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* 1. Are you aware of people in your county that have been or are proposed to be disenrolled in 2016 from the Ohio Home Care Waiver, PASSPORT Waiver, or Assisted Living Waiver?

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* 2. If your answer to Question 1 was "yes," what is the total number of people who have been disenrolled or are at risk of disenrollment from the Ohio Home Care Waiver?

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* 3. If your answer to Question 1 was "yes," what is the total number of people who have been disenrolled or are at risk of disenrollment from the PASSPORT Waiver?

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* 4. If your answer to Question 1 was "yes," what is the total number of people who have been disenrolled or are at risk of disenrollment from the Assisted Living Waiver?

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* 5. Who can we contact at your county board for additional questions?

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* 6. Do you have any additional comments you would like to share?

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