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* 1. What steps are you taking to prepare and respond to COVID-19?

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* 2. Are you able to telecommute (work from home)?

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* 3. Are you following advice from any of these organizations? Check all that apply:

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* 4. Are you sharing that advice with your staff and residents?

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* 5. What type of work do you do?

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* 6. Has any of your work been impacted due to COVID-19? If yes, can you list specifics?

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* 7. Have you experienced delayed payment due to COVID-19?

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* 8. If you are an owner or management agent, have you seen a significant impact on your residents?

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* 9. What could CMS offer you to help during this time?

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* 10. Optional Contact Information

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