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This survey is mainly targeted at persons with disabilities in Southern Africa. We are interested in understanding how the current COVID-19 crisis is affecting you and how you feel about the ongoing response interventions at the local community, national and even regional levels. The information gathered will greatly enhance SAFOD's own regional response strategy for persons with disabilities. We greatly appreciate you taking the time to share your thoughts.

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* 1. I agree to participate in the research study. I understand the purpose and nature of this study and I am participating voluntarily. I understand that I can withdraw from the study at any time, without any penalty or consequences.

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* 2. I grant permission for the data generated from this interview to be used in the researcher's publications on this topic.

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* 3. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission. Choose one of the following options:

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* 4. Please type your name in the box below to indicate agreement to participate in this study.

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