Form 10 Healthcare Workers Core Module

CORE MODULE Form Approved

7/23/10 OMB No. 10AP-xxxx

Expiration Date: xx/xx/2011

PROGRAMMING INSTRUCTIONS APPEAR IN BLUE.

SECTION 1: Demographics

Are you male or female?

Male Female

Do you consider yourself Latino or of Hispanic origin or descent?

Yes, I am Latino/Hispanic/Spanish No, I am not Latino/Hispanic/Spanish

Which of the following categories describes your race? Please  all that apply.

White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaskan Native

In what year were you born?

include drop down pick list of years from 1993 to 1935 (18 to 75 years of age) (use radio buttons)

Were you born in the USA?

Yes, born in USA  Go to Question 7 No, not born in USA

In what year did you first come to the USA?

Year you first came to USA: include drop down pick list of years from 2011 to 1935 (75 years) (use radio buttons)

In which of the following languages are you fluent? Please  all that apply.

English Arabic Bengali Chinese French German Hindi Italian Japanese Korean Portuguese Russian Spanish Tagalog Urdu Vietnamese Other language (Please specify): ___________________

What is the highest education level you have completed?

Less than grade 12 Grade 12 (high school grad) or GED Vocational certificate Associate’s degree Bachelor’s degree Master’s degree Doctoral or professional degree (MD/DO, DDS/DMD, PhD, ScD, Pharm.D., etc.) Post doctoral education

SECTION 2: Employment Status

How many employers do you currently work for who provide healthcare or health-related services? (If you are self-employed, consider yourself the employer.)

One Two Three More than three

display question 10 on separate screen:

If you work for more than one employer, the following questions apply to your primary employer i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.

Which of the following best describes your employer? Ambulatory Health Care Services Physician office Dentist office Offices of other health practitioners (e.g., registered or licensed practical nurses, respiratory therapists, dental hygienists, chiropractors, optometrists, podiatrists) Outpatient care centers (e.g., freestanding ambulatory surgical centers and clinics, free standing emergency medical centers and clinics, HMO medical centers and clinics, dialysis centers, mental health and substance abuse centers) Medical laboratory Diagnostic imaging center (CT scan and MRI centers, X-ray labs) Blood/organ bank Home health care provider Other ambulatory health care facility Hospitals General medical and surgical hospital Psychiatric hospital Substance abuse hospital Specialty hospital (except psychiatric and substance abuse) Nursing and Residential Care Facilities Nursing care facility Residential mental retardation/mental health/substance abuse facility Community care facility for the elderly Other residential care facility Social Assistance/Services Individual and family services (includes home care) facility Community food and housing, emergency and other relief services Vocational rehabilitation facility Child day care facility Other (Please specify): ___________________________________

.	Which of the following best describes your current occupation? Please  only one.

display specialty after major catejory is selected

If Respondent marked any one of the nurse categories  Go to Question 12; otherwise  Go to Question 13.

• Physician

• Primary care

• General surgery

• Physician Specialist (Please  only one)

• Anesthesiologist

• Other (Please specify):_____________________

• Dentist or Other Dental Professional

• General Dentist

• Endodontist

• Oral and maxillofacial surgeon

• Orthodontist

• Pediatric dentist

• Periodontist

• Prosthodontist

• Dental hygienist

• Dental technician

• Dental assistant

• Other dental professional (Please specify): _______

• Pharmacist/Other Pharmacy Professional

• Pharmacist

• Pharmacy technician

• Other pharmacy professional (Please specify): _

• Therapist

• Respiratory Therapist

• Other (Please specify):______________________

• Technologist or Technician

• Anesthesiologist Technician

• Central Supply/Processing Technician

• Dental Technician

• Echocardiology Technician

• EEG/Neuro Technician

• GI Lab Technician

• Pharmacy Technician

• Radiologic Technologist or Technician

• Sterilization technician

• Surgical Technologist

• Ultrasound Technician

• Other (Please specify):
  ______________________

• Nurse

• AIDS care nurse

• Ambulatory care nurse

• Anesthetist (nurse)

