The study questionnaire was designed to be both short and simple in order to encourage the participation of busy government officials. Many questions were limited to multiple choice items. This limited the number of possible answers and may not have fully captured the variety of uses of the initiative or the varying stages of integration of the initiative into existing programs. An exhaustive questionnaire would likely have resulted in a much lower response rate. A second limitation relates to the selection of the individual to be responsible for completing the questionnaire on behalf of the respondent organization/agency. The degree to which respondents were familiar with their organization/agency’s use of the initiative cannot be verified. Another limitation is the inability to generalize some of the tribal health organization results because of the limited number of respondents. For example, while 75 percent of MTAHB responded to the survey, the actual number of respondents was only 7. Finally, no follow-up was made with respondents to verify reported information or retrieve missing data.