2022 BRFSS IGA.PDF

Maricopa County — Formal (2022-04-20)

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INTERGOVERNMENTAL AGREEMENT 
MARICOPA COUNTY  
by and through the 
DEPARTMENT OF PUBLIC HEALTH 
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012 
 
1. 
Agreement No:  RGA2022-001  
 
2.        Agreement Type: Fixed Price 
     
3. 
Agreement Amount: $115,000 (Year 1) 
4.        Purpose: BRFSS Survey 
   
5. 
Start Date:    
January 1, 2022                 
6.        Expiration Date:  July 31, 2023  
        
                                                      
 
 
This Agreement is entered into by and between the Arizona Department of Health Services (ADHS) 
(referred to herein as “Contractor”), and Maricopa County, by and through its Department of Public Health 
(MCDPH) (referred to hereinafter as “County”).  Contractor and the County are collectively referred to 
herein as the “Parties'' and individually as a “Party.”  Contractor, for and in consideration of the covenants 
and conditions set forth herein, shall provide and perform the services as set forth below.  All rights and 
obligations of the Parties shall be governed by the terms of this Agreement, its exhibits, attachments, and 
appendices, including any subcontracts or amendments as set forth herein and in: 
 
Section I 
- 
General Provisions 
 
Section III 
- 
Work Statement 
Section II 
- 
Special Provisions 
 
Section IV 
- 
Compensation  
 
This Agreement contains all the terms and conditions agreed to by the Parties.  No other understanding, 
oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind the 
Parties.  Nothing in this Agreement shall be construed as consent to any lawsuit or waiver of any defense 
in a lawsuit brought against the County or the Contractor in any State or federal Court. 
 
 
Legal Notice under this Agreement shall be given by personal delivery or by registered or certified mail, 
postage prepaid, return receipt requested, to the addresses set forth below and shall be effective upon 
receipt by the Party to whom addressed unless otherwise indicated in the notice. 
 
Notice to Contractor: Office Chief, Arizona Health Disparities Center, ADHS 
Phone 602-542-2849 
Address:   
150 N. 18th Avenue, Phoenix, AZ 85007  
 
 
 
 
Notice to Department:  MCDPH Grants/Contract Unit 
 
 
 
Phone:  (602) 372-0674 
 
 
  
Address:                   4041 North Central Avenue, Suite #1400, Phoenix, Arizona  85012

SECTION I                                                                                                         GENERAL PROVISIONS 
 
2 
 
 
 
IN WITNESS WHEREOF, the parties enter into this Agreement: 
 
 
 
       
ARIZONA DEPARTMENT OF HEALTH SERVICES 
 
MARICOPA COUNTY BOARD OF SUPERVISORS 
 
 
 
Signature 
 
 
 
 
Signature 
 
 
 
Name 
Christopher Balderrama 
 
 
 
Name 
 
 
Bill Gates 
 
 
Title 
Procurement Services Supervisor 
 
 
 
Title 
 
 
Chairman, Board of Supervisors 
 
 
Date 
 
 
 
 
Date 
 
 
 
 
 
ATTEST: 
Signature 
 
 
ADHS Contract # RGA2022-001 
 
 
 
Date 
Juanita Garza, Clerk of the Board 
 
 
Pursuant to A.R.S. § 11-952, the undersigned public agency 
attorney has determined that this Intergovernmental 
Agreement is in proper form and is within the powers and 
authority granted under the laws of the State of Arizona. 
 
 
Pursuant to A.R.S. § 11-952, the Attorney for the Board of 
Supervisors has determined that this Intergovernmental 
Agreement is within the powers and authority granted under the 
laws of the State of Arizona. 
 
Signature 
 
 
Signature 
 
 
Date 
 
 
Date 
Anne Longo, Attorney for Maricopa County

SECTION I                                                                                                         GENERAL PROVISIONS 
 
3 
 
 
 
1. EFFECT 
 
To the extent the Special Provisions are in conflict with the General Provisions, the 
Special Provisions shall control.  To the extent the Work Statement(s) and the Special 
or General Provisions are in conflict, the Work Statement(s) shall control. 
 
2. DEFINITIONS 
 
As used throughout this Agreement, the following terms shall have the following 
meanings: 
 
A. Agreement means this document and all attachments and amendments hereto. 
 
B. Contractor means the person, firm or organization listed on the Cover Page of 
this Agreement. 
 
C. County means Maricopa County, Arizona. 
     
D. Department means the Maricopa County Department of Public Health. 
 
E. Funding Source means any federal, State, or private agency funding source, 
which may impose conditions on the funding that will be passed on to the 
Contractor. 
 
F. Contractor Staff, Employee or Faculty means a person or persons employed 
by, contracted with, or retained by the Contractor for the purpose of providing the 
services and responsibilities contained in this Contract. 
 
G. HIPAA  means the Health Insurance Portability and Accountability Act of 1996 (PL 
104-191) and the United States Department of Health and Human Services 
(DHHS) final regulations on “Privacy Standards for Individually Identifiable Health 
Information”, as amended and clarified from time to time. 
 
3. GENERAL REQUIREMENTS 
 
A. The terms of this Agreement shall be construed in accordance with Arizona law.  
Any lawsuit arising out of this Agreement shall be brought in the appropriate court 
in Maricopa County. 
 
B. The Contractor shall, without limitation, obtain and maintain all licenses, permits, 
and authority necessary to do business, render services, and perform work under 
this Agreement, and shall comply with all laws regarding unemployment insurance, 
disability, and workers’ compensation. 
 
C. The Contractor is an independent contractor in the performance of work and the 
provision of services under this Agreement and is not to be considered an officer, 
employee, or agent of the County. 
 
4. AMENDMENTS

SECTION I                                                                                                         GENERAL PROVISIONS 
 
4 
 
 
 
All Amendments to this Agreement must be in writing and signed by authorized 
persons for both Parties.  All amendments shall clearly state the effective date of the 
action. 
 
 
5. ADEQUACY OF RECORDS 
 
If the Contractor's books, records and other documents related to this Agreement are 
not sufficient to support and document that allowable services were provided to eligible 
clients, the Contractor shall reimburse the County for the services not adequately 
supported and documented. 
 
6. RETENTION OF RECORDS 
 
A.  This provision applies to all financial and programmatic records, supporting 
documents, statistical records, and other records of the County and Contractor that 
relate to this Agreement. 
 
