Attachment D Sample Letter

Attachment D

Sample Notification Letter

Form Approved

OMB No. 0920-0566

Exp. Date xx/xx/20xx

SAMPLE NOTIFICATION LETTER

Date

Name

Address

City, State Zip

Dear M_. _____,

I am from the National Institute for Occupational Safety and Health (NIOSH). We are a federal research agency that works to improve worker health and safety. I am sending you this letter and enclosed information because we recently finished a study that included _(gender)_who worked for at least _(x)_ days at _(industry__ plants in:

• city, state (company name)

• city, state (company name)

• city, state (company name)

By receiving this letter, our records indicated that you worked at one of these facilities some time during ____ to _____.

Our study found health concerns that we feel you should be aware of. Please see the enclosed information to learn more. Some of these numbers seem very high, particularly the findings related to ______. This increased risk of _____ has been found in other studies. We feel this information would be important to share with your doctor at your next yearly visit to allow for better patient care.

If you have questions about the study or the information I’ve included, please email me at _______ or call xxx-xxx-xxxx (direct) or xxx-xxx-xxxx (toll-free).

Additional copies of the fact sheet can be found at __________.

If you would like more information about the study, you may call or email me to request copies of the study manuscripts.

Sincerely,

Health Communication Specialist

Industrywide Studies Branch

Division of Surveillance, Hazard

Evaluations and Field Studies

Public reporting burden of this collection of information is estimated to average 10 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 30333; ATTN: PRA (0920-0566).