Customer Satisfaction Survey for the CDC Newborn Screeni

CDC Laboratory Customer Satisfaction Survey

Form Approved
0MB No. 0923-0047
Expiration Date: 12/31/2018
Thank you for participating in our short data collection on Customer Satisfaction of the CDC Newborn Screening Quality
Assurance Program. We would like to obtain your input regarding the service that you recently requested This information will
be used to identify areas of improvement.
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 0MB 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-7 4, Atlanta, Georgia, 30333, A TIN PRA (0923-0047).

* 1. Please provide the following information regarding the services that you requested from the CDC Newborn Screening
Quality Assurance Program:
QA Program(s) Requested

Date of Request
(MO/DAY/YR)
Date of Last Report
(MO/DAY/YR)