What My Fiscal Intermediary Means to Me: Story Bank Registration

Please complete this form if you are interested in your story being shared with the public as part of CDANY's efforts to prevent New York State from shutting down its entire fiscal intermediary system and replacing it with one single company.

By providing information here, you agree to be contacted by CDANY and may be asked to speak to the media or interviewed.

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* 1. I am a

Consumer who uses CDPAP.

Designated representative who helps a consumer self-direct their own services

Personal assistant (worker)

Other (please specify)

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* 2. What is your name?

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* 3. What town/city do you live in?

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* 4. Phone Number

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* 5. Email Address

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* 6. Do you prefer to be contacted by phone or email?

Phone