RESIDENTIAL NEEDS SURVEY

The Arizona Department of Housing has received a federal grant that will provide monthly rental assistance for persons with development disabilities who are Arizona Long Term Care (ALTCS) eligible or households that include a person or persons with developmental disabilities who are ALTCS eligible. The rent paid for certain apartment units will only equal 30 percent of a household's income. Assistance will be available at certain apartment complexes that are yet to be developed. The purpose of this survey is to gather information from persons interested in living in one of these apartment complexes. Our goal is to design the right type of housing in the right locations which will be the most in demand. 
 
Your answers to the following questions will help us build the right model! 

If you need assistance to complete this survey . . .
If you need accommodations in order to complete the survey due to language, sensory, mobility, or any impairment, please contact the Arizona Department of Housing (ADOH) at (602) 771-1000 or (602) 771-1001 TTY accessible. Si necesita ayuda en español para entender este documento, puede solicitar, sin costo adicional, llamando al (602) 771-1010.  A prior notification (preferably 48-hour) will enable us to make arrangements to assist you in completing the survey. The ADOH does not discriminate on the basis of disability in the admission, access, treatment, or employment in any programs or activities. ADOH’s Fair Housing Specialist, who may be reached at the telephone numbers above, has been designated to coordinate Limited English Proficiency and compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s Section 504 (24 CFR, part 8 dated June 2, 1988).  Equal Housing Opportunity.

This survey may be completed on-line or in paper format, but respondents should only complete one survey. The web link to complete this survey on-line is here: www.surveymonkey.com/r/AZHOUSING  
 
Deadline to complete this survey: August 21, 2015
If you have any questions about this survey, please call 1-866-229-5553

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* 1. What is your current living arrangement? Check all that apply.

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* 2. Who do you want to live with in an apartment? Check all that apply.

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* 3. If you said you would like to live with a relative or relatives in the apartment, tell us who they are. Check all that apply.

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* 4. If you lived with a relative or relatives, how many people would live in your apartment in total, counting yourself?

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* 5. If you will be living in your apartment with other people, what would be the combined annual income of all persons living with you (including your income)? Or, if you said you would live alone, what is your annual income?

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* 6. Where do you currently live?

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* 7. Where would you most like to live? Check all that apply.

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* 8. If you would like to live in Maricopa County, let us know where. Check all that apply.

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* 9. If you would like to live in Pima County, tell us where. Check all that apply.

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* 10. What type of features and/or services would you like to have available at the apartment complex? Check all that apply.

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* 11. What accessibility features do you require? Check all that apply.

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* 12. If you depend on or would like to take public transportation, what type?

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* 13. How much advance  notice would you need before moving to a new apartment?

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* 14. How likely are you to apply to live in such an apartment unit?

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* 15. Is there anything you would like to tell us about yourself and your housing needs?

Thank you for taking the time to complete this survey.
Responses to this survey are confidential. Any information you provide is completely voluntary.
Please note that it is not necessary to provide your name or other identifying information when responding to this survey.

The Arizona Department of Housing anticipates that apartment units available through this program will become available starting in 2017. Once available, participation information will be made available through the Arizona Department of Housing and Arizona Department of Economic Security websites.

If you are completing a paper copy of this survey, the survey should be returned no later than August 21, 2015 to:
Arizona Department of Housing
1110 W. Washington, Suite 310
Phoenix, AZ  85007
Fax: (602) 771-1002
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