2015 PIAT Assistive Technology Survey
Pennsylvania’s Initiative on Assistive Technology (PIAT), a program of the Institute on
Disabilities at Temple University, is the Commonwealth’s statewide “Assistive
Technology Act” Program. You may be familiar with some of the ways that PIAT helps
Pennsylvanians with disabilities and older Pennsylvanians learn about and obtain
assistive technology.
Assistive technology (AT) means devices and services that can help people with
disabilities and older Pennsylvanians do the things they want to do, and be more
independent at school, at work, and at home. Assistive technology devices include
special equipment to help you cook “one-handed”, telephones that amplify the speaker’s
voice, computers that type when you talk, devices that can help you read your mail or
your favorite magazine, adaptations to help you get into your car or remain independent
in your home, and much more. Assistive technology also means the services that can
help you find, pay for, and use the devices you need.
The Assistive Technology Act of 2004, as amended, Public Law 108-364, is the federal
law that describes required activities. We are currently developing our new State Plan
for Assistive Technology, and this survey (which is arranged according to the key
activities required by the AT Act) will help us find out what you want, so we can do these
activities in a way that meets the needs of Pennsylvanians with disabilities and seniors.
We appreciate you taking five to ten minutes to complete this short survey. This survey
is ONLY for people who live in Pennsylvania, or serve people in Pennsylvania.
If possible, this survey should be completed online at:
https://www.surveymonkey.com/s/PIAT2015ATSurvey.
If that is not possible, please complete this printed version of the survey and return it by
January 15, 2015 by fax (215-204-6336), mail (PIAT Survey, c/o Institute on
Disabilities, 1755 N. 13th Street, Student Center Room 411S, Philadelphia, PA 19122).
Please note: Questions marked with an asterisk (*) require a response.
If you need help to complete the print version of the survey, would like to complete the
survey by telephone, or would like the survey in alternate formats (e.g. large print)
please contact us at 800-204-7428 (voice), or email Yvette Bolden at
bolden@temple.edu.
After January 15, 2015, the survey will be CLOSED and we will not accept any more
responses.
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2015 PIAT Assistive Technology Survey
1. *To help us know whether we are reaching Pennsylvanians from across the state
with this survey, please indicate your county of residence. If you are a service
provider, please indicate the county where you work. Check only one response.
Adams ___
Allegheny ___
Armstrong ___
Beaver ___
Bedford ___
Berks ___
Blair ___
Bradford ___
Bucks ___
Butler ___
Cambria ___
Cameron ___
Carbon ___
Centre ___
Chester ___
Clarion ___
Clearfield ___
Clinton ___
Columbia ___
Crawford ___
Cumberland ___
Dauphin ___
Delaware ___
Elk ___
Erie ___
Fayette ___
Forest ___
Franklin ___
Fulton ___
Greene ___
Huntingdon ___
Indiana ___
Jefferson ___
Juniata ___
Lackawanna ___
Lancaster ___
Lawrence ___
Lebanon ___
Lehigh ___
Luzerne ___
Lycoming ___
McKean ___
Mercer ___
Mifflin ___
Monroe ___
Montgomery ___
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Montour ___
Northampton___
Northumberland ___
Perry ___
Philadelphia ___
Pike ___
Potter ___
Schuylkill ___
Snyder ___
Somerset ___
Sullivan ___
Susquehanna ___
Tioga ___
Union ___
Venango ___
Warren ___
Washington ___
Wayne ___
Westmoreland ___
Wyoming ___
York ___
2015 PIAT Assistive Technology Survey
2. *PIAT provides statewide services through our network of eight (8) Assistive
Technology Resource Centers (ATRCs). Each ATRC area is comprised of five or
more counties. Our ATRCs are: Community Resources for Independence, Three
Rivers Center for Independent Living, United Cerebral Palsy of Central PA, Center
for Independent Living of North Central PA (Roads to Freedom), United Cerebral
Palsy of Northeastern PA, Tri-County Patriots for Independent Living, Good
Shepherd Rehabilitation Hospital, and the Institute on Disabilities at Temple
University. More information about the ATRCs and the counties they serve can be
found at http://disabilities.temple.edu/programs/assistive/atlend/atrc.shtml
Please check all that apply:
___
___
___
___
___
___
I never heard of my ATRC and/or its AT activities.
I have heard of my ATRC but not used it for AT.
I have heard of my ATRC and have been in contact with them about AT.
I have used my ATRC and would use them again.
I plan to contact my ATRC in the future.
I have used my ATRC in the past and would not contact them again.
If you responded that you would not contact your ATRC again, please tell us why:
Acquisition: State Financing
3. *Pennsylvania's Telecommunication Device Distribution Program (TDDP) provides
free, specialized telephone equipment to eligible Pennsylvanians who have a
disability that prevents them from using regular telephone equipment. The TDDP
was created by Act 34 of 1995. To learn more about TDDP, call 800-204-7428
(voice), 215-204-3330 (voice), 866-268-0579 (TTY), tddp@temple.edu (email), or go
to http://disabilities.temple.edu/tddp
Please check all that apply:
___
___
___
___
___
___
___
___
I never heard of this program before.
