Contribute to Prompt Payment Efforts Question Title * 1. Organization Name: Question Title * 2. Your Name: Question Title * 3. Your e-mail address: Question Title * 4. Can we publish your organization's name in our report to the State of Alaska? (Your answers will remain confidential if you select no) Yes No Other (please specify) Question Title * 5. Which part of the state are your services delivered? (select all that apply) Anchorage Kenai Peninsula Interior Southwest Arctic Mat-Su Southeast Chugach/Copper River Aleutian/Kodiak Question Title * 6. Which state department do you receive funds (grants/contracts) from? Administration Commerce, Community & Economic Development Corrections Education & Early Development Environmental Conservation Family and Community Services Fish and Game Health Labor & Workforce Development Law Military and Veterans Affairs Natural Resources Public Safety Revenue Transportation & Public Facilities Other (please specify) Question Title * 7. In the last two years, what is the maximum length of time that your organization has waited for payment? 1 month 3 months 6 months 9 months 12 months more than 12 months None. We have not waited for payment. Question Title * 8. What is the amount of funds have you waited for (or are currently waiting for)? Less than $50,000 $50,000 - $250,000 $250,000 - $500,000 $500,000 - $1 million more than $1 million Question Title * 9. Briefly describe the impact of the delayed payments: Question Title * 10. Are you willing to testify before the Alaska State Legislature if needed? Yes No Other (please specify) Done