Cattaraugus County NY Connects Care Directory Survey - ARDENT SOLUTIONS

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Does your organization provide services to Cattaraugus County residents and would like to be listed in the New York State NY Connects Resource Directory? If yes, please complete the following survey to assist the Cattaraugus County Office for the Aging and NY Connects Cattaraugus County populate this important database.

If your organization provides more than one service or program, please complete and submit a form for each.

New York State NY Connects Service Directory- Enter Your Information Here

PROVIDER INFORMATION

* Indicates required field

Provider Name *

Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Primary Phone Number *

Mailing Address (if different than physical address) *

Line 1

Line 2

City

State

Zip Code

Country

Website URL *

Fax Number *

Provider Description *

PROGRAM INFORMATION

Program Name *

Phone Number *

Days Open- Check All That Apply *

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Varies

Hours of Operation *

Language(s)- Check All That Apply *

English Interpreter Service Available Multi-Lingual American Sign Language

Intake Process- Check All That Apply *

Appointment Preferred Appointment Required Call For Details Physician Enrollment Required Professional Enrollment Required Enrollment Required Walk-In

Program Description *

Cost for Services *

Additional Counties Served By This Specific Program (outside Cattaraugus County): *

Is the program known under any other name? *

Target Groups/Subcultures Served? *

Eligibility Requirements: *

RESOURCE BY CATEGORY

Please indicate which category or categories this program or service should be listed under in the New York State NY Connects Resource Directory by reviewing each category heading, reading its definition, and selecting the appropriate sub-category(s) that are relevant to your program or service. This information will allow individuals to "search" for services easily and efficiently when visiting the on-line directory. Please Select All That Apply.

1. Basic Needs- Programs that furnish survival level resources including food, housing, material goods, transportation and utilities for individuals with low or fixed incomes, people who are homeless, older adults and/or people with disabilities who are otherwise unable to adequately provide for themselves and their families. Also included are related services that are available to the community at large.

Please Select All That Apply *

Food Housing/Shelter Material Goods Transportation Utilities

2. Consumer Services- Programs that provide for the education and protection of individuals who buy products and services for personal use. Included are programs that establish and enforce consumer protection, fair trade and other regulatory legislation; provide information and/or counseling to help consumers manage their finances, make informed credit and purchasing decisions, and understand their tax obligations and pay their taxes; and/or ensure that consumers have access to fair hearings, mediation or binding arbitration and appropriate remedies when they have complaints.

Please Select All That Apply *

Consumer Assistance and Protection Consumer Regulations OptionMoney Management Tax Organizations and Services

3. Criminal Justice and Legal Services- - Programs that promote and preserve the conditions that enable community residents to live in a safe and peaceful environment through the enforcement of laws that protect life and property and the administration of justice according to the principles of law and equity. Included are crime prevention programs as well as programs that investigate and make arrests for criminal behavior; provide support for witnesses to and victims of crimes; and provide for the arraignment, prosecution and defense, judgment, sentencing, confinement and eventual release and resettlement of offenders.

Please Select All That Apply *

Criminal Correctional System Judicial Services Law Enforcement Agencies Law Enforcement Services Legal Assistance Modalities Legal Services

4. Education- Programs that provide opportunities for people to acquire the knowledge, skills, desirable qualities of behavior and character, wisdom and general competence that will enable them to fully participate in and enjoy the social, political, economic and intellectual life of the community.

Please Select All That Apply *

Educational Institutions/Schools Educational Programs Educational Support Services

5. Environmental and Public Health/Safety- Programs that protect and conserve natural resources, prevent or reduce environmental pollution, promote environmental and public health, develop and implement measures for safety education and accident prevention, provide emergency rescue services for people in trouble and/or take other steps to enhance public health and safety and enable people to live in ecological balance and harmony with their surroundings.

Please Select All That Apply *

Environmental Protection and Improvement Public Health Public Safety

6. Health Care- Programs whose primary purpose is to help individuals and families achieve and maintain physical well-being through the study, prevention, screening, evaluation and treatment of people who have illnesses, injuries or disabilities; and the provision of family planning, maternity and other services that relate to human reproduction and sexual health.

Please Select All That Apply *

Emergency Medical Care Health Screening/Diagnostic Services Health Supportive Services Human Reproduction Inpatient Health Facilities Medical Laboratories Outpatient Health Facilities Rehabilitation/Habilitation Services Specialized Treatment Speciality Medicine

7. Income Support and Employment- Programs that help to meet the economic needs of the community by helping residents prepare for, find and sustain gainful employment; providing public assistance and support for those who are eligible; ensuring that retirees, older adults, people with disabilities and other eligible individuals receive the social insurance benefits to which they are entitled; and offering temporary financial assistance for people who are experiencing an unexpected financial crisis in situations where support related to their specific circumstances is unavailable.

Please Select All That Apply *

Employment Public Assistance Programs Social Insurance Programs Temporary Financial Assistance

8. Individual and Family Life- Programs that promote the personal, social and spiritual development of people in the community by offering services that replace or supplement the care and support that is generally available through the family unit; providing for the humane care, protection and control of the pets and other domestic animals; and offering social, religious/spiritual and leisure-time activities that are personally satisfying and lead to optimal social functioning.

Please Select All That Apply *

Death Certification/Burial Arrangements Domestic Animal Services Individual and Family Support Services Leisure Activities/Recreation Mutual Support Social Development and Enrichment Spiritual Enrichment Volunteer Opportunities

9. Mental Health and Substance Abuse- Programs that provide preventive, diagnostic and treatment services in a variety of community and hospital-based settings to help people achieve, maintain and enhance a state of emotional well-being, personal empowerment and the skills to cope with everyday demands without excessive stress or reliance on alcohol or other drugs. Treatment may include emotional support, introspection and problem-solving assistance using a variety of modalities and approaches, and medication, as needed, for individuals who have a physical and/or psychological dependency on one or a combination of addictive substances or for people who range from experiencing difficult life transitions or problems in coping with daily living to those with severe, chronic mental illnesses that seriously impact their lives.

Please Select All That Apply *

Counseling Approaches Counseling Settings Mental Health Care Facilities Mental Health Evaluation and Treatment Mental Health Support Services Substance Abuse Services

10. Organizational/Community/International Services- Programs that provide any of a broad spectrum of services that benefit entire communities or which offer services that are statewide, regional, national or international in scope. Included are opportunities for individuals or groups to enjoy the artistic and cultural life of the community, participate in community improvement or service projects, engage in philanthropic endeavors, have a voice in the political process, obtain or offer assistance in times of disaster, have access to information services, and/or benefit from the availability of a variety of services for residents, community agencies, organizations, businesses and industries, and other individuals/groups.

Please Select All That Apply *

Community Economic Development and Finances Community Facilities/Centers Community Groups and Government/Administrative Offices Community Planning and Public Works Disaster Services Donor Services Information Services Military Services Occupational/Professional Associations Organizational Development and Management Services Political Organization and Participation

11. Target Populations- Individuals who have specific disabilities, medical diagnoses, ethnic backgrounds, national origins, family relationships, income levels, religious affiliations, special problems or considerations, or other targeted characteristics.

Please Select All That Apply *

Age Groups Benefits Recipients Caregivers Citizenship Disabilities and Health Conditions Families and Individuals Needing Support Family Relationships Income/Employment Status Living Situation/Housing Status Military Personnel/Contractors Occupations Offenders Organizational/Practitioner Perspectives Religious Groups/Communities Topical Identifiers/Issues Transients Victims/Survivors Volunteers

Additional Comments/Information: *

Submit

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