I have heard about the program but have not used it.
I have heard about this program and have used it.
I used this program in the past and would use it again.
I plan to use this program in the future.
I used another program to get free telephone equipment.
I (or the people I work with) would not use this kind of program.
I used this program in the past and would NOT use it again.
If you responded that you would not use this program again, please explain why:
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2015 PIAT Assistive Technology Survey
4. *The National Deaf-Blind Equipment Distribution Program, also known as
iCanConnect, is a program that provides advanced telecommunications equipment
free of charge to low-income people of all ages who have combined vision and
hearing loss. This program was mandated by the 21st Century Communications
and Video Accessibility Act of 2010 and established by the Federal Communications
Commission (FCC). In Pennsylvania, this program is administered by PIAT and is
known as "iCanConnectPA". For more information about iCanConnectPA, call 800204-7428 (voice), 215-204-3330 (voice), 866-268-0579 (TTY),
iCanConnectPA@temple.edu (email), http://disabilities.temple.edu/icanconnect.
Please check all that apply:
___
___
___
___
___
___
___
___
I never heard of this program before.
I have heard about the program but have not used it.
I have heard about this program and have used it.
I used this program in the past and would use it again.
I plan to use this program in the future.
I used another program to get free telecommunications equipment.
I (or the people I work with) would not use this kind of program.
I used this program in the past and would NOT use it again.
If you responded that you would not use this program again, please explain why:
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2015 PIAT Assistive Technology Survey
Acquisition: Device Reutilization
5. *The Reused and Exchanged Equipment Partnership (REEP) is a way for people
with disabilities to obtain previously owned equipment, usually at low or no cost.
This can be done through the REEP classifieds by contacting people who are
interested in selling or donating assistive devices they are no longer using. You can
also donate or obtain used equipment from our REEP partners. To learn more
about REEP, call 800-204-7428 (voice), 215-204-3330 (voice), 866-268-0579 (TTY),
ATreuse@temple.edu (email), http:disabilities.temple.edu/reep.
Please check all that apply:
___
___
___
___
___
___
___
___
I never heard of this program before.
I have heard about the program but have not used it.
I have heard about this program and have used it.
I used this program in the past and would use it again.
I plan to use this program in the future.
I used another program to get reused equipment.
I (or the people I work with) would not use this kind of program.
I used this program in the past and would NOT use it again.
If you responded that you would not use this program again, please explain why:
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2015 PIAT Assistive Technology Survey
Access: Device Lending
6. *Pennsylvania's Assistive Technology Lending Library is a way for people with
disabilities of all ages to try out different assistive devices to see if they can help. By
borrowing a device and trying it in their own home, school, place of employment, or
other setting, people with disabilities can identify the devices that can help them.
You can also borrow a device while you are waiting for funding for a device of your
own, or as a "loaner" while your device is being repaired. To learn more about the
Lending Library, call 800-204-7428 (voice), 215-204-3330 (voice), 866-268-0579
(TTY), ATlend@temple.edu (email), http:disabilities.temple.edu/atlend.
Please check all that apply:
___
___
___
___
___
___
___
___
I never heard of this program before.
I have heard about the program but have not used it.
I have heard about this program and have used it.
I used this program in the past and would use it again.
I plan to use this program in the future.
I used another program to borrow equipment.
I (or the people I work with) would not use this kind of program.
I used this program in the past and would NOT use it again.
If you responded that you would not use this program again, please explain why:
Access: Device Demonstration
7. *One of the ways people can learn about assistive technology is to see an assistive
device demonstrated by someone who knows how to use it. The Assistive
Technology Resource Centers (ATRCs) that work with PIAT conduct device
demonstrations or organize the opportunity to see devices demonstrated by vendors
and others who know how to use them. For more information about device
demonstrations, or to request a device demonstration, contact PIAT at 800-2047428 (voice), 215-204-3330 (voice), 866-268-0579 (TTY), ATdemo@temple.edu
(email), http:disabilities.temple.edu/piat.
Please check all that apply:
___
___
___
___
___
I never heard of this program before.
I have heard about the program but have not used it.
I have heard about this program and have been to a device demonstration.
I used this program in the past and would use it again.
I plan to use this program in the future.
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2015 PIAT Assistive Technology Survey
___ I used another program to see devices demonstrated.
___ I (or the people I work with) would not use this kind of program.
___ I used this program in the past and would NOT use it again.
If you responded that you would not use this program again, please explain why:
Transition
8. *Assistive Technology can be crucial to success in post-secondary education,
employment, and independent living. There are also new environments and
activities where different assistive technologies may be useful. It is important to
consider AT during any transition process so that AT is not "lost in transition".