• Cardiac rehabilitation nurse

• Case management

• Clinical nurse specialist/Nurse clinician

• Correctional nurse

• Director/CEO (nurse)

• Educator (nurse)

• Enterostomal therapy nurse

• Gastroenterology/Endoscopy nurse

• Genetics nurse

• General Nurse (no specialty)

• Home health nurse

• Hematology/Oncology nurse

• Infection control nurse

• Infusion/IV therapy nurse

• Long-term care nurse

• Managed care nurse

• Manager/administrator (nurse)

• Midwife (nurse)

• Nephrology nurse

• Neuroscience nurse

• Occupational health nurse

• Ophthalmic nurse

• OR Nurse

• Perioperative nurse

• Orthopaedic nurse

• Otorhinolaryngology nurse

• Pediatric nurse

• Perianesthesia nurse

• Perinatal nurse

• Primary care/Office nurse

• Psychiatric nurse

• Reconstructive surgical nurse

• Rehabilitation nurse

• Respiratory nurse

• School nurse

• Subacute care nurse

• Transplant nurse

• Trauma nurse

• Other nursing specialty (Please specify):
  ___________________________________

• Other HealthCare Professional

• Anesthesiologist assistant

• Home health aide

• Medical assistant

• Physician assistant

• Surgical assistant

• Other (Please specify): ____________________

	display following note above questions 12-20: If you work for more than one employer, please continue to think about your primary employer , i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
		Are you a staff nurse or an advanced practice nurse as defined by the different types of nursing licenses?				Staff Nurse (RN, LPN, LVN) Advanced Practice Nurse (NP, CRNA, CNS, CNM)
		How much of your time is spent in direct patient care activities?				76-100% 51-75% 26-50% 1-25% No direct patient care
		How long have you worked for your current employer?				Less than 6 months At least 6 months but less than a year 1-5 years 6-10 years 11-20 years More than 20 years
		How long have you worked as a {fill with current occupation as reported in Question 11}?				Less than 6 months At least 6 months but less than a year 1-5 years 6-10 years 11-20 years 21- 30 years More than 30 years
		How would you describe your work arrangement?					I am self-employed I am paid by a temporary agency I work for a contractor who provides services to others under contract I am a regular, permanent employee I am a student trainee I am an intern, resident or fellow
		What is the total number of workers at your primary place of employment?					Only myself 2-9 workers 10-99 workers 100-249 workers 250-1,000 workers More than 1,000 workers
		Which of the following best characterizes your employer?						For profit (individual, partnership or corporation) Non-profit or not-for-profit corporation City, county, district or state government (including public university-based) Federal government (e.g., military, VHA, IHS) Other (Please specify): ______________________
		In what state do you work for your primary employer?						display drop down pick list of states (use radio buttons)
.		Is your primary place of employment located in an urban, suburban or rural area?					Urban (large city; 50,000 people or more) Urban (small city; fewer than 50,000 people) Suburban (developed areas adjacent to cities) Rural (areas outside cities generally characterized by farms, ranches, small towns, and unpopulated regions)
		Please check all of the locations where you worked in the past 7 calendar days. Please  all that apply. For each respondent, randomize order of first three categories Ambulatory Health Care Facilities Physician office Dentist office Offices of other health practitioners (e.g., registered or licensed practical nurses, respiratory therapists, dental hygienists, chiropractors, optometrists, podiatrists) Outpatient care centers (e.g., freestanding ambulatory surgical centers and clinics, free standing emergency medical centers and clinics, HMO medical centers and clinics, dialysis centers, mental health and substance abuse centers) Medical laboratory Diagnostic imaging center (CT scan and MRI centers, X-ray labs) Blood and organ banks Other ambulatory health care facility (Please specify): __________________________ Hospitals General medical and surgical hospital Psychiatric hospital Substance abuse hospital Specialty hospital (except psychiatric and substance abuse) (Please specify:__________) Nursing and Residential Care Facilities Nursing care facility Residential mental retardation, mental health and substance abuse facilities Community care facilities for the elderly Other residential care facilities (Please specify): __________________________ Other Homes of patients (including in-home hospice) Homeless shelter Emergency shelter Food bank (that provides health care services) Child day care facility Educational facility Correctional facility Other (Please specify): _________________________________

