ID Action 2010 Registrant Survey 1. 2010 ID Action Registrant Survey The DD Council and its projects, including ID Action, advocates for the development of services and supports so that Iowans with developmental disabilities can make choices and take control of their lives. We want to hear from you about the needs and issues facing Iowans with disabilities. Thank you for your participation! Question Title * 1. I am: A parent, guardian or caregiver who is answering for a person with a disability who is less than 18 years of age. 18 to 24 years 25 to 49 years 50 to 64 years 65 or older Question Title * 2. I am an Iowan with one or more of the following (check all that apply): I am an Iowan who is blind or visually impaired. I am an Iowan who is deaf or hard of hearing. I am an Iowan with an intellectual disability. I am an Iowan with a physical disability. I am an Iowan with a mental illness. I am an Iowan who has a personal care attendant. I am an Iowan who receives Medicaid. I am an Iowan who receives Medicare. I am an Iowan who receives Social Security. I am currently employed. I am currently unemployed. I do not have a disability, but my spouse, child or other family member for which I am responsible does have a disability. I do not have a disability. Question Title * 3. I live: I live in a rural area. I live near a city or town. Question Title * 4. I live in the following county: Question Title * 5. I get my information and news from (check all that apply): TV Radio Newspaper Internet Telephone Mail Text Messaging TTY Relay Iowa Family Members and Friends Social media such as Facebook, My Space, Twitter, You Tube, etc. The following questions ask for your opinion on what the most important needs are for Iowans with Disabilities in specific areas. Question Title * 6. In your opinion, what are the most important needs related to ACCESSIBILITY in Iowa?(ACCESSIBILITY: The physical access to buildings/services and accessible paths of travel. This includes accessible voting machines and voting locations.) Question Title * 7. In your opinion, what are the most important needs related to COMMUNICATIONS in Iowa?(COMMUNICATIONS: Website accessibility, various forms, technology and people first language.) Question Title * 8. In your opinion, what are the most important needs related to EDUCATION in Iowa? (EDUCATION: Accessible education technologies, reasonable accommodations, student rights.) Question Title * 9. In your opinion, what are the most important needs to EMERGENCY MANAGEMENT in Iowa?(EMERGENCY MANAGEMENT: Emergency management planning for Iowans with disabilities for natural, man-made, or disease-related disasters.) Question Title * 10. In your opinion, what are the most important needs related to HEALTH in Iowa?(HEALTH: Access to health insurance, Medicaid and Medicare, long-term health care and mental health.) Question Title * 11. In your opinion, what are the most important needs related to HOUSING in Iowa?(HOUSING: Affordable housing, housing discrimination, home modification, tax exemptions, financial assistance.) Question Title * 12. In your opinion, what are the most important needs related to RECREATION and THE ARTS in Iowa?(RECREATION AND THE ARTS: Availability of services and facilities for recreational purposes, physical access to entertainment venues.) Question Title * 13. In your opinion, what are the most important needs related to TRANSPORTATION in Iowa?(TRANSPORTATION: Accessible parking and transportation.) Question Title * 14. In your opinion, what are the most important needs related to EMPLOYMENT in Iowa?(EMPLOYMENT: Equal opportunity, reasonable accommodations, prohibition of discrimination.) Question Title * 15. If you would like to be included in a drawing for a $50 gift card, please provide your name and phone number. Name: Phone Number: Done