Thinking about different transitions, please rank the following in order of how
important they are to you, by placing a 1 next to the most important, a 2 next to the
second most important, and so on:
#___Early intervention to school
#___School to work
#___School to post-secondary education
#___School to independent living
#___Nursing home to community living
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2015 PIAT Assistive Technology Survey
What is important to YOU?
9. *Please rate how important the assistive technology activity listed below is to you.
Please check one response per statement.
Obtain free
specialized
telecommunications
equipment
Most
Somewhat
important ___ Important ___
Less
Least
Important ___ Important ___
Most
important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
Borrow assistive
technology devices to
try
Most
important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
Buy used equipment,
or find donated used
equipment
Most
important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
See assistive
technology devices
demonstrated
Most
important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
Most
important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
Find information about
assistive technology
Most
services and providers important ___
Somewhat
Important ___
Less
Least
Important ___ Important ___
Borrow money to buy
assistive technology
Find information about
assistive technology
devices that can help
me
Comments:
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2015 PIAT Assistive Technology Survey
About You
Completing this optional section will help us know more about who this survey reached.
If you do not wish to complete this section, please skip to question 23.
10. Please tell us which of the following categories BEST describes you.
___ Person with a disability (Skip to question 11)
___ Family member, guardian, or caregiver of a person with a disability (Skip to
question 14)
___ Provider of services to persons with disabilities (Skip to question 17)
___ Other (friend, advocate, student, or have some other relationship to a person
with a disability) (Skip to question 20)
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2015 PIAT Assistive Technology Survey
Person with a Disability
Answer these questions ONLY if your response to question 10 was “Person with a
Disability”
11. What is your age?
___ 6-21
___ 22-64
___ 65 and over
12. Which race/ethnicity best describes you?
___ African-American or Black
___ Asian/Pacific Islanders
___ Caucasian or White
___ Latino or Hispanic
___ Native American
___ Other (please specify): _________________
13. Disability:
___ Physical
___ Intellectual/Cognitive
___ Sensory – Hearing
___ Sensory – Vision
___ Communication
___ Multiple
___ Other (please specify): _________________
SKIP TO QUESTION 23.
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2015 PIAT Assistive Technology Survey
Family member, guardian, or caregiver
Answer these questions ONLY if your response to question 10 was “Family member,
guardian, or caregiver of a person with a disability”
14. What is the age of the person with a disability?
___ Birth to 2
___ 3-5
___ 6-21
___ 22-64
___ 65 and over
15. Which race/ethnicity best describes the person with a disability?
___ African-American or Black
___ Asian/Pacific Islanders
___ Caucasian or White
___ Latino or Hispanic
___ Native American
___ Other (please specify): _________________
16. Indicate the person’s disability:
___ Physical
___ Intellectual/Cognitive
___ Sensory – Hearing
___ Sensory – Vision
___ Communication
___ Multiple
___ Other (please specify): _________________
SKIP TO QUESTION 23.
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2015 PIAT Assistive Technology Survey
Service Provider
Answer these questions ONLY if your response to question 10 was “Provider of
services to persons with disabilities” Please describe the persons with disabilities that
you most frequently serve. Only one answer is permitted for each question.
17. Age:
___
___
___
___
___
Birth to 2
3-5
6-21
22-64
65 and over
18. Race/Ethnicity:
___ African-American or Black
___ Asian/Pacific Islanders
___ Caucasian or White
___ Latino or Hispanic
___ Native American
___ Other (please specify): _________________
19. Disability:
___ Physical
___ Intellectual/Cognitive
___ Sensory – Hearing
___ Sensory – Vision
___ Communication
___ Multiple
___ Other (please specify): _________________
SKIP TO QUESTION 23.
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2015 PIAT Assistive Technology Survey
Other (friend, advocate, student, or other relationship to a person with a
disability)
Answer these questions ONLY if your response to question 10 was “Other.” When
answering the questions below, please describe the person with a disability.
20. What is the age of the person with a disability?
___ Birth to 2
___ 3-5
___ 6-21
___ 22-64
___ 65 and over
21. Which race/ethnicity best describes the person with a disability?
___ African-American or Black
___ Asian/Pacific Islanders
___ Caucasian or White
___ Latino or Hispanic
___ Native American
___ Other (please specify): _________________
22. Indicate the person’s disability:
___ Physical
___ Intellectual/Cognitive
___ Sensory – Hearing
___ Sensory – Vision
___ Communication
___ Multiple
___ Other (please specify): _________________
SKIP TO QUESTION 23.
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2015 PIAT Assistive Technology Survey
23. Is there anything else you would like to tell us about learning about, finding and
getting assistive technology in Pennsylvania?
Thanks for taking the time to complete this survey. Your answers will help us plan a
statewide program that meets the assistive technology needs of Pennsylvanians with
disabilities and older Pennsylvanians.
To learn more about PIAT, a program of the Institute on Disabilities at Temple
University, or to join our mailing list, go to www.disabilities.temple.edu.
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