AHCCCS/Medicaid & Federal Programs Impact Survey

Thank you for taking the time to share the importance of AHCCCS/Medicaid and other federal programs to you, your family and your community by completing this brief survey. We are collecting stories to help shine a light on the potential impacts of loss of federal funds to Arizonans like you. Your story will help our fight to protect vital services for children and families.
1.What is your first and last name?
2.Email address
3.Phone Number
4.Address
5.City
6.Zip code
7.Organization (if applicable)
8.How will the pause in federal funds harm you and/or children and families in your community?
9.Please select the program(s) that will have the biggest impact on you or the people you serve (please select no more than 3):(Required.)
10.To better understand the kinds of people who will be impacted, please tell us which of the following people in your story would be most affected by potential federal funding cuts (select all that apply):
11.Are you willing to (select all that apply):