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Name: _2023_Agency_Monitoring_Questionnaire
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Label: 2023 Agency Monitoring Questionnaire
Description: Survey Data Locations
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Type ID Field:
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globalid
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note1
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Welcome to the 2023 Annual Agency Monitoring Survey for the 5310 Program. This annual survey is administered by OKI as part of its oversight requirements for the Federal 5310 program. Please respond to all questions below no later than March 4th, 2023. At the end, click the Submit button to finalize your survey. You may contact Summer Jones should you have any questions or need assistance as you complete., type: esriFieldTypeString
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agency
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Select your agency from the list below:, type: esriFieldTypeString
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[AFF: Abilities First Foundation]
, [BAWAC: BAWAC]
, [CJN: Cancer Justice Network]
, ...20 more...
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aff
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bawac
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ccma
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cabvi
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css
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ctt
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est
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esr
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gcbhs
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koc
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lr
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mkc
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mjcc
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mow
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mhwp
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nkd
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oprs
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osci
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pip
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Name:Partners in PrimeAddress:230 Ludlow StreetCity:HamiltonState:OH, type: esriFieldTypeString
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semv
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Name:SEM VillaAddress:201 Mound AvenueCity:MilfordState:OH, type: esriFieldTypeString
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va
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Name:Volunteers of AmericaAddress:570 S Fourth StreetCity:LouisvilleState:KY, type: esriFieldTypeString
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wccs
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poc
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-
ag_review_yn
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are the contact details for your agency correct?, type: esriFieldTypeString
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[no: No]
, [yes: Yes]
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ag_updated_notes
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: You have indicated that the contact details of your agency are not correct. Please use the space below to correct any details., type: esriFieldTypeString
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no_vehicles
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nullable: true, editable: true, defaultValue: null, length: 255, alias: The number of vehicles located here are:, type: esriFieldTypeString
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no_vehicles_correct
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nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the number of vehicles correct?, type: esriFieldTypeString
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[no: No]
, [yes: Yes]
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-
risk_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Has your agency run an operating deficit over the past two years?, type: esriFieldTypeString
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[no: No]
, [yes: Yes]
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-
risk_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. Do you anticipate budget cutbacks in the near future?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
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-
risk_q3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Have you reduced 5310 vehicle transport to your clients over the past year?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
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-
risk_q4
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nullable: true, editable: true, defaultValue: null, length: 255, alias: 4. Do you anticipate service cutbacks in the near future?, type: esriFieldTypeString
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[no: No]
, [yes: Yes]
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-
risk_q5
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nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. Are you utilizing your 5310 vheicles for the specified purposes stated in your original grant application to OKI?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
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-
risk_q6
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6. Have you had to decline servie to your clients due to lack of operating services?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
risk_q7
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 7. Has your ridership declined over the past year?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
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-
risk_q8
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 8. On average, what percentage % of your 5310-supported vehicle fleet is in operation on a daily basis?, type: esriFieldTypeString
)
-
risk_q9
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 9. Do you have sufficient number of qualified vehicle operators (drivers) to fully operate your 5310 fleet to meet client service demand?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
risk_q10
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 10. Have any accidents involving 5310-funded vehicles occurred over the past year?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Has your agency received any negative audit findings related to the management of federal or state grant funds in the past three (3) years?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. Describe your internal control process by which invoices submitted by vendors for purchases to be reimbursed by federal grants are approved and paid?, type: esriFieldTypeString
)
-
fm_q3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Is the individual who approves the invoice the same person who issues the check for payment and/or records the expense in the General Ledger?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q4
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 4. How long do you retain records of expenditures made under grant funded agreements?, type: esriFieldTypeString
)
-
fm_q5
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. Are these records safely stored in a secure location?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q6
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6. Do you have sufficient funding in place to support the full operation of your 5310 vehicle passenger service?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q7
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 7. If you receive grant funds for Preventive Maintenance, are you submitting your reimbursement request to SORTA or OKI on a regular timely basis?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
fm_q8
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 8. Do you have adequate local funds in place to match the FTA funds used for preventive maintenance?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
ds_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Have any 5310 vehicles been stolen or damaged by vandalism over the past year?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
ds_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. Is the insurance coverage for your 5310-funded vehicles up to date and in full force?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
ds_q3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Have you experienced any problems with your insurance carrier?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
m_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Have your 5310 passenger vehicles undergone the recommended level and frequency of preventive maintenance inspections?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
m_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. Do any of your 5310-funded vehicles experience frequent breaksdowns?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
m_q3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. How do you ensure that only qualified drivers operate your 5310 vehicles in passenger service?, type: esriFieldTypeString
)
-
ada_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Are the wheelchair lifts on your vehicles operating properly?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
ada_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. How often do you perform maintenance on your wheelchair lifts?, type: esriFieldTypeString
)
-
ada_q3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Have you any ADA-related complaints files over the past two (2) years?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
title9_q1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Does your agency have current Title VI Program Plan?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
title9_q2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. Have you received any Title VI discrimination complaits over the past two (2) years?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
title9_q3a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Have you recuded 5310 vehicle transport service to your clients over the past year?, type: esriFieldTypeString
, Coded Values:
[no: No]
, [yes: Yes]
)
-
title9_q3b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3b. You have answered "yes" to the previous question. Please explain further below:, type: esriFieldTypeString
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title9_q4
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nullable: true, editable: true, defaultValue: null, length: 255, alias: If required by your Plan how do you inform your clients of their rights under Title VI?, type: esriFieldTypeString
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endnote
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Thank you for your answers. To submit, click the button below. For any questions, please contact Travis Miller ., type: esriFieldTypeString
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title9_q2b
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title9_q3
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nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. If required by your Plan, how do you inform your clients of their rights under Title VI?, type: esriFieldTypeString
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