Information Advice and Fitness CIC Community Consultation

We are a new Community Interest Company that intend to offer paid for services in and around Allerdale. In order to get up and running we are applying for funding.
We hope to offer help applying for benefits, exercises for people who have been shielding, drop in activity groups, and help with mental well-being. although some of these services maybe limited by location, due to time and staff experience qualifications.
The funders have requested proof of Community Consultation, so it would benefit us greatly if you would please take the time to fill in our survey.
In order for the Community Interest Company to be sustainable and continue to provide help, we will need to charge for our services. when picking the options for fees, please consider that they will not only have to cover staffing, but also, fuel, stationary, training, phones Insurance etc...

1. What is your age?

2. Which town do you live in or near?

3. What is your approximate average household income?
(We ask this as household incomes in the area are normally below the national average, this may help us gain funding as it is an indicator that help filling in forms may be needed)

4. Do you have any physical disabilities/mental health problems or has your health/fitness got worse due to Covid 19, either through contracting the virus or due to the restrictions and lockdowns.

	yes	no	got worse
physical disability	physical disability yes	physical disability no	physical disability got worse
mental health problems	mental health problems yes	mental health problems no	mental health problems got worse
fitness	fitness yes	fitness no	fitness got worse

5. Were you shielding?

6. Are you claiming any benefits such as Personal Independence Payments (16 - pension age) Attendance Allowance (above pension age)?

7. Do you find it difficult to do daily household tasks?

8. Do you sometimes struggle to fill in forms and do you feel there is enough help available to help fill forms in when applying for Personal Independence payments or Attendance Allowance?

	yes	no
Online Forms	Online Forms yes	Online Forms no
Paper Forms	Paper Forms yes	Paper Forms no
Enough help	Enough help yes	Enough help no

9. Would you consider using a paid for service to help you fill in and apply for benefits such as Personal Independence Payments and Attendance Allowance? (average time to fill in forms 1 1/2 hours) (if claims are successful rates are minimum standard rate PIP mobility £23.70 per week, standard rate PIP daily living £60 per week. AA lower rate £60 per week)

	£15	£20	£25
Yes	Yes £15	Yes £20	Yes £25
No	No £15	No £20	No £25
Maybe	Maybe £15	Maybe £20	Maybe £25

10. Would you use a paid for service to help you apply for a Blue Badge? In addition to the £10 fee payable for the badge (average time 1/2 hour, + time to check ID and get signatures if over the phone)

	£5	£10	£15
Yes	Yes £5	Yes £10	Yes £15
No	No £5	No £10	No £15

11. Do you feel there is a need for a mental health well-being group in your area?
Do you feel there is a need for a drop in activity group for older people in your area?

	Yes	No	Don't no
Mental health group	Mental health group Yes	Mental health group No	Mental health group Don't no
Drop In activity group	Drop In activity group Yes	Drop In activity group No	Drop In activity group Don't no

12. To help get your fitness/health back would you consider an exercise program that takes physical problems into account?

In my own home one to one or with my partner
In my own home first moving onto group exercises as fitness and confidence improve
Group exercises
No

13. What sort of activities would you want at the drop in activity group?

	Yes	No	Maybe
Quizzes	Quizzes Yes	Quizzes No	Quizzes Maybe
Bingo	Bingo Yes	Bingo No	Bingo Maybe
Board games	Board games Yes	Board games No	Board games Maybe
Dominoes	Dominoes Yes	Dominoes No	Dominoes Maybe
Talks or demonstrations	Talks or demonstrations Yes	Talks or demonstrations No	Talks or demonstrations Maybe
Physical games such as balloon volley ball, parachute games, darts	Physical games such as balloon volley ball, parachute games, darts Yes	Physical games such as balloon volley ball, parachute games, darts No	Physical games such as balloon volley ball, parachute games, darts Maybe
Seated exercises	Seated exercises Yes	Seated exercises No	Seated exercises Maybe
Art/craft activities	Art/craft activities Yes	Art/craft activities No	Art/craft activities Maybe
Other	Other Yes	Other No	Other Maybe

Comments:

14. Number of people in your household:

Any other comments:

15. Do you want to be contacted about our services once we are running?
If Yes, please add contact details in the comments box.