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OMB No.0920-0940
Expires 03/31/2018
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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 (0920-0940).
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NOTE: Participants will only see page 4 if they’ve answered “no” or “I’m not sure” to Questions 3, 4, or
5.
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| File Type | application/pdf |
| Author | Tyrawski, Jennifer (CDC) |
| File Modified | 2017-01-03 |
| File Created | 2016-12-22 |