LIVE - Provider Temporary Site Capacity Survey

Program Information

We are seeking to identify unused/vacant sites that may be available to provide temporary services for individuals in the community.

This survey was designed to capture unused/vacant space (e.g., residential, day program rooms, etc.) at your program(s). If you have multiple programs with unused/vacant space, please complete this survey once for each program.

Questions regarding this survey should be directed by email to the OPWDD Emergency Operations Center (EOC) at: EOC_Activation@opwdd.ny.gov

1. Provider Name (Corp ID/Agency Name) *This question is required.

3. Site Street Address *This question is required.

4. Site City *This question is required.

5. Site Zip Code (Enter 5 Digit Code) *This question is required. This question requires a valid number format.

6. Site County *This question is required.

8. Does Your Agency Have Access To the Following Types of Building That Potentially Could be Utilized as Repurposed Space to Service Individuals with IDD?
(Check All That Apply) *This question is required.

Not Applicable
College Campus/Dormitory
Former/Closed Nursing Home
Hotels
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.