It is expected that there will be some level of cuts to the ability of family to serve as PAs in the Governor's 30-day amendments. We are seeking information to help fight this cut.

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* 1. What is the name of your FI? (Will not be shared. Only collected to track responses.)

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* 2. Where does your FI operate? (Check all that apply, or Statewide)

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* 3. Please indicate the percentage (%) of your consumers in each age category.

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* 4. Please indicate the percentage (%) of your consumers in each racial and/or ethnic category. Please note that consumers may fall into more than one category. If you do not collect information on a particular category, please type N/A.

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* 5. Do you track whether or not a PA is of relation to the consumer?

T