Transportation Needs Assessment - Agency Survey Question Title * 1. Your Organization Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. Please indicate the type(s) of service(s) your organization provides. (Check all that apply.) Senior services Medical service Disability services Employment services Counseling Food and/or clothing Client transportation Government services Housing Education Recreation/fitness Legal services Economic development Community development Religious Other (please specify) Question Title * 3. What county or counties does your organization serve? (Check all that apply.) Hardin Marshall Poweshiek Tama Question Title * 4. Does your organization provide client transportation in any of the following ways? (Check all that apply.) We do not provide transportation. We contract with transportation provider to serve clients. Our staff provides client transportation. Volunteers provide client transportation. We purchase or subsidize fares or passes for clients with local transportation providers. We operate our own transportation vehicles directly. Other (please specify) Question Title * 5. If you operate your own transportation vehicles directly, please list the number of vehicles by type. N/A Van non ADA accessible Van ADA accessible Bus non ADA accessible Bus ADA accessible Automobiles Question Title * 6. If you purchase or subsidize fares or passes for clients with local transportation providers, please indicate which provider(s): Question Title * 7. Who are your principle clients (list): Question Title * 8. What are your operational hours? Question Title * 9. What days of the week do you operate? Question Title * 10. What is your priority call system (e.g., scheduled appointments, disabled, elderly, general public)? Question Title * 11. What are your service restrictions limitations? Question Title * 12. What level of assistance is provided for riders? (Check all that apply.) N/A Curb-to-curb (drivers may assist riders in and out of vehicle). Door-to-door (drivers may assist riders to the entrance of origin/destination). Drivers are permitted to assist with packages. Passengers are permitted to travel with a personal care escort. No assistance is provided. Other (please specify) Question Title * 13. What are your transportation eligibility requirements? (Check all that apply.) N/A None Residents only Senior clients only Children Age specific Geographic service area Church membership Veterans only Disabled/ADA Medicaid Medical Other (please specify) Question Title * 14. What types of transportation limitations are experienced by the people your agency serves? (Check all that apply.) Aging related Visual impairment Hearing impairment Physical disability Developmental disability Multiple disabilities Financial limitations Remote/rural location Language barriers Other (please specify) Question Title * 15. Who are your drivers? (Check all that apply.) N/A Staff Volunteers Other (please specify) Question Title * 16. What is the purpose of the trips? (Check all that apply.) N/A Access our services Medical appointments Meals Recreation Employment Shopping Other (please specify) Question Title * 17. What types of trips do your clients need? (Check all that apply.) Shopping Medical Family/friend visits Employment Social/entertainment Education Senior nutrition Social service appointments Religious Other (please specify) Question Title * 18. Do your clients need medical transportation outside the county? Yes No Question Title * 19. If the answer to the last question (above) is yes, where do your clients need medical transportation? Question Title * 20. If your clients need medical transportation outside the county, how often do they need this transportation service? (Check all that apply.) Daily Weekly Monthly Other (please specify) Question Title * 21. When do your clients need transportation for your services? (Check all that apply.) Weekdays, 7:00 am to 5:00 pm Weekdays, 5:00 pm to 10:00 pm Saturday, 7:00 am to 5:00 pm Saturday, 5:00 pm to 10:00 pm Weekdays, before 7:00 am Weekdays, after 10:00 pm Weekends, before 7:00 am Weekends, after 10:00 pm Other (please specify) Question Title * 22. How much should a one-way trip cost within the Region? Less than $1.00 $1.00 $2.00 $3.00 $4.00 $5.00 $6.00 Other (please specify) Question Title * 23. What type of public transportation do your clients need? (Check all that apply.) Fixed route scheduled bus service (pick-up at designated bus stops). Fixed route, deviated service (bus operates regular routes, can go off routes on request). Curb-to-curb demand response service (call ahead for scheduled pick-up). Door-to-door demand response (call ahead for scheduled pick-up for elderly or persons with disabilities). Other (please specify) Question Title * 24. Based on your experience, what are the barriers to coordinating transportation services with other agencies? (Check all that apply.) Federal regulations State regulations Liability issues Competition from other providers Funding Reluctance of providers to coordinate Not enough equipment/staff Other (please specify) Question Title * 25. Are there unmet public transportation needs in the Region? Yes No Question Title * 26. If yes, what group(s) have unmet transportation needs? (Check all that apply.) Senior citizens Persons with disabilities General public Students Low income persons All of the above N/A Other (please specify) Question Title * 27. Please indicate how current transit service could be improved. (Check all that apply.) Extend service hours to 8:00 pm. Extend service hours to 9:00 pm. Provide weekend service. Provide service on Holidays. Central dispatch/information source (one phone number to call for a ride, etc.). Better advertising/marketing. Expanded service outside of town. Accessibility of service. Affordability of service. Better coordination between service providers. Other (please specify) Question Title * 28. If you could change one thing about public transportation for your clients, what would it be and why? Question Title * 29. Would you like us to contact you for follow-up information regarding your survey answers? Yes No Done