display following note above questions 22-33: If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
.	Are you a full-time or part-time employee?		Full-time (typically 32 or more hours per week) Part-time (typically less than 32 hours per week)
	How are you paid?		Salaried Paid by the hour Fee-for-service Other (Please specify):____________
	Which of the following best describes the hours you usually work?		Regular daytime shift or schedule (work anytime between 6am and 6pm) Regular evening shift (work anytime between 2 pm and midnight) Regular night shift (work anytime between 9pm and 8am) Regular shift plus periodic on-call Rotating shift (work shift that changes periodically from days to evenings or nights) Split shift (work shift consisting of two distinct work periods each day) Irregular shift/on call (unscheduled work arranged by the employer) Other schedule (Please specify): ________________________________
	Which of the following best describes your work schedule in a typical work week?		Weekdays only (Monday - Friday) Weekends only (Saturday and Sunday) Mix of weekdays and weekends
	In the past 7 calendar days, how many days did you work? d isplay calendar highlighting the past 7 calendar days. Applies to all questions with ‘in the past 7 calendar days’						1 day 2 days 3 days 4 days 5 days 6 days 7 days
	In the past 7 calendar days, what was the usual length of your work shift?					Less than 8 hours 8 hours 10 hours 12 hours More than 12 hours Other (please specify): ____________
	In the past 7 calendar days, what was the total number of hours you worked?					Total number of hours worked: ________
	During the past 7 calendar days, did you work…					…more hours than usual …fewer hours than usual …about the same number of hours as usual
	In the past 7 calendar days, did you work overtime (work done in addition to regular working hours)?					Yes No
	Was the overtime mandatory (i.e., required by the employer)?					Yes No
If Respondent reported working for more than one healthcare employer in Question 9  Go to Question 32. otherwise,  Go to Question 33.
	Besides the {fill in answer from Question 28} hours you worked for your primary employer in the past 7 calendar days, what was the total number of hours you worked (paid or volunteer) for any other employers who provide healthcare or health-related services?					__ __hours
	During the past 7 calendar days, how many hours did you work (paid or volunteer) for employers who do not provide healthcare or health-related services?					__ __hours If no other jobs, enter “0.”

	To which of the following professional associations do you belong? Please  all that apply.
American Academy of Anesthesiologist Assistants (AAAA) American Association of Nurse Anesthetists (AANA) American Academy of Physician Assistants (AAPA) American Association of Pharmacy Technicians (AAPT) American Association for Respiratory Care (AARC) American Dental Association (ADA) American Dental Assistants Association (ADAA) American Dental Hygienists Association (ADHA) American Nurses Association (ANA) Association of periOperative Registered Nurses (AORN) Association of Pediatric Hematology/Oncology Nurses (APHON) American Society of Anesthesiologists (ASA) American Society of Perianesthesia Nurses (ASPAN) American Society of Health-System Pharmacists (ASHP) American Society of Radiologic Technicians (ASRT) Association of Surgical Technologists (AST) International Association of Healthcare Central Service Materiel Managers (IAHCSMM) Infusion Nurses Society (INS) National Pharmacy Technician Association (NPTA) National Surgical Assistants Association (NSAA) Oncology Nurses Society (ONS) Society of Gastroenterology Nurses and Associates (SGNA) Other (please specify): _______________________________________
	Are you a member of a labor union?		Yes No

SECTION 3: Workplace Conditions display following note above questions 36-50: If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
36.	Are any of the following chemical agents used or present in the area(s) where you work?	Yes	No	I don’t know
	a. Glutaraldehyde			
	b. Ortho-phthaldehyde			
	c. Formaldehyde			
	d. Nitrous oxide			
	e. Anesthetic gases (other than nitrous oxide)			
	f. Antineoplastic agents (i.e., chemotherapeutic agents)			
	g. Pentamidine aerosol			
	h. Tobramycin aerosol			
	i. Ribavirin aerosol			
	j. Surgical smoke			
	k. Ethylene oxide			
	l. Methyl methacrylate			
if respondent marked ‘yes’ display appropriate follow-up question below. if respondent marked ‘no’ or ‘i don’t know’ to 36 a through l  Go to Question 38.

