
Reliable public transportation
Safe public transportation stops or areas
Special transportation services for people with disabilities and older adults
Well-maintained streets
Easy to read traffic signs
Enforced speed limits
Public parking lots, spaces and areas to park
Affordable public parking
Well-lit, safe streets and intersections for all users (pedestrians, bicyclists, drivers)
Audio/visual pedestrian crossings
Driver education/refresher courses

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* 18. Does the community where you live have the following?

  Yes No Not sure
Accessible and convenient public transportation
Affordable public transportation
Well-maintained public transportation vehicles
Reliable public transportation
Safe public transportation stops or areas
Special transportation services for people with disabilities and older adults
Well-maintained streets
Easy to read traffic signs
Enforced speed limits
Public parking lots, spaces and areas to park
Affordable public parking
Well-lit, safe streets and intersections for all users (pedestrians, bicyclists, drivers)
Audio/visual pedestrian crossings
Driver education/refresher courses

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* 19. In general, when compared to most people your age, how would you rate your health?

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* 20. How important is it to you to remain physically active for as long as possible?

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* 21. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Health and wellness programs and classes in areas such as nutrition, smoking cessation and weight control
Fitness activities specifically geared to older adults
Conveniently located health and social services
A service that helps seniors find and access health and supportive services
Conveniently located emergency care centers
Easy to find information on local health and supportive services
Home care services including health, personal care and housekeeping
Well-trained certified home health care providers
Affordable home health care providers
Well-maintained hospitals and health care facilities
A variety of health care professionals including specialists
Health care professionals who speak different languages
Easily understandable and helpful local hospital or clinic answering services
Respectful and helpful hospital and clinic staff

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* 22. Does the community where you live have the following?

  Yes No Not sure
Health and wellness programs and classes in areas such as nutrition, smoking cessation and weight control
Fitness activities specifically geared to older adults
Conveniently located health and social services
A service that helps seniors find and access health and supportive services
Conveniently located emergency care centers
Easy to find information on local health and supportive services
Home care services including health, personal care and housekeeping
Well-trained certified home health care providers
Affordable home health care providers
Well-maintained hospitals and health care facilities
A variety of healthcare professionals including specialists
Health care professionals who speak different languages
Easily understandable and helpful local hospital or clinic answering services
Respectful and helpful hospital and clinic staff

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* 23. About how frequently do you interact with your friends, family or neighbors in your community? This interaction could be by telephone or in person.

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* 24. About how frequently do you interact with your friends, family or neighbors in your community through email, text or social media (such as Facebook.)

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* 25. Where do you typically go for continuing education or self-improvement classes/workshops in your community? [CHECK ALL THAT APPLY]

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* 26. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Conveniently located venues for entertainment
Activities specifically geared to older adults
Activities that offer senior discounts
Activities that are affordable to all residents
Activities involving young and older people
Accurate and widely publicized information about social activities
A variety of cultural activities for diverse populations
Local schools that involve older adults in events and activities
Continuing education classes
Social clubs such as for books, gardening, crafts or hobbies

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* 27. Does the community where you live have the following?

  Yes No Not sure
Conveniently located venues for entertainment
Activities specifically geared to older adults
Activities that offer senior discounts
Activities that are affordable to all residents
Activities that involve both younger and older people
Accurate and widely publicized information about social activities
A variety of cultural activities for diverse populations
Local schools that involve older adults in events and activities
Continuing education classes
Social clubs such as for books, gardening, crafts or hobbies

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* 28. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
A range of volunteer activities to choose from
Volunteer training opportunities to help people perform better in their volunteer roles
Opportunities for older adults to participate in decision making bodies such as community councils or committees
Easy to find information about local volunteer opportunities
Transportation to and from volunteer activities for those who need it

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* 29. Does the community where you live have the following?

  Yes No Not sure
A range of volunteer activities to choose from
Volunteer training opportunities to help people perform better in their volunteer roles
Opportunities for older adults to participate in decision making bodies such as community councils or committees
Easy to find information about local volunteer opportunities
Transportation to and from volunteer activities for those who need it

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* 30. Which of the following best describes your current employment status?

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* 31. If you are employed, how likely is it that you will continue to work for as long as possible, rather than choosing to retire and no longer work for pay? 

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* 32. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
A range of flexible job opportunities for older adults
Job training opportunities for older adults who want to learn new job skills within their job or get training in a different field of work
Jobs that are adapted to meet the needs of people with disabilities

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* 33. Does the community where you live have the following?

  Yes No Not sure
A range of flexible job opportunities for older adults
Job training opportunities for older adults who want to learn new job skills within their job or get training in a different field of work
Jobs that are adapted to meet the needs of people with disabilities

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* 34. Would you turn to the following resources if you, a family member or friend needed information about services for older adults, such as caregiving services, home-delivered meals, home repair, medical transport or social activities?

  Yes No
Local senior centers
Local Area Agency on Aging (AAA)
Family or friends
Local nonprofit organizations
AARP
Faith-based organizations such as churches or synagogues
Internet
Phone book
Your doctor or other health care professional
Local government offices such as the Department of Health
Library

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* 35. How important do you think it is to have the following in your community?

  Extremely important Very important Somewhat important Not very important Not at all important
Access to community information in one central source
Clearly displayed printed community information with large lettering
An automated community information source that is easy to understand like a toll-free telephone number
Free access to computers and the Internet in public places such as the library, senior centers or government buildings
Community information that is delivered in person to people who may have difficulty or may not be able to leave their home
Community information that is available in a number of different languages

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* 36. Does the community where you live have the following?

  Yes No Not sure
Access to community information in one central source
Clearly displayed printed community information with large lettering
An automated community information source that is easy to understand like a toll-free telephone number
Free access to computers and the Internet in public places such as the library, senior centers or government buildings