Introduction

This survey is for Vendors that deliver attendant care, respite, hourly-habitation, IDLA, and homemaker.

For the purposes of this survey, a DCW is a provider that delivers any of the identified services.

Please only provide information as it pertains to the services outlined in this survey for DDD. If your agency provides addition services do your best to estimate the portion of information that applies to these services for DDD members.

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* 2. Please enter your AHCCCS ID

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* 3. Please enter your Employer ID

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* 4. Please enter the following contact information:

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* 5. Do you provide attendant care (ATC), respite (RSP/RSD), hourly habilitation (HAH), hourly and daily individual living habilitation (HAI, HID) and homemaker (HSK) services?

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