37.	Please estimate the potential for exposure to the chemical agents used or present in your job. Answer for what the exposure level would be if you did not wear personal protective equipment and protective clothing.
		No Exposure	Low Exposure	Medium Exposure	High Exposure	Unsure of Exposure
	a. Glutaraldehyde					
	b. Ortho-phthaldehyde					
	c. Formaldehyde					
	d. Nitrous oxide					
	e. Anesthetic gases (other than nitrous oxide)					
	f. Antineoplastic agents (i.e., chemotherapeutic agents)					
	g. Pentamidine aerosol					
	h. Tobramycin aerosol					
	i. Ribavirin aerosol					
	j. Surgical smoke					
	k. Ethylene oxide (EtO)					
	l. Methyl methacrylate					

38.	Are any of the following present in the area(s) where you work?	Yes	No	I don’t know
	a. Infectious diseases (e.g., Influenza, TB, HIV, HBV, HCV, MRSA, VRE)			
	b. Needles and other sharps			
	c. Non-ionizing radiation (e.g., UV, microwaves, radio-frequency, magnetic/electric fields, etc.)			
	d. Ionizing radiation (e.g., X-rays, gamma rays, etc.) (uses may include fluoroscopy, CT scans, radiosurgery, radioactive seeding, sterilization)			
	Noise			
	f. Poor indoor air quality (e.g., molds, cigarette smoke, vehicle exhaust, etc.)			
	g. Machine safety hazards (e.g., exposed moving parts)			
	h. Temperature extremes			

if respondent marked ‘yes’ display appropriate follow-up question below.

if respondent marked ‘no’ or ‘i don’t know’ to 38 a through h  Go to Question 40.

39.		Please estimate the potential for exposure to the hazards present in your job. Answer for what the exposure level would be if you did not wear personal protective equipment and protective clothing, where applicable.
			No Exposure	Low Exposure	Medium Exposure	High Exposure	Unsure of Exposure
		a. Infectious diseases (e.g., Influenza, TB, HIV, HBV, HCV, MRSA, VRE)					
		b. Needles and other sharps					
		c. Non-ionizing radiation (e.g., UV, microwaves, radio-frequency, magnetic/electric fields, etc.)					
		d. Ionizing radiation (e.g., X-rays, gamma rays, etc.) (uses may include fluoroscopy, CT scans, radiosurgery, radioactive seeding, sterilization)					
		e. Noise					
		f. Poor indoor air quality (e.g., molds, cigarette smoke, vehicle exhaust, etc.)					
		g. Machine safety hazards (e.g., exposed moving parts)					
		h. Temperature extremes					

40.

Are there any other health and safety hazards present in the area(s) where you work?

Yes No

IF Respondent marked ‘No’  Go to Question 42

41.	Please list up to three other health and safety hazards and estimate the potential for exposure to each of them. Answer for what the exposure level would be if you did not wear personal protective equipment and protective clothing, where applicable.
			No Exposure	Low Exposure			Medium Exposure	High Exposure	Unsure of Exposure
	1. (enter specific hazard)								
	2. (enter specific hazard)								
	3. (enter specific hazard)								
42.	In the past 12 months, have you experienced a work-related injury, illness or exposure?					Yes No  GO to Question 49
43.		What was the nature of the work-related injury, illness or exposure? For each respondent, Randomize order of responses with exception of ‘Other’ Please  all that apply. Laceration Wrist, arm or shoulder pain Back pain Slip, trip or fall Physical assault Needlesticks and other sharps injuries Asthma Breathing problems (other than asthma) Skin rash of hand(s), wrist(s) or forearm(s) Hearing problems Vision problems Body fluid exposure Infectious disease exposure Stress Exposure to chemicals (Please specify): __________________________________________________________________ Other (Please specify up to 2 more) 1. ________________________________________________________________ 2. ________________________________________________________________

