PAACT Providers: Federal Shutdown Impact Survey

Name

First

Last

Program

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Are you currently serving families who may be impacted by the federal shutdown (e.g., TSA employees)?

Approximately how many families in your program may be impacted?

What challenges are impacted families experiencing? (Select all that apply)

Other (if not listed above, please share any additional challenges impacted families are facing):

Have any families requested financial flexibility (e.g., payment plans, delayed payments)?

requested

How is this situation impacting your program? (Select all that apply)

Other (please share any additional ways this situation is affecting your program):

What support would be most helpful to your program right now? (Select all that apply)

Other (please specify any additional supports that would be helpful to your program at this time):

Is there anything else you would like to share about how this situation is affecting your program or families?