Part 1: Agency Characteristics

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* 1. Agency Name

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* 2. Does this agency directly operate transportation?

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* 3. Does this agency purchase transportation from another agency?

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* 4. What type of legal authority does this agency have?

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* 5. How many annual one-way passenger trips does this agency provide?

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* 6. What is the average number of trip denials per week for this agency?

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* 7. Are vehicles only available for human service agency clients? 

*Please note: Answering “Yes” indicates that your agency is closed door. Your agency is considered closed door if you ONLY provide transportation to your facility as a courtesy or if you ONLY serve a particular clientele that are enrolled in your agency programs (i.e. members of a sheltered workshop, or residents in a nursing home). Answering “No” indicates that your agency is open door. This means the service is open to the public or a segment of the general public defined by age, disability, or low income. For example, if an agency provides general transportation for anyone in the community who is over the age of 60, they are considered “open door”. For example, an individual who is 60 or over can request transportation to a doctor’s appointment or the grocery store regardless of their affiliation with your agency.

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