Assessment Form

Need back by February 28th

PSA 10’s Needs Assessment for the 2022-2024 Area Plan

Crawford, Edwards, Hamilton, Jasper, Richland, Wabash, Wayne, White, Lawrence

Dear Interested Person or Organization:

SEIAOA is in the process of writing our area plan amendment which will begin in October. As part of the planning process, we need your feedback on funding priorities. Please take a moment and answer the following questions. Feel free to use additional pages and/or just send us an email at southeasternaaaceoshana@gmail.com with your comments.

Name of Organization / Person (optional): ______________________________________

1. Community Services (Title III-B)

SEIAOA currently funds the following community services. Please indicate if the funding is adequate, inadequate and add any relevant comment.

Adequate Inadequate Comment

a. Information and Assistance □ □ _______________

b. Transportation □ □ _______________

c. Legal □ □ _______________

d. Ombudsman □ □ _______________

e. Miscellaneous/GAP financial help □ □ _______________

f. Options Counseling □ □ _______________

Are there other community services that SEIAOA should fund? Please describe.

____________________________________________________________________________________________________________________________________________________

2. Meals (Title III-C1 and C2)

SEIAOA funds both congregate and home delivered meals. Please indicate if the funding is adequate, inadequate and add any relevant comment.

Adequate Inadequate Comment

a. Congregate meal □ □ _______________

b. Home delivered meals □ □ _______________

Any suggestions for improving the meal programs?__________________________________

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3. Disease Prevention & Health Promotion (Title III-D)

SEIAOA funds services for disease prevention and health promotion services at senior centers, congregate meal sites, etc.

Do you have any suggestions or comments regarding these services?__________________

__________________________________________________________________________

4. Caregiver Support Program (Title III-E)

SEIAOA funds the Caregiver Support Program. Do you have any suggestions or comments regarding these services?_____________________________________________________

__________________________________________________________________________

5. Other needed services

Do you have suggestions for other needed services? Please describe._________________

__________________________________________________________________________.

6. Additional information

Please provide any additional information of which you think SEIAOA should be aware.

7. Minimum Wage Impact

Has the increase in minimum wage impacted how you can pay for your medications, rent, gas, maintenance of vehicle or house, food or other basic necessities of life? What should we be made aware of?

___________________________________________________________________________________________________________________________________________________

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