provide Respondent with questions 44 through 48 for each item checked in Question 43.
44.		Were you evaluated by a healthcare professional (e.g., physician, nurse, physical therapist, chiropractor) for the {fill in from Question 43}?				Yes No
45.		Were you off from work, even less than one day, as a result of the {fill in from Question 43}?				Yes No  Go to Question 47
46.		How many calendar days were you off from work as a result of the {fill in from Question 43}?				Less than one day 1 day 2 days 3 days 4 to 7 days 8 or more days
47.	How many calendar days were you on restricted (light) duty work as a result of the {fill in from Question 43}?					None 1-5 days 6-10 days 11-15 days 16-20 days More than 20 days
48.	Did you receive workers’ compensation as a result of the {fill in from Question 43}?					Yes No I don’t remember
Workplace violence includes physical assaults, threats of assaults, harassment, intimidation or bullying. Sources may include patients, family members, visitors, and coworkers including supervisors.
49.	In the past 12 months, were you verbally threatened, intimidated or bullied while you were on the job?					Yes No  Go to Question 50
49a.	Who verbally threatened, intimidated or bullied you while you were on the job? Please  all that apply.					by co-worker by patient by other
50.	In the past 12 months, were you physically assaulted or threatened while you were on the job?					Yes No Go to Question 51
50a.	Who physically assaulted or threatened you while you were on the job? Please  all that apply.						by co-worker by patient by other

SECTION 4: Physical Demands
display following note above questions 51-55: If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
51.	Thinking about all of your job duties in the past 7 calendar days, how often did you…
			Frequently	Sometimes	Rarely	Never
	a. work for long periods (greater than 2 hours) with your head or arms in physically awkward positions?					
	b. reach above chest height?					
	c. squat or kneel ?					
	d. bend or twist wrists ?					
	e. make precise movements with your fingers?					
	f. work for long periods (greater than 2 hours) at a computer?					
	g. stand for long periods (greater than 2 hours)?					
52.	During a typical work week, how many times did you lift or move patients weighing 35 lbs or more?			Never  GO to Question 54 1-5 times 6-10 times 11-20 times 21-50 times More than 50 times

53.	During a typical work week, how often did you use any of the following when lifting or transferring patients weighing 35 lbs or more? skip 53f if respondent marked ‘only myself’ in question 17
		Always	Very Often	Sometimes	Rarely	Never	Not Available
	a. Lift or move by hand (unassisted)					
	b. Fixed mechanical lifting devices such as ceiling lifts, floor lifts, sit-to-stand devices						
	c. Portable mechanical lift devices such as floor lifts, sit-to-stand devices, etc.						
	d. Slip or friction reduction devices such as slip sheets, roller or slider boards, air transfer devices, etc.						
	e. Gait belts (also called transfer belts)						
	f. Lifting assistance from one or more co-workers (including designated lift teams)						
	g. Any other assistive device (Please specify) __________________________					

54.	During a typical work week, how many times did you lift or move objects, other than patients, weighing 50 lbs or more?		Never  GO to Question 56 1-5 times 6-10 times 11-20 times 21-50 times More than 50 times

55.	During a typical work week, how often did you use any of the following when lifting or moving objects, other than patients, weighing 50 lbs or more? Program to skip 55d, if R marked ‘only myself’ in Question 17
		Always	Very Often	Sometimes	Rarely	Never	Not Available
	a. Lift or move by hand					
	b. Mechanical lifting devices (e.g., winch, dolly, forklift, etc.)						
	c. Roller or slider boards						
	d. Lifting assistance from one or more co-workers						
	e. Object is on wheels or casters						
	f. Any other assistive device (Please specify) ____________________					

Section 5: Psychosocial Demands display following note above questions 56-62: If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
56.	How worried are you about becoming unemployed?		Very worried Somewhat worried Not too worried Not at all worried

