Skip survey header

2020 Q4 DHS Quarterly Report on Consumers Enrolled in CCS, F-02069 (11/2020)

Please submit your enrollment data for the fourth quarter of 2020 (reporting period of October 1 to December 31, 2020) by completing this survey no later than January 20, 2020. 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! 
This question requires a valid email address.
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid number format.