Attachment 4: Pre-test Questionnaire
Form Approved:
OMB No. 0920-XXX
Exp. Date: ________
Should I participate in this study?
You should not participate in this study if:
You have a cold.
You have the flu (influenza).
You have tuberculosis.
You have any other type of respiratory infection.
You have any illness or medical condition that might make it difficult or uncomfortable for you to inhale deeply and cough forcefully into a sampling tube.
You feel it would be uncomfortable or inappropriate for any reason for you to participate in the study.
Please check one of the following:
_____Based on the criteria above, I should participate in this study.
____Based on the criteria above, I should not participate in this study.
Public reporting burden of this collection of information is estimated to average 5 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXX-XXXX).
| File Type | application/msword |
| File Title | Attachment 4: Pre-test Questionnaire |
| Author | wdl7 |
| Last Modified By | wdl7 |
| File Modified | 2007-11-01 |
| File Created | 2007-11-01 |