RCPA Member Survey: Facility Based Employment and Day Services

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* 1. Does your agency provide facility based employment services and/or day services?

Yes

No

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* 2. Do any of the individuals you serve desire or need a variance from the 25% community requirement? If so, please give approximate number of people needing a variance.

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* 3. How many individuals require the variance due to medical needs?

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* 4. How many individuals require the variance due to behavioral needs?

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* 5. How many individuals require a variance due to their personal choice?

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* 6. Do you expect a financial hardship for your agency due to the new rate for facility based service?

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* 7. Please enter your agency name and contact information.

Agency Name

Contact name

Email address