Q1: What is the URL/URI of the web page?
_______________________________

Q2: What is the best description for the purpose of the page?

1. Web-based application.
2. Online form for receipt of services or benefits.
3. Other online form.
4. Instructions for receipt of services or benefits.
5. Description of activities of your component.
6. Employment postings.
7. Inherently graphical content (e.g. map or photograph).
8. Other (describe): ___________________________________

Q3: Is the page available on the Internet, an agency Intranet, or some combination?

1. Intranet. Deployed only over internal Intranet.
2. Internet. Deployed over Internet - available to those outside agency.
3. Combination. Deployed over Internet, but containing some portions that are available only on agency terminals.

Q4: On a weekly basis, how many times (approximately) is this page accessed by users?

1. On a weekly basis, this page is accessed approximately ________ times.
2. We have no way to track this information.

Q5: Does each non-text element on the page have a text equivalent via "alt" (alternative text attribute) or does the page otherwise include a meaningful description of the non-text element in the text accompanying the non-text element?

1. Yes.
2. Yes and no. Some non-text elements have meaningful text equivalents while others do not.
3. No, none of the non-text elements have text equivalents.
4. N/A. There are no non-text elements on the page.

Q6: For any multimedia content, is text captioning provided for all audible output and audible output provided for all important visual information?

1. Yes.
2. Yes and no. Text captioning is not provided for audible output, but audio descriptions are provided for all important visual information.
3. Yes and no. Audio descriptions are not provided for all important visual information, but text captioning is provided for audible output.
4. No, neither is provided.
5. N/A. There is no multimedia content on the page.

Q7: Are all audio descriptions and text captions synchronized with their associated dynamic content?

1. Yes, text captioning for audible output and audible output for visual information is completely synchronized with changes in the dynamic content of the page.
2. Yes and no. Text captioning is not completely synchronized with audible output as the dynamic content of the page changes or is not provided, but the audio descriptions are synchronized to the important visual information they describe.
3. Yes and no. Audio descriptions are not synchronized to the important visual information they describe or they are not provided, but text captioning is synchronized with the audible output as the dynamic content of the page changes.
4. No. Both are provided but neither is synchronized.
5. N/A. There is no multimedia content on this page.

Q8: Is the page capable of being understood and navigated even if users do not have the ability to identify specific colors or differentiate between colors?

1. Yes, the page uses color appropriately.
2. No, the page does not use color appropriately.

Q9: If the page uses cascading style sheets or JavaScript style sheets, is it viewable without style sheets or with style sheets turned off or not supported by the browser?

1. Yes.
2. No.
3. N/A. The page does not use cascading style sheets or JavaScript style sheets.

Q10: If the page uses cascading style sheets or JavaScript style sheets, is it designed so that it does not interfere with style sheets set by the browser?

1. Yes, it works without interfering with style sheets set by the browser.
2. No, it interferes with any style sheets that have been set by the browser.
3. N/A. The page does not use cascading style sheets or JavaScript style sheets.

Q11: If the page includes any server-side image maps, are duplicate text links provided for all links within the server-side image maps?

1. Yes, each link in the server-side image maps is duplicated by a separate text link.
2. Yes and no. Some of the links from the server-side image maps are duplicated in separate text links while others are not.
3. No, redundant text links are not provided for any link from the server-side image maps.
4. N/A. The page does not include any server-side image maps.

Q12: If the page includes any server-side image maps, have you established a timetable to replace the server-side image maps with client-side image maps, except where the regions cannot be defined with an available geometric shape?

1. Yes.
2. No.
3. N/A. The page does not include any server-side image maps.

Q13: If the page includes one or more client-side image maps, does each map region have a text equivalent via "alt" (alternative text attribute) or does the page otherwise include a meaningful description of the non-text element in the text accompanying it?

1. Yes.
2. Yes and no. Some of the non-text elements associated with the image map(s) have text equivalents or a meaningful text description, while others do not.
3. No. None of the non-text elements associated with the image map(s) have text equivalents or meaningful text descriptions.
4. N/A. The page does not include any client-side image maps.

Q14: If the page includes data in tables (either HTML tables or preformatted text tables using the <PRE> tag), and if any of the tables has two or more rows (including header or data cells), does each cell provide identification of row and column headers?

1. Yes, the page includes tables, some of which have two or more rows, but each cell within the table includes identification of its row and column headers.
2. No. The page includes tables, at least one of which has two or more rows, but some cells within the table fail to identify row and column headers.
3. No, but.... The page includes tables, at least one of which has two or more rows, and not every cell within the table identifies row and column headers, but there is meaningful text on the page that conveys the same information as is contained in the table.
4. N/A. The page does not include any tables or includes tables of single rows only.

Q15: If the page uses frames, does each frame have a title that meaningfully describes it?

1. Yes.
2. No.
3. N/A. The page does not use frames.

Q16: Does the page include content (such as applets or content requiring plug-ins) that may cause the screen to flicker with a frequency greater than 2 Hz and lower than 55 Hz?

1. Yes.
2. No.

Q17: If the page uses scripts, such as JavaScript or scripts in Macromedia Flash content, and if the scripts affect any content displayed to the user, is there equivalent text provided by the page or the script that is accessible to a screen reader?

