Follow-up Questions

Form Approved

OMB Control No. 0920-XXXX

Exp. Date xx/xx/20xx

Become a Partner Form

Potential follow-up questions (to be conducted via phone once the above form has been submitted)

• How does your work relate to preparedness?

• Which area most relates to your areas of interest?

  • Chemical Emergencies

  • Bioterrorism

  • Radiation Emergency

  • Mass Casualties

  • Natural Disasters & Severe Weather

  • Recent Outbreaks & Incidents

• How large is your organization?

• Who are your top five partners?

• Who are your top five clients?

• Who is your target audience?

  • Family

  • Community

  • Business

  • Clinical

  • Minorities

  • Vulnerable (e.g., disabled, aging)

  • Research or Academia

• Do you currently receive any support or funding from CDC? If yes, who is your point of contact?

• Do you have the capability to support public health preparedness activities that are of mutual interest?

• What is the best way we can communicate with you?

• Who should we be communicating with at your organization?

• How frequently can we communicate?

Public reporting burden of this collection of information is estimated to average 30 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

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