Introduction and Contact Information:

Please only provide information as it pertains to the services outlined in this survey for DDD. If your agency provides additional 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.

Please enter 0 or N/A if you are unable to provide information or if the question is not applicable

Question Title

* 2. Please Enter Your Contact Information:

Question Title

* 3. Please enter AHCCCS ID:

Question Title

* 4. Please enter Employer ID:

Question Title

* 5. Does your agency provide nursing supported group home services? (HAN)

T