Feedback Survey

Form Approved

OMB No. 0920-0556

Exp. Date xx/xx/xxxx

FEEDBACK TO CDC

ON ART DATA REPORTING

Please rate how strongly you agree or disagree with each of the following statements by clicking on the appropriate response button.

	Strongly Agree	Somewhat Agree	Neither Agree or Disagree	Somewhat Disagree	Strongly Disagree	Not Applicable	Click here to unselect a response
The ART reporting system is simple to use.	O	O	O	O	O	O	O
The customer service regarding ART data submission is a useful resource.	O	O	O	O	O	O	O
The time it takes to meet CDC annual reporting requirements is acceptable.	O	O	O	O	O	O	O
CDC’s ART success rates report is useful to consumers.	O	O	O	O	O	O	O
CDC’s ART success rates report is useful to professionals.	O	O	O	O	O	O	O
If your ART facility was validated in the past reporting year, the overall validation process was acceptable.	O	O	O	O	O	O	O

Thank you for providing feedback. Please feel free to add comments or suggestions in the space provided:

(Limit: ### characters)

Public reporting burden for this collection of information is estimated to average 2 minutes per response, including 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, GA 30333, ATTN:PRA (0920-0556).