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 (CDB)?* Do you think some of your patients need assistance in applying for the Canada Disability Benefit (CDB)?*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?The Canadian Tax Observatory reported 84% of people with disabilities don't qualify for CDB because they don't have a Disability Tax Credit Certificate. Would you like more information on community initiatives to help people sign up?* The Canadian Tax Observatory reported 84% of people with disabilities don't qualify for CDB because they don't have a Disability Tax Credit Certificate. Would you like more information on community initiatives to help people sign up?*Check all that apply.Information on medically-aware assistance to complete a draft copy Disability Tax Credit application.Community programs that assist patients to complete the CDB application.Posters to let patients know that can apply for the benefit.Posters for program sign-up clinics held in the community.No.AdvocacyWould you like to participate in advocacy issues on any of the following?* Would you like to participate in advocacy issues on any of the following?*Check all that apply.Advocate for OHIP billing for all benefit application forms for low income patients, including the federal Disability Tax Credit Certificate.The use of the Disability Tax Credit to define disability and barriers it creates.Canada Disability Benefit on issues regarding the annual amount or other program issues.Other issues related to poverty and/or disability.Form fee assistance for patients.No.Contact 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:You don't need to fill out your contact information to leave a message.
