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ARK HOUSING ASSOCIATION LTD

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Tenant information questionnaire

Household profile information 2017

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Introduction

This is a questionnaire to find out information about you.

ARK Housing Association would like this information so that they are up date about the tenants living in their homes.

If you stay with other tenants they will get their own questionnaires to fill in.

If you have any questions, please contact Knowledge Partnership on 0800 169 9376.

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About you Question 1. Please write in the boxes:

What is your title? - like Mr, Mrs, Ms

What is your first name

Your surname

Your date of birth

Are you male or female

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Question 2. Please tell us your contact information?

Home telephone number:

Mobile telephone number:

Work telephone number:

E-mail address:

Question 3. How would you like ARK to contact you? (Tick all that apply)

Home phone

Work phone

Letter

Mobile

Email

Other, please say:

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Large Large print

P • t makes the rl n words easier

to read.

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Question 4. Would you like ARK to use any of these ways to contact you?

Braille

E-mail

Text phone

Large print

Skilled signer

No additional contact needs

Another language, please say:

Question 5. Would you like ARK staff to do any of these things when they visit you?

Knock loudly

Use back door Use side door

Give me time to answer the door

No special instructions

Other, please say:

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Question 6. What is your ethnic group?

White

Scottish Other British

Gypsy orIrish traveller

Other white Polish background

Mixed Race

Any mixed race

Asian

Pakistani Indian

Bangladeshi Chinese

Other Asian background

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Black

Caribbean African

Other black background

Any other ethnic group

Arab

Other ethnic group

I’d rather not say

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Question 7. Please tell us if you are?

Paid 30hrs or more per week

Paid between 16hrs and 29hrs per week

Paid less than 16hrs per week

Working 30hrs or more per week

Working between 16hrs and 29hrs per week

Working less than 16hrs per week

Training/Apprentice

Unemployed

Retired

At home (not seeking work)

Student

Disabled/Long term illness

Other

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Employed:

Volunteer:

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Question 8. Do you have a disability?

Yes No

Question 9. Please tell us how much you get paid for working each week. (the amount you get before income tax):

£

Question 10. Do you have a bank account for managing your money?

Yes No

Question 11. Does your bank account let you make Direct Debit payments?

Yes No

Don’t know

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Question 12. Do you have household contents insurance?

Yes No

Don’t know

Question 13. Have you used a Foodbank in the last year?

Yes No

Question 14. Would you use a Welfare Advice Service if ARK were to provide this?

Yes No

Don’t know

Question 15. How much do you spend on gas and electricity each month?

£

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Question 16. How do you currently pay for your energy bills?

Monthly direct debit

Quarterly direct debit

Quarterly cash or cheque

Payment card

Prepayment meter

Fuel direct

Other method

Question 17. Have you ever tried to get more value for money from your current energy supplier?

Yes No

Question 18. Have you heard about an energy provider called ‘OUR Power’?

Yes No

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Question 19. Does your home have a Smart Meter?

Yes No

Question 20. Would you like to be involved in helping ARK make decisions? If so how would you like to be involved… (Tick all that apply)

Writing for the ARK newsletter

Being asked about ARK policies

Being part of a group of tenants who comment on ARK’s policies

Joining a tenants’ group

Joining estate walkabouts

Looking at ARK services in depth

Joining the ARK Voices Group

Testing ARK services by phone or visits

None of the above

Other, please say:

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Keeping your information safe ARK Housing Association will look after this information as set out in the law.

This information will be used to:

• Check our services are fair

• Plan new services

• Keep your records up-to-date

• Help us provide a service to your household.

We will keep your information safe and only pass it on if the law says that we must.

Please sign to say that the details given on this form are correct.

Your name

Your signature

Today’s date

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Thursday

31 August

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Thank you

Please check that you have completed all of the questions.

Post this questionnaire and your Tenant Satisfaction Form to Knowledge Partnership in the pre-paid envelope.

You must post it by Thursday 31st August 2017.

All returned survey forms will be entered into a prize draw to win one of three £30 shopping vouchers.

This form will be held separately from your Tenant Satisfaction Survey questionnaire.

Easy read by Easy-Read-Online.co.uk

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