2019 Q3 DHS Quarterly Report on Consumers Enrolled in CCS, F-02069 (09/2019)

Please submit your enrollment data for the third quarter of 2019 (reporting period of July 1 to September 30, 2019) by completing this survey by October 20, 2019. A separate survey must be submitted for each Comprehensive Community Services (CCS) program or county within a CCS region. After submitting, you will receive an email confirming the survey was successfully completed; the email will also include a copy of the survey answers for your records. Any questions can be directed to Kathryn VerPlanck. Thank you!

1. Select the name of the county or tribe contracting for or directly operating your CCS. *This question is required.

2. Select the formal name of the CCS regional entity that operates your CCS. *This question is required.

3. Enter the name of the person responsible for completing this survey. *This question is required.

4. What is your email address? *This question is required. This question requires a valid email address.

5. Report the number of CCS consumers being served at the end of the last quarter (2019 quarter two).

This number should match the number reported on last quarter's survey under "Number being served at the end of this quarter." *This question is required. This question requires a valid number format.

6. If for any reason the number you reported above does NOT match the number served at the end of last quarter (as reported last quarter under "the number served at the end of this quarter"), provide an explanation for the discrepancy, including how you plan to address the issue in the future.

7. Report the number of CCS consumers admitted during this quarter. *This question is required. This question requires a valid number format.

8. Report the number of CCS consumers discharged during this quarter. *This question is required. This question requires a valid number format.

9. Report the number of CCS consumers being served at the end of this quarter.

This value should equal the number served at the beginning of this quarter/end of last quarter plus the net value of consumers admitted and consumers discharged during this quarter. For example, if:

Five consumers were being served at the beginning of this quarter/end of last quarter
Three were admitted during this quarter
Two were discharged during this quarter
Six consumers should be reported as being served at the end of this quarter (5+3-2= 6).

*This question is required. This question requires a valid number format.