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1. What type of agency do you represent? 1. What type of agency do you represent? Aging Services Provider Area Agency on Aging Behavioral Health Provider Senior Center Family Services Organization Other (please explain)

2. What is the status of your interest in the Healthy IDEAS program? 2. What is the status of your interest in the Healthy IDEAS program? General information Funded and are ready to purchase the training and technical assistance needed for implementation Information to support a funding request for implementation resources Other (please explain)

3. We have multiple in‐person contacts with older adults at risk for depressive symptoms (chronic health conditions, functional disability, and social isolation) for a period of three to six months. 3. We have multiple in‐person contacts with older adults at risk for depressive symptoms (chronic health conditions, functional disability, and social isolation) for a period of three to six months. Yes No

4. We provide ongoing care to our clients over a period of at least 6 months or longer. 4. We provide ongoing care to our clients over a period of at least 6 months or longer. Yes No

5. In the past year, what was the average caseload per case manager for the program that would implement Healthy IDEAS? 5. In the past year, what was the average caseload per case manager for the program that would implement Healthy IDEAS? 1-10 10-20 20 or more

6. Estimate the number of Case Managers engaged in your current program. 6. Estimate the number of Case Managers engaged in your current program. 1-5 5-10 10 or more

7. Estimate the number of Number of management staff (Supervisors, Clinical Managers or Program Directors) engaged in your current program. 7. Estimate the number of Number of management staff (Supervisors, Clinical Managers or Program Directors) engaged in your current program. 1-5 5-10 10 or more

If you selected OTHER to any questions, please explain here.