Assisted bin collections consultation form 1. Are you aware of the waste assisted collections service that we offer to residents? (Required) Are you aware of the waste assisted collections service that we offer to residents? Please select ... Yes No 2. Are you aware that if you have a physical disability or mental health problems, are in receipt of Personal Independence Payment (PIP) and do not live with any other physically fit person over the age of 16, you are entitled to an assisted collection? (Required) Are you aware that if you have a physical disability or mental health problems, are in receipt of Personal Independence Payment (PIP) and do not live with any other physically fit person over the age of 16, you are entitled to an assisted collection? Please select ... Yes No 3. Are you aware that this includes a temporary assisted collection (up to a maximum of 6 months) due to loss of mobility, such as a broken leg or recovering from major surgery or treatment, whilst you are in this situation? (Required) Are you aware that this includes a temporary assisted collection (up to a maximum of 6 months) due to loss of mobility, such as a broken leg or recovering from major surgery or treatment, whilst you are in this situation? Please select ... Yes No 4. If you are an adult and you meet the criteria above, do you think your age is relevant when asking for assistance? (Required) If you are an adult and you meet the criteria above, do you think your age is relevant when asking for assistance? Please select ... Yes No 5. Please let us know where about in the city you live by giving us your postcode (Required) 6. Please provide any further comments