B. The County and Contractor shall retain all financial books, records, and other 
documents related to this Agreement for five (5) years after final payment or until 
after the resolution of any audit questions, which could be more than five (5) years, 
whichever is longer.  County, federal, or State auditors, and any other persons duly 
authorized by the County, shall have full access to and the right to examine, copy 
and make use of any and all such financial books, records and other documents. 
 
7. ASSIGNMENT AND SUBCONTRACTING 
 
No rights, liability, obligations or duties under this Agreement may be assigned, 
delegated, or subcontracted without the prior written approval of the County and 
Contractor. 
 
8. AUDIT DISALLOWANCES 
 
A. The Contractor shall, upon written demand therefore, reimburse the County for any 
payments made under this Agreement that are disallowed, by a federal, State or 
County audit in the amount of the disallowance, as well as court costs and attorney 
fees the County incurs to pursue legal action relating to a disallowance. 
 
B. If the County determines that a cost for which payment has been made is a 
disallowed cost, the County shall notify the Contractor in writing of the disallowance 
and the required course of action, which shall be at the option of the County either 
to adjust any future claim submitted by the Contractor by the amount of the 
disallowance or to require immediate repayment of the disallowed amount by the 
Contractor. 
 
C. The County shall, upon review and agreement of the Parties, remit to the 
Contractor any payments determined to have been insufficiently paid, in the 
amount of the payment shortfall, as well as court costs and attorney fees the 
Contractor incurs to pursue legal action relating to such short payment.

SECTION I                                                                                                         GENERAL PROVISIONS 
 
5 
 
 
 
9. AGREEMENT COMPLIANCE MONITORING 
 
County may monitor the Contractor's compliance with, and performance under, the 
terms and conditions of this Agreement.  On-site visits for compliance monitoring may 
be made by the County and/or its grantor agencies at any time during the Contractor's 
normal business hours, announced or unannounced.  During an on-site visit, the 
Contractor shall make its records and documents related to work performed or 
services provided under this Agreement available to the County for inspection and 
copying. 
 
10. AVAILABILITY OF FUNDS 
 
A. The provisions of this Agreement relating to the payment for services shall become 
effective when funds assigned for the purpose of compensating the Contractor, as 
provided herein, are actually available to the County for disbursement.  The 
Department shall be the sole authority in determining the availability of funds under 
this Agreement and the County shall keep the Contractor fully informed as to the 
availability of funds. The County shall refer no clients to Contractor for periods of 
time for which funding is not available unless at the discretion of both parties, an 
alternate source of funds is made available to continue the medical service. 
 
 
B. If any action is taken by any State agency, federal department, or any other agency 
or instrumentality to suspend, decrease, or terminate its fiscal obligations under or 
in connection with this Agreement, the County may amend, suspend, decrease, or 
terminate its obligations under or in connection with this Agreement.  If this 
Agreement is terminated, the County shall be liable for payment only for services 
rendered prior to the effective date of the termination, provided that such services 
are performed in accordance with the provisions of this Agreement.  The County 
shall give written notice of the effective date of any suspension, amendment, or 
termination under this section at least ten (10) days in advance. 
 
11. CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS 
 
A. The Contractor shall, during the term of this Agreement, immediately inform the 
County in writing of the award of any other contract or grant where the award of 
such contract or grant may affect either the direct or indirect costs being paid or 
reimbursed under this Agreement.  Failure by the Contractor to notify the County 
of such award shall be considered a material breach of this Agreement and the 
County may immediately terminate this Agreement without liability. 
 
B. County may request, and the Contractor shall provide within a reasonable time, 
not exceeding ten (10) working days, a copy of such other contract or grant, when, 
in the opinion of the Department, the award of the contract or grant may affect the 
costs being paid or reimbursed under this Agreement. 
 
C. If the County determines that the award to the Contractor of such other contract or 
grant has affected the costs being paid or reimbursed under this Agreement, the 
County shall prepare an amendment to this Agreement effecting a cost adjustment.  
If the Contractor disputes the proposed cost adjustment, the dispute shall be

SECTION I                                                                                                         GENERAL PROVISIONS 
 
6 
 
 
 
resolved pursuant to the "Disputes'' clause section contained herein. 
 
12. DEFAULT 
 
For material breach of contractual obligations, or upon the happening of any event 
which would jeopardize the ability of the Contractor to perform its contractual 
obligations, the County may suspend, modify, or terminate this Agreement 
immediately upon giving written notice to the Contractor in the event of non-
performance of any stated objectives. Unless expressly stated otherwise in this 
Agreement, such determination will not be made until such time as the disputes 
process has been exhausted.   
 
13. TERMINATION 
 
A. Either Party may terminate this Agreement at any time by giving the other Party at 
least thirty (30) calendar days prior written notice.  The notice shall be given by 
personal delivery or by registered or certified mail, postage prepaid, return receipt 
requested. 
 
B. This Agreement may be terminated by mutual written agreement of the Parties 
specifying the termination date therein. 
 
C. The County may terminate this Agreement upon twenty-four (24) hour notice when 
the County deems the health or welfare of a patient is endangered or the 
Contractor’s non-compliance jeopardizes funding source financial participation.  If 
not terminated by one of the above methods, this Agreement will terminate upon 
the expiration date of this Agreement as stated on the Cover Page of this 
Agreement. 
 
D. Either Party has the right to terminate this Agreement for cause upon fourteen (14) 
working days written notice for any of the following reasons: 
 
(1) Breach of this Contract which is not corrected within fourteen (14) working days 
after written notice thereof or registered mail, return receipt requested. 
 
(2) Inability to discharge the duties and responsibility under this Contract for a 
continual period of 30 days or more. 
 
E. This contract is subject to cancellation in accordance with the provision of A.R.S. 
§ 38-511. 
 
14. SEVERABILITY 
 
Any provision of this Agreement that is determined to be invalid, void, or illegal by a 
court shall in no way affect, impair, or invalidate any other provision hereof, and the 
remaining provisions shall remain in full force and effect. 
 
15. STRICT COMPLIANCE 
 
Acceptance by the County of performance that is not in strict compliance with the terms

SECTION I                                                                                                         GENERAL PROVISIONS 
 
7 
 
 
 
of this Agreement shall not be deemed to waive the requirement of strict compliance 
for all future performance. All changes in performance obligations under this 
Agreement must be in writing and signed by the Parties. 
 
16. NON-LIABILITY 
 
A. The County and its officers, representatives, agents, and employees shall not be 
liable for any act or omission by the Contractor or any subcontractor, employee, 
officer, agent, or representative of the Contractor or any subcontractor occurring 
in the performance of this Agreement, nor shall they be liable for purchases or 
contracts made by the Contractor or any subcontractor in connection with this 
Agreement. 
 
