SURVEY INFORMATION/PARTICIPANT CONSENT

SECTION 1: SURVEY LANGUAGE

SECTION 2: CLIENT INFORMATION
 
SECTION 3: CLIENT ACCESS TO COMMUNICATIONS AND TRANSPORTATION 

SECTION 4: SNAP ENROLLMENT

SECTION 5: PUBLIC AID OFFICE LANGUAGE

SECTION 6: PUBLIC AID OFFICE VISITS

SECTION 7: MANAGE MY CASE

SECTION 8: DHS HOTLINE
 
SECTION 9: DEMOGRAPHIC INFORMATION

SECTION 10: DISABILITY STATUS


The purpose of this survey is to improve customer service provided by public aid offices to individuals receiving SNAP benefits. This is a research project being conducted by the Greater Chicago Food Depository and the Shriver Center on Poverty Law. You are invited to participate in this research project because you receive SNAP benefits or have received SNAP benefits in the past.

Your participation in this survey is completely voluntary. If you choose not to participate, there will not be any negative consequences. Your receipt of SNAP benefits will not be affected by your decision to participate in this survey. If you decide to participate in the survey, you may skip any question you do not wish to answer and you may stop the survey at any time.

Participation in this survey will take about 15 minutes. The process involves completing the survey on paper or online. 

To thank you for your participation in this survey, you will be entered into a raffle with a 1 in 15 chance of winning a $50 gift card. The raffle drawing will be held once per month. You must provide us with your phone or email so that we can notify you if you have won. 

The Food Depository and Shriver Center do not work for the government and will keep your responses to the survey confidential. Your survey responses will be kept separate from your name and contact information. Your name and contact information will only be used to conduct the raffle and will be deleted as soon as the raffle winner is drawn. 

If you have any questions about this survey, you may contact Claudia Rodriguez, Senior Manager of Public Benefits Outreach at the Greater Chicago Food Depository: 773-843-5416.

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* 1. Participant Consent
 
By clicking on the 'agree' button, you indicate that:
 
  • You have read and understand the above information
  • You are age 18 or older
  • You currently receive SNAP benefits or have received SNAP benefits in the last two years
  • You voluntarily agree to participate in this survey

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* 2. SECTION 1: SURVEY LANGUAGE

What language would you like to use to take this survey?

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* 3. SECTION 2: CLIENT INFORMATION
 
What is your zip code? 

<<If you do not know, skip to next question>>

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* 4. What is your gender?

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* 5. What is your age?

<<If response is “under 18”, skip to end of survey>>

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* 6. How many adults live in your household?

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* 7. How many children live in your household?

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* 8.
SECTION 3: CLIENT ACCESS TO COMMUNICATIONS AND TRANSPORTATION 

What access do you have to the following forms of communication?

  No Access Limited Access Daily Access Prefer not to say
Land Line
Cell phone to make calls
Cell phone for text messaging
Text messaging
Email
Internet for web browsing

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* 9. Do you use a government phone (such as SafeLink or Assurance)?

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* 10. What do you typically use to access the internet for web browsing or email? Select all that apply.

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* 11. What forms of transportation do you typically use to run errands, including visiting a public aid office? Select all that apply.

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* 12. SECTION 4: SNAP ENROLLMENT

Which of the following statements best summarizes your experience with SNAP benefits?

<<If you have not received SNAP benefits in the last two years, skip to end of survey>>

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* 13. How many months have you been receiving SNAP benefits continuously or without interruption?

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* 14. If you are currently receiving benefits, what is your monthly benefit amount?

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* 15. How did you apply for SNAP benefits?

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* 16. Did anyone help you apply for SNAP benefits?

<<If yes, proceed to next question. If no, skip to Section 5>>

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* 17. Who helped you apply for SNAP benefits?

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* 18. SECTION 5: PUBLIC AID OFFICE LANGUAGE

What language would you prefer to use to communicate with the public aid office about your SNAP benefits?

<<If English, skip to Section 6>>

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* 19. When you visit the public aid office, are the printed materials such as flyers and brochures available in your preferred language?

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* 20. When you visit or call the public aid office, is a caseworker available to speak with you in your preferred language?

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* 21. What language does the public aid office typically use to communicate with you about your SNAP benefits?

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* 22. How easy is it for you to communicate with the public aid office in your preferred language?

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* 23. SECTION 6: PUBLIC AID OFFICE VISITS

What is the name of your public aid office? If you do not know the name, list the intersections.

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* 24. Have you ever visited the public aid office to manage your SNAP benefits?

<<If no, skip to Section 7>>

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* 25. How easy is it to visit your public aid office?

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* 26. What is the biggest challenge you experience visiting your public aid? Select all that apply.

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* 27. What is the average waiting time when you visit the public aid office?

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* 28. Are you typically able to resolve your issue when you visit the public aid office?

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* 29. In general, how would you rate the level of customer service at public aid office visits?

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* 30. Do you have feedback or suggestions to improve public aid office visits?

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* 31. SECTION 7: MANAGE MY CASE

Have you ever used Manage My Case to manage your SNAP benefits?

<<If no, skip to Section 8>>

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* 32. How easy is it to use Manage My Case?

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* 33. What is the biggest challenge you experience using Manage My Case? Select all that apply.

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* 34. Are you typically able to resolve your issue when you use Manage My Case?

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* 35. In general, how would you rate the level of customer service on Manage My Case?

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* 36. Do you have feedback or suggestions to improve Manage My Case?

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* 37. SECTION 8: DHS HOTLINE

Have you ever contacted the DHS hotline to manage your SNAP benefits?

<<If no, skip to Section 9>>

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* 38. How easy is it to use the DHS hotline?

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* 39. What is the biggest challenge you experience using the DHS hotline? Select all that apply.

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* 40. What is the average waiting time when you call the DHS hotline?

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* 41. Are you typically able to resolve your issue when you call the DHS hotline?

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* 42. In general, how would you rate the level of customer service on the DHS hotline?

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* 43. Do you have feedback or suggestions to improve the DHS hotline?

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* 44. Section 9: DEMOGRAPHIC INFORMATION

This next section asks about your background and living situation. We ask these questions to help us understand who we are reaching with this survey and who we may be missing. Your answers with also help us improves services that better support people like yourself. Thank you.

How do you describe your gender identity?

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* 45. What year were you born?

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* 46. What is the zip code where you are currently living?

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* 47. How many people, including yourself, are currently living in your household and sharing expenses?

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* 48. SECTION 10: DISABILITY STATUS

The next question asks about disabilities or mobility challenges you may manage on a daily basis. They will help us design programs based on people’s needs and experiences.

Please check the boxes below if you have serious difficulty with any of the following activities:

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* 49. Thank you for participating in this survey.



If you would like to be entered into the raffle, please provide your name, phone, and email below so that we can contact you if you win. The raffle will be drawn once per month. You have a 1 in 15 chance of winning a $50 gift card.

As a reminder, your responses to the survey are confidential. Your survey responses will be kept separate from your name and contact information. Your name and contact information will only be used to conduct the raffle and will be deleted as soon as the raffle winner is drawn.

If you have any questions about this survey, you may contact Claudia Rodriguez, Senior Manager of Public Benefits Outreach at the Greater Chicago Food Depository: 773-843-5416.

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