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* 1. Is/are your program(s) residential, outpatient, or both?

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* 2. Please indicate what type of payments your organization accepts:

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* 3. For residential, indicate how many beds you currently have (maximum capacity under normal circumstances)

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* 4. For outpatient, what is the maximum number of clients you can serve under normal circumstances?

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* 5. Has the COVID-19 virus reduced your capacity?

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* 6. Have there been changes to your staff due to the virus?

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* 7. Has the virus impacted the financial health of your organization?

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* 8. Please estimate, in dollars, what losses your organization stands to incur if the emergency, shelter in place, order stays in effect for 90 days:

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* 9. If you have furloughed or laid off employees, please indicate the number of employees released:

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* 10. Are you currently accepting new clients?

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* 11. If you are accepting new clients, please describe your efforts to prevent new clients from transmitting the virus:

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* 12. Should a client test positive for COVID-19, do you presently have personal protective devices (gowns, masks, gloves) to protect staff members from contracting the disease?

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* 13. CCAPP is working around the clock to address the needs of our programs and the clients you serve. Are there any needs you wish to communicate to us so that we can put them before the appropriate state government officials:

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