B. The Contractor and its officers, representatives, agents, and employees shall not 
be liable for any act or omission by the County or any County subcontractor, 
employee, officer, agent, or representative of the County or any County 
subcontractor occurring in the performance of this Agreement, nor shall they be 
liable for purchases or contracts made by the County or any County subcontractor 
in connection with this Agreement. 
 
17. INDEMNITY 
 
Each Party (as “Indemnitor”) agrees to indemnify, defend, and hold harmless the other 
Party (as “Indemnitee”) from and against all claims, losses, liability, costs, and 
expenses (including reasonable attorneys’ fees) (hereinafter collectively referred to as 
“Claims”) arising out of bodily injury of any person (including death) or property 
damage, but only to the extent that such Claims, which result in vicarious liability to 
Indemnitee, are caused by the act, omission, negligence, misconduct, or other fault of 
Indemnitor, its officers, agents, employees, or volunteers.  
 
18. COVENANT AGAINST CONTINGENT FEES 
 
The Contractor warrants that no person or entity has been employed or retained to 
solicit or secure this Agreement upon an agreement or understanding for a 
commission, percentage, brokerage, or contingent fee.  For breach or violation of this 
warranty, the County may immediately terminate this Agreement without liability. 
 
19. SAFEGUARDING CLIENT INFORMATION 
 
The use or disclosure by any Party of any information concerning an eligible individual 
served under this Agreement is directly limited to the performance of this Agreement. 
County and Contractor shall safeguard confidential and privileged client and patient 
information i.e., medical, financial and patient specific information, and shall only 
disclose such information in accordance with all applicable federal, state and local 
laws, rules, and/or regulations, including HIPAA. The use or disclosure by any party of 
any information concerning a client or patient served under this Agreement or any 
other applicable payer contract is directly limited to services under this Agreement 
subject to applicable federal, state and local laws, rules and/or regulations.  
Contractor’s obligation to maintain the confidentiality of all medical, financial and 
patient specific information shall exist after termination or expiration of this Contract.

SECTION I                                                                                                         GENERAL PROVISIONS 
 
8 
 
 
 
County shall assist Contractor with regard to Contractors’ obligation to comply with 
HIPAA. 
 
  
20. RIGHTS IN DATA 
 
The Parties shall have the use of data and reports resulting from this Agreement 
without cost or other restriction, except as otherwise provided herein or by law.  Each 
Party shall supply to the other Party, upon request, any available information known 
to the supplying Party that is relevant to this Agreement and to the performance 
hereunder. 
 
21. OWNERSHIP OF INFORMATION 
 
Subject to applicable state and federal laws, rules and regulations, including, without 
limitation, those concerning confidentiality of patient records, the Contractor shall have 
full and complete ownership rights to and the sole and exclusive right to inspect, 
reproduce, duplicate, adapt, distribute, display, disclose and otherwise use all reports, 
information, data and material prepared by the Contractor in performance of the 
Agreement. County may examine and may receive copies of such information 
necessary for County's performance of this Agreement. 
 
22. NON-DISCRIMINATION 
 
The Contractor, in connection with any service or other activity under this Agreement, 
shall not in any way discriminate against any person on the grounds of race, color, 
religion, sex, national origin, age, disability, affiliation or belief.  The Contractor shall 
include this clause in all its subcontracts related to this Agreement. 
 
23. EQUAL EMPLOYMENT OPPORTUNITY 
 
The Contractor shall not discriminate against any employee or applicant for 
employment because of race, age, disability, color, religion, sex, or national origin.  
The Contractor shall take affirmative action to ensure that applicants are employed 
and that employees are treated during employment without regard to their race, age, 
disability, color, religion, sex, or national origin.  Such action shall include, but is not 
limited to, the following:  employment, upgrading, demotion or transfer, recruitment, or 
recruitment advertising, lay-off or termination, rates of pay or other forms of 
compensation, and selection for training, including apprenticeship.  The Contractor 
shall, to the extent such provisions apply, comply with Titles VI and VII of the Civil 
Rights Act of 1964, as amended (42 U.S.C. §§ 2000a, et seq.); the Rehabilitation Act 
of 1973, as amended (29 U.S.C. §§ 701, et seq.); the Age Discrimination in 
Employment Act of 1967, as amended (29 U.S.C. §§ 621, et seq.); the Immigration 
Reform and Control Act of 1986 (Pub. L. No. 99-603) (“IRCA”); and Arizona Executive 
Order 2009-09, which mandates that all persons shall have equal access to 
employment opportunities.  The Contractor shall also comply with all applicable 
provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. §§ 12101, et seq.). 
 
24. RIGHT OF PARTIAL CANCELLATION

SECTION I                                                                                                         GENERAL PROVISIONS 
 
9 
 
 
 
If more than one activity is funded by this Agreement, the County reserves the right to 
terminate this Agreement or any part thereof based on the Contractor's failure to 
perform any part of this Agreement without impairing, invalidating or canceling the 
remaining Work Statement obligations. 
 
 
25. RIGHT TO EXTEND AGREEMENT 
 
Subject to the availability of funds and acceptable Contractor performance, the 
Contractor hereby acknowledges and agrees that the County shall have the right to 
extend this Agreement for additional one-year periods, not to exceed a total extended 
term of five (5) years, except that the cost will be subject to renegotiation.  Any 
extension of this Agreement shall be in writing mutually acceptable to the Department 
and the Contractor and signed by both Parties. 
 
26. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION 
 
A.  The undersigned, an authorized representative of the Contractor, certifies, to the 
best of his or her knowledge and belief, that the Contractor, defined as the primary 
participant in accordance with 45 C.F.R. Part 76, and its principals: 
 
1)  are not presently debarred, suspended, proposed for debarment, declared 
ineligible, or voluntarily excluded from covered transactions by any federal 
department or agency; 
 
2)  have not within the 3-year period preceding this Agreement been convicted of 
or had a civil judgment entered against them for the commission of fraud or a 
criminal offense in connection with obtaining, attempting to obtain, or 
performing a public (federal, State or local) transaction or contract under a 
public transaction; violation of federal or State antitrust statues or commission 
of embezzlement, theft, forgery, bribery, falsification or destruction of records, 
making false statements, or receiving stolen property;  
 
3)  are not presently indicted or otherwise criminally or civilly charged by a 
government entity (federal, State or local) with the commission of any of the 
offenses enumerated in paragraph (2) of this certification; and 
 
4)  have not within the 3-year period preceding this Agreement had one or more 
public transactions (federal, State or local) terminated for cause or default. 
 
B.   If the Contractor is not able to provide this certification, an explanation as to why 
shall be attached to this Agreement. 
 
C.   The Contractor shall include, without modification, this Paragraph in all lower tier 
covered transactions (i.e., transactions with subcontractors) and in all solicitations 
for lower tier covered transactions related to this Agreement. 
 
27. E-VERIFICATION OF EMPLOYEES 
 
The Contractor warrants that it is in compliance with A.R.S. § 41-4401 and further

SECTION I                                                                                                         GENERAL PROVISIONS 
 
10 
 
 
 
acknowledges: 
  
A. That the Contractor and its subcontractors, if any, warrant their compliance with all 
federal immigration laws and regulations that relate to their employees and their 
compliance with A.R.S. § 23-214; 
  
B. That a breach of the warranty under subsection A above shall be deemed a 
material breach of this Agreement that entitles the County to, among other things, 
immediately terminate this Agreement without liability; 
  
C.  That the County and any contracting government entity retains the legal right to 
inspect the papers of any contractor or subcontractor employee who works on this 
Agreement to ensure that the contractor or subcontractor is complying with the 
warranty provided under subsection A above and that the contractor agrees to 
make all papers and employment records of said employee(s) available during 
normal working hours in order to facilitate such an inspection;  
 
D.   That nothing herein shall make any contractor or subcontractor an agent or 
employee of the County or contracting government entity. 
 
28. DISPOSITION OF PROPERTY 
 
All property acquired with funds provided for in this agreement shall become the 
property of the funding source.

SECTION II 
 
 
                                                                            SPECIAL PROVISIONS        
11 
 
 
 
1. EFFECT 
 
To the extent that the Special Provisions are in conflict with the General Provisions, the 
Special Provisions shall control.  To the extent that the Work Statement(s) are in conflict with 
the Special or General Provisions, the Work Statement(s) shall control. 
 
2. DISPUTES 
 
Except as otherwise provided by law, or otherwise specifically agreed to by the Parties, any 
dispute not involving a question of law arising out of this Agreement that is not resolved 
between the Parties within a reasonable time, which shall not exceed 120 days, shall be 
resolved as follows:  
 
A. Disputes must be filed with the person administering this Agreement for the 
County, if one has been appointed, or, if not, with the Procurement Officer, within 
ten (10) days from the date the Contractor knew or should have known the basis 
of the dispute.  
 
B. The person administering this Agreement or the Procurement Officer, as 
applicable, shall respond in writing to the dispute within fourteen (14) days.  
 
C. The Contractor may abide by the decision or may appeal the decision to the 
Director of the Department within seven (7) days. 
 
D. Any claim or controversy arising out of or in connection with this Agreement not 
resolved in accordance with paragraphs 2.A. through 2.C. above shall be resolved 
through binding arbitration conducted by a single arbitrator in accordance with the 
American Arbitration Association (AAA) Commercial Arbitration Rules, then in 
effect, in Phoenix, Arizona; provided, however, matters that primarily involve 
Provider's professional competence or conduct shall not be eligible for arbitration. 
If possible the arbitrator shall be an attorney with at least fifteen {15) years of 
experience, including at least five (5) years' experience in managed health care. 
The parties shall conduct a mandatory settlement conference at the initiation of 
arbitration, to be administered by AAA. The arbitrator shall have no authority to 
provide a remedy or award damages that would not be available to such prevailing 
party in a court of law, nor shall the arbitrator have the authority to award punitive 
damages. Each party shall bear its own costs and expenses, including its own 
attorneys' fees, and shall bear an equal share of the arbitrator's and administrative 
fees of arbitration. The parties agree to accept any decision by the arbitrator as a 
final determination of the matter in dispute, and judgment on the award rendered 
by the arbitrator may be entered in any court having jurisdiction. Arbitration must 
be initiated within one year of the earlier of the date the claim or controversy arose, 
was discovered or should have been discovered with reasonable diligence; 
otherwise it shall be deemed waived. The use of binding arbitration shall not 
preclude a request for equitable and injunctive relief made to a court of appropriate 
jurisdiction. 
 
This Paragraph shall not apply to claims arising from bodily injury, death, or property 
damage.

SECTION II 
 
 
                                                                            SPECIAL PROVISIONS        
12 
 
 
 
3. CHANGES 
 
A. The Department may, at any time, by written order, make changes within the general 
scope of this Agreement in any one or more of the following areas: 
 
1) Work Statement activities reflecting changes in funding source or County regulations, 
policies, or requirements.   
 
2) Administrative requirements, such as changes in reporting periods, frequency of 
reports, or report formats, required by funding source or County regulations, policies, 
or requirements. 
 
3) Contractor reimbursement schedules and/or program budgets. 
  
B. The order will not increase or decrease the maximum reimbursable amount to be paid the 
Contractor.  Additionally, the order will not direct substantive changes in services to be 
rendered by the Contractor. 
 
C. Any dispute or disagreement caused by such order shall constitute a "Dispute" within the 
meaning of the Disputes Clause of the Special Provisions of this Agreement and shall be 
administered accordingly. 
 
4. AUDIT REQUIREMENT 
 
A. If the Contractor expends $750,000 or more in a year in federal awards, the Contractor 
shall have a single audit conducted for that year according to the Office Management and 
Budget, Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE 
REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL 
AWARDS contained in Title 2 C.F.R. § 200.  The audit report shall be submitted to the 
County for review within nine (9) months following the close of the fiscal year.  The 
Contractor shall take any necessary corrective action to remedy any material weaknesses 
and/or reportable conditions identified in the audit report within six (6) months after the 
release date of the report.  The County may consider sanctions as described in § .225 of 
OMB Circular A-133 for contractors not in compliance with the audit requirements.  All 
books and records shall be maintained in accordance with Generally Accepted Accounting 
Principles (GAAP). 
 
B. The Contractor shall schedule an annual financial audit to be submitted to the County for 
review within twelve (12) months following the close of the program’s fiscal year.  
Contractor understands that its failure to meet this requirement may result in the loss of 
current funding and disqualification from consideration for future County-administered 
funding. 
 
C. Comply with the requirement of the Federal Office of Management and Budget (“OMB”) 
Circular A-133.  The Contractor is responsible for having an audit performed in accordance 
with, and when required, by OMB Circular A-133, and for sending a copy of the report 
issued as a result of the audit to the County within thirty (30) days of issuance.  The County 
reserves the right to engage an auditor, at the Contractor’s expense, to perform an OMB 
Circular A-133 audit of the Contractor in the event that the Contractor fails to engage an 
auditor or the County rejects or disapproves of the auditor engaged by the Contractor.

SECTION II 
 
 
                                                                            SPECIAL PROVISIONS        
13 
 
 
 
5. INSURANCE 
 
A. The Contractor shall have in effect at all times during the term of this Agreement insurance 
or comparable self-insurance that is adequate to protect the County, its officers, 
employees, property, and equipment against the losses set forth below.  The Contractor 
shall provide the County with a certificate of insurance or a certified copy of the insurance 
policy naming the County as an additional insured, or, if the Contractor is self-insured, 
shall provide the County with a letter indicating that it is self-insured. 
 
B. The following types and amounts of insurance are required as minimums: 
 
1) Workers’ compensation and unemployment insurance as required by law.  
 
2)   Unemployment insurance as required by Arizona law. 
 
3) Public liability, bodily injury, and property damage policies that insure against claims 
for liability for the Contractor’s negligence or maintenance of unsafe vehicles, facilities, 
or equipment brought by clients receiving services pursuant to this Agreement and by 
lawful visitors of such clients.  The limits of the policies shall not be less than 
$2,000,000 per occurrence and $4,000,000 aggregate.  
  
C.  Automobile and Truck Liability, Bodily Injury and Property Damages: 
 
1) General liability, each occurrence; $1,000,000 
 
2) Property damage; $1,000,000 
 
3) Combined single limit; $1,000,000 
 
D. Standard minimum deductible amounts are allowable.  Any losses applied against 
insurance deductible are the sole responsibility of the Contractor. 
 
E.   Professional Liability: 
 
1) Insurance for the Contractor and its agents, employees, and other staff shall be 
maintained with coverage limits of one million dollars ($1,000,000) per person, three 
million dollars ($3,000,000) per occurrence. 
 
2) The Contractor agrees that in the event it, or any of its agents, employees, and other 
staff working under this Agreement, is named as a defendant in litigation, or is 
identified in a written notice of claim, wherein professional misconduct is alleged and 
such allegations arise under the services or terms of this Agreement, the Contractor 
will promptly notify the Department in writing.  The duty to notify under this paragraph 
applies whether or not the County is alleged to be involved, is named as a party to the 
matter, or could be potentially liable as a party. 
 
F. The Contractor shall immediately inform the Department of any cancellation of its 
insurance or any decrease in its lines of coverage at least thirty (30) days before such 
action takes place.

SECTION II 
 
 
                                                                            SPECIAL PROVISIONS        
14 
 
 
 
G. In the event the Contractor(s) is/are a public entity, then the Insurance Requirements shall 
not apply. Such a public entity shall provide a Certificate of Self-Insurance. If the 
Contractor(s) is/are a State of Arizona agency, board, commission, or university, none of 
the above shall apply. 
 
6. SPECIAL REQUIREMENTS 
 
A. If the use of subcontractors is approved by the County, the Contractor agrees to use 
written subcontracts or consultant agreements that conform to federal and State laws and 
regulations and the requirements of this Agreement appropriate to the service or activity 
covered by the subcontract.  These provisions apply with equal force to the subcontract 
as if the subcontractor were the Contractor.  The Contractor is responsible for performance 
under this Agreement whether or not any subcontractors are used.  The Contractor shall 
submit a copy of each subcontract to the County upon written request. 
 
7. REPORTING REQUIREMENTS 
 
If requested by the County, the Contractor shall submit annual progress reports on or before 
the third (3rd) day of the month following the end of the reporting period. 
   
8. STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST 
 
Pursuant to A.R.S. § 38-511, the County may cancel this Agreement without penalty or further 
obligation, within three years after execution of this Agreement, if any person significantly 
involved in initiating, negotiating, securing, drafting, or creating this Agreement on behalf of 
the County is, at any time while this Agreement or any extension of this Agreement is in effect, 
an employee or agent of any other Party to this Agreement in any capacity or is a consultant 
to any other Party to this Agreement with respect to the subject matter of this Agreement.  In 
addition, the County may recoup any fee or commission paid or due to any person significantly 
involved in initiating, negotiating, securing, drafting, or creating this Agreement on behalf of 
the County from any other Party to this Agreement arising as the result of this Agreement. 
 
9. POLICY ON CONFIDENTIALITY 
 
The Contractor and the County understand and agree that this Agreement is subject to all 
State and federal laws protecting client confidentiality of medical, behavioral health and drug 
treatment information. 
 
10. LAWS, RULES AND REGULATIONS 
 
The Contractor and the County understand and agree that this Agreement is subject to all 
State and federal laws, rules, and regulations that pertain hereto. 
 
11. SPONSORSHIP ACKNOWLEDGMENT 
 
All promotional materials, brochures, and flyers prepared by the Contractor relating to this 
Agreement shall include the following statement, “Sponsored by Maricopa County Department 
of Public Health.”

SECTION III 
 
 
                                                                                  WORK STATEMENT       
15 
 
 
 
1. BACKGROUND: 
 
The Arizona Behavioral Risk Factor Surveillance System (BRFSS) telephone survey has been 
in existence since 1984 and is partially funded by the Center of Disease Control and 
Prevention (CDC). This surveillance collects and summarizes the data on health-related 
topics as reported by Arizona adults aged 18 and over living at home. 
 
2. PURPOSE: 
 
Using a scientifically selected telephone sample, the BRFSS Survey is given to residents of 
Maricopa County, completed annually by ADHS.  This data is then used to supplement our 
community health assessment activities by providing social context to our health indicator 
data. Collection of this data will be used to reduce health disparities for all race/ethnicity 
groups, income levels, and geographic areas. 
 
In addition to the Centers for Disease Control (CDC) survey questions, this agreement 
includes State added questions regarding: Place of Flu Vaccination, (split 2) COVID 
Vaccination, (split 2), Reaction to Race, (split 2), and Social Determinants and Health Equity 
(split 1 & 2) into the BRFSS 2022 survey. 
 
A. The Arizona BRFSS 2022 is a split survey consisting of 8,000 partial and completed 
interviews each. Maricopa County questions will be in Split 2 of the AZ BRFSS 2022 
survey.  The Arizona Department of Health Services with CDC agreed to absorb the cost 
of the Social Determinant & Health Equity Modules which includes the Food Assistance 
questions) which will be in Split 1 and 2.  There is a sample expansion of 1,000 of 8,000 
interviews for Maricopa County which includes Hispanic oversample. 
  
B. Place of Flu question is to develop understanding about contextual effects on individual 
and community health, to quantify these effects, and to use this information to develop 
more effective strategies and interventions to improve health and to reduce or eliminate 
disparities in health. The Place of Flu consists of 1 question; Flu vaccination coverage has 
increased for adults over the past three flu seasons and has also been increasing for 
children. The racial/ethnic disparities in flu vaccination coverage persist. 
 
C. The COVID-19 Vaccination questions can help raise awareness of health disparities 
through understanding and intervening on individual-level risk factors for major causes of 
morbidity and mortality. Understanding coronavirus disease (COVID-19) surveillance can 
be enhanced by collecting population-level data on individual prevention measures. We 
described the use of a state-based, population-level surveillance system on COVID-19 
prevention and information-seeking behaviors in Arizona. 
 
D. Reaction to Race questions will help establish a baseline for socially-assigned 
race/ethnicity and other race reaction questions to help understand health equity and how 
race and health interact. Health disparities commonly exist between racial/ethnic groups. 
It is important to understand how one’s self-identified race/ethnicity and socially assigned 
race/ethnicity impact their perceived healthcare quality and health status.  
 
E. Sexual Orientation & Health Equity - Many health care providers do not routinely discuss 
sexual orientation or gender identity (SO/GI) with patients, and many health care facilities 
have not developed systems to collect structured SO/GI data from all patients. Without

SECTION III 
 
 
                                                                                  WORK STATEMENT       
16 
 
 
 
this information, lesbian, gay, bisexual, and transgender (LGBT) patients and their specific 
health care needs cannot be identified, the health disparities they experience cannot be 
addressed, and important health care services may not be delivered. Such services 
include appropriate preventive screenings, assessments of risk for sexually transmitted 
diseases and HIV, discussions about parenting, and effective interventions for behavioral 
health concerns that can be related to the experiences of anti-LGBT stigma.1 
 
3.   RESPONSIBILITIES OF CONTRACTOR (ADHS) 
 
A. Assign Arizona BRFSS Program Manager/Coordinator, Bureau of Public Health Statistics, 
to serve as a project liaison. 
 
B. Regularly communicate with Maricopa County, as needed, through the duration of the 
project to ensure project goals are achieved. 
 
C. Work in collaboration with MCDPH to conduct public relations activities about the project 
and findings from the survey. 
 
D. Include the following list of questions in the Arizona BRFSS 2022 questionnaire: CDC’s 
Place of Flu Vaccination Module (1 question) in survey split 2; CDC’s partial COVID 
Vaccination Module (2 questions) in survey split 2; CDC’s partial Reaction to Race Module 
(5 questions) in survey split 2; and CDC’s partial Sexual Orientation Module (2 questions) 
in survey split 1 & 2. 
 
E. Survey residents of Arizona in accordance with standard BRFSS survey processes and 
use the 9 questions of the CDC’s partial Modules as State-Added questions and one CDC 
Module in accordance with the policies and practices set forth by CDC and ADHS. 
 
F. Notify Maricopa County when the data from the BRFSS 2022 survey is ready to export 
from the AZ BRFSS website. 
 
G. Receive and accept a contribution of $115,000 from Maricopa County as restricted 
earmarked funds designated specifically toward the costs of the 10 questions as State-
Added and one CDC module in the 2022 BRFSS survey.   
 
H. Any notice or other communication to be given shall be in writing and may be personally 
served, sent by a recognized overnight courier or sent by U.S. mail, and shall be deemed 
to have been delivered or, if delivery is refused, when tendered for delivery properly 
addressed as directed below or to such other address later designated by a party in writing 
to the other party. 
 
4. RESPONSIBILITIES OF COUNTY 
 
A. Payment for the acquisition of the BRFSS 10 question(s) consisting of 9 State-Added 
questions and 1 CDC module. 
 
B. Effectively utilize the survey questions to design programs and allocate resources.

SECTION III 
 
 
                                                                                  WORK STATEMENT       
17 
 
 
 
5. SCOPE OF WORK:    
 
A. ADHS agrees to include the attached questions. See Attachment A. 
 
B. The IGA shall commence on January 1, 2022 and will expire on July 31, 2023.

SECTION IV 
                                                COMPENSATION 
 
 
18 
 
 
 
1. COMPENSATION 
 
A. The Contractor shall submit a detailed monthly invoice by the 25th of the following month. 
 
B. The Department shall, within thirty (30) working days from the date of receipt of 
Contractor’s invoice, process and remit to the Contractor a warrant for payment.  Should 
the Department make disallowance in the claim, the claim shall be processed to the 
reduced amount. The Contractor shall be notified at the address below in writing of the 
amount and reasons for any disallowances and shall be afforded the opportunity to 
document the appropriateness of the disallowed costs and to resubmit an invoice for 
payment. 
 
C. Each Party assumes sole and exclusive responsibility for payment of any federal and state 
income taxes, federal social security taxes, workers’ compensation, and unemployment 
insurance benefits for its physicians, staff, agents, and employees, as well as any and all 
other mandatory governmental deductions or obligations. 
 
D. The Agreement amount is not-to-exceed $115,000 for the budget period of January 1, 
2022 through July 31, 2023. 
 
2. METHOD OF PAYMENT 
 
 
A. The Contractor shall submit one (1) legible copy of their detailed invoice before payment(s) 
can be made.  At a minimum, the invoice must provide the following information: 
 
● Company name, address, and contact 
● County bill-to name and contact information 
● Contract Serial Number 
● County purchase order number 
● Invoice number and date 
● Payment terms 
● Date of service or delivery 
● Quantity  
● Contract Item number(s) 
● Description of Purchase (services) 
● Pricing per unit of service 
● Extended price 
● Total Amount Due 
 
B. Problems regarding billing or invoicing shall be directed to the using agency as listed on 
the Purchase Order 
 
C. The Contractor must maintain and have available upon request supporting documents for 
each monthly reimbursement request, including invoices of costs incurred and expenditure 
reports. 
  
D. Subject to the availability of funds, the County will, within thirty (30) working days from the 
date of receipt of documents enumerated herein, process and remit to the Contractor a 
warrant for payment up to the maximum total allowable for services provided.  Should the 
County make a disallowance in the claim, the claim shall be processed for the reduced

SECTION IV 
                                                COMPENSATION 
 
 
19 
 
 
 
amount.  If the Contractor protests the amount or the reason for a disallowance, the protest 
shall be construed as a dispute concerning a question of fact within the meaning of the 
“Disputes” clause of the Special Provisions of this Agreement. 
 
E. The Contractor understands and agrees that the County will not honor any claim for 
payment submitted six (6) months after the date of service.  The Contractor understands 
and agrees that the County will not process any claim for payment for services rendered 
prior to the expiration date that is submitted sixty (45) days after the expiration date without 
approval of the County. 
 
F. Payments made by the County to the Contractor are conditioned upon the timely receipt 
of applicable, accurate, and complete invoices submitted by the Contractor.  The 
Contractor forfeits the right to reimbursement for costs incurred in any month for which it 
fails to meet the deadline for submitting the monthly reports, except if such failure is 
beyond the reasonable control of the Contractor.   
 
G. The Contractor shall submit one invoice to: 
 
Maricopa County Department of Public Health  
Program Operations Administrator 
4041 N Central Ave, Suite #1400 
Phoenix, AZ 85006 
602-506-4926 
 
 
4.   PRICE SHEET 
 
BRFSS 2022 SURVEY 
 
ITEM 
# of Questions 
RATE/ question 
TOTAL 
Place of Flu 
Vaccination 
1 
$11,500 
$11,500.00 
COVID Vaccination 
2 
$11,500 
$23,000.00 
Reaction to Race 
5 
$11,500 
$57,500.00 
Sexual Orientation 
and Gender Identity  
 
2 
 
$11,500 
 
$23,000.00 
Grand Total 
10 
 
$115,000.00

SECTION IV 
                                                COMPENSATION 
 
 
20 
 
 
 
5. NOTICE 
 
Any notice given under this Agreement shall be sent to the attention of the following:  
 
Department 
Contractor 
Maricopa County Department 
Of Public Health 
Program Operations Administrator 
4041 N Central Ave, Suite #1400 
Phoenix, AZ 85006 
602-506-4926 
Office Chief, Arizona Health Disparities 
Center, ADHS 
150 N. 18th Avenue 
Phoenix, AZ 85007 
602-542-2849 
 
 
Public Health 
 
Grants and Contracts Unit 
 
Attn:  Grants Administrator 
 
4041 N Central Ave, Suite 1400 
 
Phoenix, AZ 85012

ATTACHMENT A 
21 
 
 
 
Module 4: Place of Flu Vaccination (Split 2) 
Questio
n 
Number 
 
Question 
text 
Variable 
names 
Responses 
(DO NOT 
READ 
UNLESS 
OTHERWISE 
NOTED) 
SKIP 
INFO/ 
CATI Note 
Interviewer Note 
(s) 
Column(
s) 
 
 
 
 
 
Ask if 
CIMM= 1 
This 
question 
may be 
inserted in 
core after 
CIMM.02 
 
 
MFP.01 
 
At what kind 
of place did 
you get 
your last flu 
shot or 
vaccine? 
IMFVPLA1 
 
Read if 
necessary: 
01 A doctor’s 
office or health 
maintenance 
organization 
(HMO) 
02 A health 
department 
03 Another 
type of clinic or 
health center 
(a community 
health center) 
04 A senior, 
recreation, or 
community 
center 
05 A store 
(supermarket, 
drug store) 
06 A hospital 
(inpatient or 
outpatient) 
  
Read if 
necessary: How 
would you 
describe the 
place where you 
went to get your 
most recent flu 
vaccine? 
If the respondent 
indicates that it 
was a drive 
through 
immunization 
site, ask the 
location of the 
site. If the 
respondent 
remembers only 
that it was drive 
through and 
cannot identify 
the location, 
code “11” 
348-349

ATTACHMENT A 
22 
 
 
 
07 An 
emergency 
room 
08 Workplace 
09 Some other 
kind of place 
10 A school 
11 A drive 
though location 
at some other 
place than 
listed above 
Do not read: 
77 Don’t know 
/ Not sure 
99 Refused 
AZ State-Added 5: COVID Vaccination (Split 2) 
 
Questio
n 
Number 
Question text 
Variable 
names 
Responses  
(DO NOT 
READ 
UNLESS 
OTHERWISE 
NOTED) 
SKIP INFO/ 
CATI Note 
Interviewer Note 
(s) 
Column(s) 
 
 
 
 
 
 
 
MCOV.0
1 
Have you 
received at 
least one dose 
of a  COVID-
19 
vaccination? 
 
¿Ha recibido 
al menos una 
dosis de la 
vacuna contra 
el COVID-19? 
***NEW*** 
1 Yes 
 
Go to next 
section 
 
 
2 No  
 
Go to 
MCOV.02 
(COVACGET
) 
7 Don’t know / 
Not sure 
9 Refused 
Go to next 
section 
MCOV.0
2 
Would you say 
you will 
definitely get a 
COVACGE
T 
1 = Will 
definitely get a 
vaccine  
Go to next 
section

ATTACHMENT A 
23 
 
 
 
vaccine, will 
probably get a 
vaccine, will 
probably not 
get a vaccine, 
will definitely 
not get a 
vaccine, or are 
you not sure? 
 
¿Diría que, 
seguramente 
se vacunará, 
probablement
e se vacunará, 
probablement
e no se 
vacunará, 
definitivament
e no se 
vacunará, o 
no está 
seguro? 
2 = Will 
probably get a 
vaccine  
3 = Will 
probably not 
get a vaccine  
4 = Will 
definitely not 
get a vaccine  
7 = Don’t 
know/Not sure  
9 = Refused  
 
1 = 
Seguramente 
se vacunará  
2 = 
Probablemente 
se vacunará  
3 = 
Probablemente 
no se vacunará  
4 = 
Seguramente 
no se vacunará 
AZ State-Added 8: Reactions to Race (Split 2) 
Question Number 
Question 
text 
Variable 
names 
Responses  
(DO NOT 
READ 
UNLESS 
OTHERWIS
E NOTED) 
SKIP INFO/ 
CATI Note 
Interviewer 
Note (s) 
Column(
s) 
AZRTR.05 
Earlier I 
asked you to 
self-identify 
your race. 
Now I will ask 
you how other 
people 
identify you 
and treat you. 
Within the 
past 12 
months, when 
seeking 
health care, 
do you feel 
your 
experiences 
were worse 
than, the 
same as, or 
better than for 
 
1 Worse 
than other 
races 
2 The same 
as other 
races 
3 Better than 
other races 
4 Worse 
than some 
races, better 
than others 
5   Only 
encountered 
people of the 
same race 
7 Don’t know 
/ Not sure 
9 Refused 
 
If the 
respondent 
indicates that 
they do not 
know about 
other people’s 
experiences 
when seeking 
health care, 
say: “This 
question is 
asking about 
your 
perceptions 
when seeking 
health care.  It 
does not 
require 
specific 
knowledge 
about other

ATTACHMENT A 
24 
 
 
 
people of 
other races? 
people’s 
experiences 
AZRTR.01 
 
How do other 
people 
usually 
classify you in 
this country?  
Would you 
say: White, 
Black or 
African 
American, 
Hispanic or 
Latino, Asian, 
Native 
Hawaiian or 
Other Pacific 
Islander, 
American 
Indian or 
Alaska 
Native, or 
some other 
group?  
 
01 White 
02 Black or 
African 
American 
03 Hispanic 
or Latino 
04 Asian 
05 Native 
Hawaiian or 
Other Pacific 
Islander 
06 American 
Indian or 
Alaska 
Native 
07 Mixed 
Race 
08 Some 
other group  
77 Don’t 
know / Not 
sure 
99 Refused 
 
 
If the 
respondent 
requests 
clarification of 
this question, 
say: “We want 
to know how 
OTHER 
people 
usually 
classify you in 
this country, 
which might 
be different 
from how you 
classify 
yourself.” 
 
Interviewer 
note:  do not 
offer “mixed 
race” as a 
category but 
use as a code 
if respondent 
offers it. 
 
AZRTR.02 
How often do 
you think 
about your 
race?  Would 
you say 
never, once a 
year, once a 
month, once 
a week, once 
a day, once 
an hour, or 
constantly?
 
 
 
1 Never 
2 Once a 
year 
3 Once a 
month 
4 Once a 
week 
5 Once a 
day 
6 Once an 
hour 
8 Constantly 
7 Don’t know 
/ Not sure 
9 Refused 
 
The 
responses 
can be 
interpreted as 
meaning “at 
least” the 
indicated time 
frequency. If a 
respondent 
cannot decide 
between two 
categories, 
check the 
response for 
the lower 
frequency. 
For example, 
if a

ATTACHMENT A 
25 
 
 
 
respondent 
says that they 
think about 
their race 
between once 
a week and 
once a month, 
check “once a 
month” as the 
response. 
AZRTR.03 
Within the 
past  12 
months, on 
average, 
were you 
treated worse 
than, the 
same as, or 
better than 
people of 
other races?  
 
1 Worse 
than other 
races 
2 The same 
as other 
races 
3 Better than 
other races 
4 Worse 
than some 
races, better 
than others 
5   Only 
encountered 
people of the 
same race 
7 Don’t know 
/ Not sure 
9 Refused 
 
 
 
 
 
 
 
If 
EMPLOY1= 
3, 5, 6, 7, 8, 
9 GOTO 
NEXT 
MODULE 
[CATI skip 
pattern: This 
question 
should only 
be asked of 
those who 
are 
“employed 
for wages,” 
“self-
employed,” 
or “out of 
work for less 
than one 
year.”] 
 
 
AZRTR.04 
Within the 
past 12 
months at 
work, do you 
feel you were 
 
1 Worse 
than other 
races

ATTACHMENT A 
26 
 
 
 
treated worse 
than, the 
same as, or 
better than 
people of 
other races?
 
 
2 The same 
as other 
races 
3 Better than 
other races 
4 Worse 
than some 
races, better 
than others 
5   Only 
encountered 
people of the 
same race 
7 Don’t know 
/ Not sure 
9 Refused

ATTACHMENT A 
27 
 
 
 
AZ State Added 7: Sexual Orientation and Gender Identity (SOGI) 
(Split 1 and 2) 
Question 
Number 
Question text 
Variable 
names 
Responses  
(DO NOT 
READ UNLESS 
OTHERWISE 
NOTED) 
SKIP INFO/ 
CATI Note 
Interviewer 
Note (s) 
Column(
s) 
Prologue 
The next two questions are about sexual orientation and gender identity 
 
 
 
 
If sex= male 
(using 
BIRTHSEX, 
CELLSEX, 
LANDSEX ) 
continue, 
otherwise go 
to 
MSOGI.01b. 
 
 
MSOGI.01
a 
 
Which of the 
following best 
represents 
how you think 
of yourself?
 
 
SOMALE 
1 = Gay 
2 = Straight, 
that is, not gay 
3 = Bisexual 
4 = Something 
else 
7 = I don't know 
the answer 
9 = Refused 
 
Read if 
necessary: We 
ask this 
question in 
order to better 
understand the 
health and 
health care 
needs of people 
with different 
sexual 
orientations. 
 
Please say the 
number before 
the text 
response.  
Respondent can 
answer with 
either the 
number or the 
text/word. 
551

ATTACHMENT A 
28 
 
 
 
 
 
 
 
 
 
 
MSOGI.02
a 
Do you 
consider 
yourself to be 
transgender?   
TRNSGND
R 
1  Yes, 
Transgender, 
male-to-female   
2  Yes, 
Transgender, 
female to male 
3 Yes, 
Transgender, 
gender 
nonconforming 
4 No 
7 Don’t 
know/not sure 
9 Refused 
 
Read if 
necessary: 
Some people 
describe 
themselves as 
transgender 
when they 
experience a 
different gender 
identity from 
their sex at 
birth.  For 
example, a 
person born into 
a male body, 
but who feels 
female or lives 
as a woman 
would be 
transgender.  
Some 
transgender 
people change 
their physical 
appearance so 
that it matches 
their internal 
gender identity. 
Some 
transgender 
people take 
hormones and 
some have 
surgery. A 
transgender 
person may be 
of any sexual 
orientation – 
straight, gay, 
lesbian, or 
bisexual.   
 
If asked about 
definition of 
gender non-
553

ATTACHMENT A 
29 
 
 
 
conforming: 
Some people 
think of 
themselves as 
gender non-
conforming 
when they do 
not identify only 
as a man or 
only as a 
woman.  
 
If yes, ask Do 
you consider 
yourself to be 1. 
male-to-female, 
2. female-to-
male, or 3. 
gender non-
conforming? 
 
Please say the 
number before 
the text 
response.  
Respondent can 
answer with 
either the 
number or the 
text/word.