Opportunity & Access Survey for New York City Residents by New York Lawyers for the Public Interest, Inc. (NYLPI)

NOTE: If you speak a LANGUAGE OTHER THAN ENGLISH and language has been a problem in getting services, please give details on the last page under the access problem section and set this field to yes.

YES
NO

Below is a list of physical settings or services that people with disabilities regularly use. You will have an opportunity to tell us if you faced a physical or service access problem for each of the services by selecting the number 0 for not at all, to 5 for a greatest problem. If not applicable to you, please select N/A from the dropdown box.

Housing: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Housing: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Hotels: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Hotels: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Health Care: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Health Care: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Doctors, Dentists, Health Providers: physical access problem (explanation below)
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Doctors, Dentists, Health Providers: service access problem (explanation below)
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Mental Health Providers: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Mental Health Providers: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Social Security Administration: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Social Security Administration: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Welfare: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Welfare: service access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem

Public Parking or Permits: physical access problem
Select One N/A 0 no problem 1 2 3 4 5 greatest problem