This instrument was developed for the National Board and Care Survey project. This project was conducted by the Bureau of the Census under contract for the Department of Health and Human Services (HHS) Office of Disability, Aging and Long-Term Care Policy. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
| NOTE: This is a recreation of this form. See the PDF version for a scanned version of the actual form. |
QUESTIONNAIRE 6
Interagency Councils
(Complete one per state)
FIFTY STATE SURVEY OF AGENCIES INVOLVED
IN THE REGULATION OF BOARD AND CARE HOMES
| STATE: _________________________ AGENCY: _________________________ CONTACT: _________________________ POSITION: _________________________ | DATE: _________________________ INTERVIEWER: _________________________ |
| START TIME: _________________________ |
INTERAGENCY COUNCILS
1. Does the board and care program in your state have separate offices for activities relating to clients and facilities? (For example, licensure, enforcement, financing, client services.)
_____Yes Y = Yes
N = No
D = Don't Know_____No _____Don't Know
2. Is there a coordinating unit or interagency group for board and care within your state?
_____Yes Y = Yes
N = No
D = Don't Know_____No (IF NO, SKIP TO NEXT QUESTIONNAIRE.) _____Don't Know
3. What is the name of the coordinating unit? _________________________ Abbreviate as possible.
4. When was it begun? 19_____
5. What authority does this coordinating unit have over the other state agencies with responisibilities for board and care homes? _________________________
6. How is the coordinating unit funded? _________________________
7. Describe its accomplishments. (LIST EACH ACCOMPLISHMENTS SEPARATELY.)
A. _________________________ B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________
8. Describe its major limitations. (LIST EACH LIMITATION SEPARATELY.)
A. _________________________ B. _________________________ C. _________________________ D. _________________________ E. _________________________ F. _________________________
| ENDING TIME: _________________________ |