Introduction

This survey is for vendors that deliver attendant care, respite, hourly-habilitation, IDLA, and homemaker services.

For the purposes of this survey, a DCW is a provider that delivers any of the identified services.

Please only provide information as it pertains to the services outlined in this survey for DDD. If your agency provides addition services do your best to estimate the portion of information that applies to these services for DDD members.

We understand that you've provided answers to many of these questions in prior survey rounds. To ensure we can trend information reliably over time by survey we need the answers repeatedly so we appreciate you providing them again. Please save your answers so you can reuse them in additional surveys.

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* 1. What is your organizations name?

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* 2. Please enter your AHCCCS ID

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* 3. Please enter your Employer ID

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* 4. Please enter the following contact information:

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* 5. Do you provide attendant care (ATC), respite (RSP/RSD), hourly habilitation (HAH), hourly and daily individual living habilitation (HAI, HID) and homemaker (HSK) services?

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