57.	Do you feel discriminated against on your job for any of the following reasons? Please  all that apply.			Age Race or ethnic origin Gender Disability Job status or position Some other reason I don’t feel discriminated against on my job
58.	Overall, how satisfied would you say you are with your job?			Very satisfied Somewhat satisfied Not too satisfied Not at all satisfied
59.	How much stress would you say you experienced at work in the past 7 calendar days?			Almost no stress at all Moderate amount of stress A lot of stress
Section 6: Personal Protective Equipment
60.	During a typical work day, how many hours, on average, do you wear water-resistant gloves? Water-resistent gloves include latex, vinyl, nitrile, butyl and other materials which are impervious to water.			Less than 1 hour 1-2 hours 3-4 hours 5-6 hours 7-8 hours 9-10 hours 11-12 hours More than 12 hours
61.	Is your primary place of employment latex-free?			Yes  Go to Question 63 No I don’t know
62.	Are any of the protective gloves you wear during a typical work week made of natural latex rubber? display the three choices and “Please  all that apply” after ‘yes’ is selected.			Yes ‘powdered’ ‘powder-free’ ‘powder-free, low protein/allergen’ No I don’t know
SECTION 7: Seasonal Influenza
display following note above questions 63-65:
If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
skip questions 63 and 64, if Respondent checked ‘no direct patient care’ in Question 13.
63.	Have you provided care to patients with seasonal flu or flu symptoms in the last 12 months?				Yes No  Go to Question 65 I don’t know  Go to Question 65

64.	When caring for patients with seasonal flu or flu symptoms, which of the following do you wear? Please  all that apply.
	Standard surgical mask		N95 respirator (includes surgical N95 respirator)
	Half-facepiece air purifying respirator		Full-facepiece air purifying respirator
	Powered air purifying respirator (PAPR)		Other (Please specify): ___________________________
	None of the above		I don’t know

65.

Have you received a seasonal influenza vaccine in the last 12 months?

• Yes

• No

SECTION 8: Hand Hygiene If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.

66.

During a typical work day, about how many times did you use any of the following hand sanitation or skin care products on your job?

Never

1-5 times

6-20 times

21-40 times

More than 40 times

Product not available

a. Alcohol-based hand sanitizer ………………….











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b. Alcohol-free hand sanitizer……………………..











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c. Soap and water…………………………………..











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d. Skin moisturizing lotion …………………………











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e. Other (Please specify): _____________________









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SECTION 9: Health and Safety Perceptions If you work for more than one employer, please continue to think about your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer. Repeat insructions and scale if greater than one web page

67.

Please indicate the level to which you agree or disagree with the following statements. For each respondent, randomize order of statements

Strongly Disagree

Disagree

Agree

Strongly Agree

Not Applicable

a. The health and safety of workers is a major priority for management









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b. I feel safe from work-related injury or illness



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

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c. I usually have enough time to take safety precautions while completing my duties



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

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d. I feel free to express my concerns about health and safety conditions to management









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e. Proper personal protective equipment is available to me









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f. I am often required to do a task that makes me feel like I might be at risk of getting hurt



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g. People working with me are frequently exposed to dangerous or risky situations



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h. I feel managers and supervisors set proper examples by following safety rules and work practices







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i. My work area is periodically inspected to identify potential health and safety hazards

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j. Unsafe working conditions are corrected in a reasonable time period

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k. I have received adequate training from my current employer to recognize health and safety hazards in my job

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l. I feel that there is adequate staffing to perform my job duties

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m. On my job. I have a lot of say in how I do my work

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n. I can report injuries to my manager without worrying about how it will affect my job

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o I can report injuries to my manager without worrying about how it will affect my department’s safety record

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p. It is easy for me to combine work with family responsibilities

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q. I feel my organization has a positive safety culture

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r. Health and safety concerns influence my decision to continue working in the health care field

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Go to 2^nd hazard module if indictated by screening module.

Otherwise, end survey with “thank you” statement

Thank you for participating in the NIOSH Health and Safety Practices Survey of Healthcare Workers. Your answers have been submitted.

Public reporting burden of this collection of information is estimated to average 17 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 30329-4018; ATTN: PRA (10AP-xxxx).