Survey for Medical Professionals Why this survey?The Hamilton Roundtable for Poverty Reduction and its community partners have been engaged with the establishment of the Canada Disability Benefit (CDB) since consultations began. This program could provide an additional $200 of monthly income to the over 11,600 residents who report always or often living with activity limitations. If even a portion of these individuals qualify and apply, the CDB could generate up to $28 million annually in new income for local residents. That’s a life-changing prospect for eligible individuals. We believe this modest income boost can contribute to better health and well-being. Quick Facts: Low-income individuals experience higher rates of diabetes, cardiovascular disease, and lower over-all life expectancy. Poverty increases the incidence of stress related mental health issues like anxiety, and are more likely to develop or face relapse of mental illness. People with disabilities are twice as likely to live in poverty than those without a disability. This income could alleviate the financial barriers to accessing physical and mental health treatment. Can you help us? We are conducting a survey to gauge awareness around the Canada Disability Benefit such as looking at what is entailed such as requiring a Disability Tax Credit Certificate to apply. We are also trying to understand possible barriers for patients such as form fees for low-income individuals in your practice. This survey is hosted on our own website and is anonymous unless you choose to share your identity. About the ProgramAre you aware of a new federal benefit for persons with disability?* Are you aware of a new federal benefit for persons with disability?*YesNoWould you like more information on the Canada Disability Benefit?* Would you like more information on the Canada Disability Benefit?*YesNoDisability Tax CreditHow many of your patients request Disability Tax Credit Certificate form to be filled in monthly?* How many of your patients request Disability Tax Credit Certificate form to be filled in monthly?*If the Disability Tax Credit Certificate form was never submitted, are you aware of the reason why? If the Disability Tax Credit Certificate form was never submitted, are you aware of the reason why?FeesThe benefit requires a valid Disability Tax Credit Certificate. Do you charge to fill out the Disability Tax Credit Certificate form?* The benefit requires a valid Disability Tax Credit Certificate. Do you charge to fill out the Disability Tax Credit Certificate form?*YesNoFee DetailsHow much do you charge to fill out the Disability Tax Certificate Form? How much do you charge to fill out the Disability Tax Certificate Form?Low Income AssistanceWould a completed draft copy of the form help you reduce fees? Would a completed draft copy of the form help you reduce fees?A draft would be completed by the individual or with the help of a medically knowledgeable volunteer prior to your starting to fill it out.YesNoDo you have a reduced fee for low-income patients?* Do you have a reduced fee for low-income patients?*YesNoIf so, by how much or what scale do you use? If so, by how much or what scale do you use?AccessibilityDo you think some of your patients need assistance in applying for the Canada Disability Benefit?* Do you think some of your patients need assistance in applying for the Canada Disability Benefit?*YesNoIf so, do you have any suggestions to help those patients access and/or complete the application? If so, do you have any suggestions to help those patients access and/or complete the application?Would you like more information on community programs, sign up posters, application clinics that are helping people sign up?* Would you like more information on community programs, sign up posters, application clinics that are helping people sign up?*YesNoAdvocacyWould you like to participate in discussions on topics like fee assistance, and other Canada Disability Benefit advocacy issues?* Would you like to participate in discussions on topics like fee assistance, and other Canada Disability Benefit advocacy issues?*YesNoContact InformationIf you indicated you wanted to be contacted for further information, please share your name: If you indicated you wanted to be contacted for further information, please share your name:And the best email to contact you at: And the best email to contact you at:Please feel free to leave us a message: Please feel free to leave us a message:
