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["County/Tribe Requesting Additional Custom Questions:"]
[]
["Up to 3 additional custom questions can be added - please complete your questions in the following format:"]
["Limit responses to no more than 5."]
[null,"Question to ask:","Responses","Question Options:"]
["Example:","How many times per month do you eat a Senior Dining meal?","1-5","Check all that apply"]
[null,null,"6-10","Check only one","X"]
[null,null,"11-15","Required to answer"]
[null,null,"16-20","Applies to CM Survey","X"]
[null,null,"20+","Applies to HDM Survey"]
[null,null,null,"Applies to both Surveys"]
[]
[1,"Question to ask:","Responses","Question Options:"]
[null,null,null,"Check all that apply"]
[null,null,null,"Check only one"]
[null,null,null,"Required to answer"]
[null,null,null,"Applies to CM Survey"]
[null,null,null,"Applies to HDM Survey"]
[null,null,null,"Applies to both Surveys"]
[]
[2,"Question to ask:","Responses","Question Options:"]
[null,null,null,"Check all that apply"]
[null,null,null,"Check only one"]
[null,null,null,"Required to answer"]
[null,null,null,"Applies to CM Survey"]
[null,null,null,"Applies to HDM Survey"]
[null,null,null,"Applies to both Surveys"]
[]
[3,"Question to ask:","Responses","Question Options:"]
[null,null,null,"Check all that apply"]
[null,null,null,"Check only one"]
[null,null,null,"Required to answer"]
[null,null,null,"Applies to CM Survey"]
[null,null,null,"Applies to HDM Survey"]
[null,null,null,"Applies to both Surveys"]