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COVID-19 Community Needs Assessment Survey
COVID-19 Community Needs Assessment Survey
1.
What county do you live in?
Steuben
Yates
Schuyler
Chemung
Other (please specify)
2.
What is the current work status of all household members who were employed prior to the COVID-19 pandemic? Check all that apply.
An essential worker, no changes
Returned to work Phase 1
Returned to work Phase 2
Working from home/remotely/virtually
Reduced hours
Unemployed/Laid off
Retired
N/A
3.
For any adult in the household whose workplace is still closed OR still on lay off/furlough because of COVID-19, are they expected to return to work by July 31, 2020?
Yes
No
Unsure
4.
If your household had a loss of income since March 13th, what was the reason(s)? Select all that apply.
Workplace closed temporarily because of stay-at-home orders
Workplace went out of business/closed permanently because of COVID-19 pandemic
Laid off due to COVID-19 pandemic
Work hours and/or salary was reduced due to COVID-19
Cannot work because I am sick with COVID-19 or caring for someone with COVID-19 or on ordered quarantine
Cannot work because I have to care for children not in school or day care because of COVID-19 related closures
Cannot get to my job because of public transportation shutdowns/limited schedules
Providing financial help to someone else
Other
5.
What, if any of these actions have you taken to make sure you have enough money on hand for basic needs?
Reduced food spending
Stop saving for retirement
Use a credit card instead of cash/debit card to pay for everyday household expenses
Borrowed money from a friend/family member
Skipped/stopped paying bills (e.g. rent/mortgage, utilities, credit card, car, insurance)
Stopped paying child support or alimony/spousal maintenance
Cut back on recreational expenses
Took on additional work
Took out a loan
None
6.
How confident are you that your household will be able to afford the kinds of food you need for the next four weeks?
Very confident
Somewhat confident
Moderately confident
Not at all confident
7.
If you did not have enough to food eat or not the kind of food you wanted to eat since COVID-19, why? Choose all that apply.
Could not afford to by more food
Couldn’t get out to buy food (e.g. didn’t have transportation, or mobility or health problems that prevented you from getting out)
Afraid to go or did not want to out to buy food
Could not get groceries or meals delivered to me
The stores did not have the food I wanted
Not applicable
8.
Since COVID-19, my household accessed the following resources to meet our food/nutritional needs?
WIC
SNAP/Food Stamps
School-based free/reduced lunch or other programs aimed at children
Community meal program or soup kitchen
Senior Home Delivered Meals
Food Pantries
Drive Through or Mobile Food Distributions
Other community program
Family, friends, neighbors
None
9.
What is your housing situation?
Own, no payments
Own, pay mortgage or loan (including home equity loan)
Rent-to-own
Rent
Homeless
Other
10.
HOMEOWNERS - Check all that apply
My mortgage is paid up to date
My mortgage payment is past due
My mortgage payment is deferred/waived
My school or property taxes are paid in full or in escrow
My school or property taxed are past due/delinquent
My mortgage is currently in forbearance
11.
RENTERS - Check all that apply
My rent is paid up to date
My rent payment is past due
My rent payment was deferred/waived
I am at risk of eviction for nonpayment of rent after August 31,2020
12.
How confident are you that your household will be able to pay your next rent or mortgage payment on time?
No confidence
Slight confidence
Moderate confidence
High confidence
Payment is/will be deferred
13.
UTILITIES - Check any and all utility bills that are past due.
Heat
Electric
Cable
Internet
Phone- landline
Phone- Cellular/Mobile
14.
How far past due are your utilitities?
30 Days
60 Days
90 Days
15.
How confident are you that your household will be able to pay all your utility bills on time next month?
No confidence
slight confidence
Moderate confidence
High confidence
16.
Does each member or your household that is either schooling ,working from home, or job searching have their own computer, laptop or chrome book?
Yes
No
17.
How reliable is your household internet connection?
Always reliable
Usually reliable
Sometimes reliable
Rarely reliable
Never reliable
18.
What type of internet connection does your household have?
Broadband (e.g. Spectrum, Empire )
DSL (e.g. Verizon)
Satellite
Cellular Data/ Mobile Wireless
Dial -Up
Do not have home internet connection
19.
Are there any other needs you, your families or your neighbors are experiencing?
Current Progress,
0 of 19 answered
