Consultation Survey

This survey is for Deaf, disabled, or older tenants of Islington Council. Please only complete this form if this applies to you.

If you are completing the paper version of this form, please feel free to write on the other side of the paper if you need more space.

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* 1. How would you describe your housing situation?

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* 2. How would you describe your impairments/disability? (Please tick all that apply)

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* 3. Your age?

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* 4. Your gender?

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* 5. Your ethnicity?

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* 6. Are you currently receiving any of the following benefits?

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* 7. Are you current receiving (or in the process of claiming) Universal Credit?

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* 8. Have you been able to get the information you need from your landlord to complete your most recent benefit application form?

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* 9. If you weren't able to get the information you needed from your landlord, what reason did they give for not being able to provide it?

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* 10. Is your Housing Benefit (or the rent portion of your Universal Credit) paid directly to you, or to your landlord?

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* 11. How would you prefer your Housing Benefit (or the rent portion of your Universal Credit) to be paid?

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* 12. Have you asked to change the way your Housing Benefit (or the rent portion of your Universal Credit) is paid, either in terms of who it is paid to, or how frequently it is paid? What was their response?

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* 13. Which of these statements describes you? (You can tick more than one box, and write your own description where it says 'Other')

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* 14. Does your income vary from month to month?

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* 15. What support do you need to attend a Work Capability Assessment meeting?

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* 16. The last time you attended a Work Capablity Assessment, did you have the support you needed?

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* 17. Is there anything else you'd like to tell us about your last Work Capability Assessment? Please use the box below

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* 18. How comfortable are you using computers and the Internet?

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* 19. Do you have access to the Internet at home?

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* 20. What support do you need to fill in benefits forms?

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* 21. If there was no one available to help you with filling in forms, what would make it easier for you to fill it in yourself?

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* 22. Is there anything that you think Islington Council could do to make it easier for you to claim Universal Credit?

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* 23. Is there anything else you would like us to know about your experience of claiming (or trying to claim) Universal Credit?

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* 24. Are you happy for us to contact you about your experience with Universal Credit?

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* 25. If yes, please give your name & contact details here, indicating how you prefer to be contacted.

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