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* 1. Organization Information:
- Organization Name
- Name of primary person filling out the survey
- Phone number of primary person filling out the survey
- Zip code of organization's primary/main office
- Date

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* 2. Please indicate the OPWDD/DOH area(s) of the state in which your organization provides services. (Mark all that apply.)

  Region I (Counties Served: Bronx, Kings, New York, Queens and Richmond. Nassau, Suffolk and Westchester) Region II (Counties Served: Dutchess, Orange, Putnam, Rockland, Sullivan and Ulster). Region III (Counties Served: Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington. Region IV (Counties Served: Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins, Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.
OPWDD/DOH area(s)

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* 3. How many total people with developmental disabilities does your organization currently serve in NY?

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* 4. How many paid employees (part-time and full-time) were employed in your organization as of May 31, 2015? (Provide a number. We are looking for a head count, NOT full-time equivalency FTE). Number of Direct Support Professionals (include on-call, temporary, and relief and all employees in CFR Code 100 and 200).

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* 5. A. Please indicate the current lowest starting wage for your Direct Support Professionals CFR Code 201. Please indicate wages in dollars paid per hour.
B. Please indicate the current average wage for your Direct Support Professionals CFR Code 201. Please indicate wages in dollars paid per hour

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* 6. Which of the following are the biggest challenges for your organization with regard to recruitment and retention? Please mark the top four.

  Finding qualified DSPs to hire New hires quitting during the first 6 months Co-workers who do not get along DSPs who are dissatisfied with supervisors Morale problems Training does not produce desired results Not enough training opportunities Supervisors who are not well prepared for the supervising role Unstable staffing patterns, scheduling issues DSP wages and benefits are not attractive Turnover of DSPs Turnover of Frontline Supervisors Staff conflict due to cultural differences
Top Four Challenges

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* 7. Counting all shifts and sites, but excluding on-call/temp or relief employees, how many direct support professionals and employees in the CFR Code 100 and 200 left your organization for any reason (voluntarily OR involuntarily) during the last year (CFR Year 2014 or 2013-14)?

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* 8. Of all the direct support professionals and employees in the CFR Code 100 and 200 who left your organization during time the last year (CFR Year 2014 or 2013-14) how many of them had worked for your organization for 6 months or less before they left?

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* 9. Please indicate the degree to which retention/turnover of direct support professionals is currently a problem for your organization:

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* 10. How many direct support professionals would you have to hire today to fill all funded but vacant positions? (Include both full and part time positions.)

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* 11. A. How many hours of overtime were paid out in last 30 days to direct support professionals and employees in CFR Code 100 and 200? B. How many DSPs/Employees worked those overtime hours? C. How many hours did DSPs/Employees work in the 30 day period?

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* 12. How many hours of overtime were paid out in the last CFR year (2014 or 2013-14) to direct support professionals and employees in CFR Code 100 and 200:

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* 13. How many dollars of overtime were paid out in the last CFR year (2014 or 2013-14) to direct support professionals and employees in CFR Code 100 and 200:

T