1. Yes. The page contains JavaScript or Macromedia Flash content that affects the content displayed to the user, but the page or script contains equivalent text that is accessible to a screen reader.
2. No. While the page contains JavaScript or Macromedia Flash content that affects the content displayed to the user, neither the page nor the script contains equivalent text that is accessible to a screen reader.
3. N/A. The page does not use JavaScript or Macromedia Flash content.

Q18: If the web page uses applets, such as downloadable Java applets, does it also contain the same information and functionality in an accessible format?

1. Yes, while the page uses applets, it contains the same information and functionality in an accessible format.
2. No, although the page uses applets, it does not contain the same information and functionality in an accessible format.
3. N/A. The page does not use any applets.

Q19: If the page uses other programmatic objects (such as Flash, Shockwave, RealAudio, or RealVideo content), or otherwise requires the use of plug-ins or programmatic support for the browser, does the page include a link to the plug-in or programmatic item required for accessing the content of the page and is that plug-in or programmatic item itself accessible to people with disabilities?

1. Yes, the page uses such programmatic objects and includes a link to the plug-ins or other items required for accessing the content of the page and those plug-ins or programmatic items are accessible to people with disabilities.
2. Yes and no. While the page uses such programmatic objects and includes a link to the plug-ins or other items required for accessing the content of the page, those plug-ins or programmatic items are not accessible to people with disabilities.
3. No, while the page uses such programmatic objects, it does not include a link to the plug-ins or other items required for accessing the content of the page.
4. N/A. The page does not use such programmatic objects.

Q20: If the page includes links to .pdf (Adobe Acrobat's portable document format) files, were those .pdf files created in a way that is likely to maximize their usability for people with disabilities?

1. Yes. While the page includes links to .pdf files, the files were created either by "printing to .pdf" or by scanning something into .pdf and then running them through an optical character recognition (OCR) process.
2. No, the page includes links to .pdf files that were created by scanning files into .pdf and were not put through an OCR process.
3. N/A. The page does not include any links to .pdf files.

Q21: If the page includes one or more electronic forms that is designed for completion online, does each form permit users of assistive technology to access the information, field elements, and functionality required for completion and submission of the form including all directions and cues?

1. Yes, the page contains one or more forms designed to be completed online. Each such form complies with all of the accessibility requirements that are the subject of this questionnaire and has been tested for usability by persons using assistive technologies.
2. Yes, but... The page contains one or more forms designed to be completed online. While each such form complies with all of the accessibility requirements that are the subject of this questionnaire, one or more of them has not been tested for usability by persons using assistive technologies.
3. Yes, but... The page contains one or more forms designed to be completed online. We have tested each of the forms using assistive technology, but we are not sure that each such form complies with all of the accessibility requirements that are the subject of this questionnaire.
4. No. The page contains one or more forms designed to be completed online, but at least one of these forms is inaccessible to people with disabilities, at least in one respect.
5. N/A. The page does not contain any forms designed to be completed online.

Q22: If the page contains one or more forms that is designed to be completed online but that is inaccessible to people with disabilities in some respect, does the page include an alternate accessible form or a link to an alternate accessible form?

1. Yes. While the page contains one or more forms that is designed to be completed online but that is inaccessible to people with disabilities in some respect, the page includes an alternate accessible form or a link to an alternate accessible form.
2. No. The page contains one or more forms designed to be completed online but that is inaccessible to people with disabilities in some respect and the page does not contain an alternate accessible form or a link to an alternate accessible form.
3. N/A. The page does not include one or more forms that is designed to be completed online or it does include such forms, but they are accessible to people with disabilities in all respects.

Q23: If the page includes navigational links to other web pages within the same website, is there a link allowing users of screen readers to skip over those links?

1. Yes.
2. No.
3. N/A. The page does not contain any navigational links to other web pages within the same website.

Q24: If the page requires users to respond within a fixed amount of time before the user is "timed out," is the user alerted that he or she will be timed out and given sufficient time to indicate that more time is required before actually being timed out?

1. Yes.
2. Yes and no. While the page warns users that they are about to be timed out, it does not give them an option to extend the length of time that the page will be kept open.
3. No. The page will time out users but does not provide prior warning or the ability to extend the length of time it will be kept open.
4. N/A. The page does not "time out" users, no matter how long a page is kept open.

Q25: Taking into consideration your responses to the previous questions, if the reviewed page likely contains barriers to access for people with disabilities, do you have an alternative text-only page that contains the same information and is updated as often as the reviewed page?

1. Yes.
2. Yes and no. While the page appears to contain barriers to access for people with disabilities and we have established a text-only alternate page, the text-only alternate page does not include the same information or is not updated as often as the reviewed page.
3. No. While the page appears to contain barriers to access for people with disabilities, we do not have an alternate text-only page.
4. N/A. The page does not appear to contain any barriers for people with disabilities, so we do not have an alternate text-only page.
5. N/A. Even though the page does not appear to contain any barriers to access for people with disabilities, we still maintain an alternate text-only page that contains the same information and is updated as often as the reviewed page.

Q26: Test this page for accessibility to persons with disabilities using assistive technology (including a screen reader, the Lynx public-domain text-only browser, or the IBM Home Page Reader). Describe the results of this test:

Q27: Describe the accessibility successes and challenges you identified during your evaluation of this page and any plans you have for addressing any problems on this and similar pages within your website: