WORD version of Survey Instrument (for reference)

CDC NSMBB Laboratory Customer Satisfaction Survey

Form Approved OMB 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 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 (0923-0047).

1. Please provide the following information regarding the services that you requested from the CDC Newborn Screening Quality Assurance Program:

1. QA Program(s) Requested:

2. Date of Request (MO/DAY/YR):

3. Date of last report (MO/DAY/YR):

2. How would you rate the following aspects of CDC's Newborn Screening Quality Assurance Program?

	Very Poor	Poor	Good	Very Good	Not Applicable
1. Convenience: Ease of obtaining information about services offered?
2. Forms: Ease of using Data Submission and Request for Participation Forms?
3. Timeliness: Reports delivered within the time promised?
4. Reports: Ease of reading and interpreting proficiency test reports?
5. Accessibility: Ease of reaching someone to interpret reports?
6. Overall impression of CDC's Newborn Screening Proficiency Testing Program and laboratory services?

Other (please specify)

3. How useful have the following services been to you?

	Not useful at all	Slightly Useful	Moderately Useful	Very Useful	Extremely Useful
1. NSQAP Annual Report
2. NSQAP specialized program reports
3. NSQAP data reporting portal

Comments on your ratings:

4. How much, if any, improvement does each of these customer services need?

	NO Improvement Needed	SOME Improvement Needed	MUCH Improvement Needed	N/A, Did not Use
1. Request for Participation Form
2. NSQAP Website
3. Data Submission
4. Request for assistance
5. Program Directory/List of Services
6. PT and Annual Reports

What other services, besides these, need improvement?

5. For those services that need improvement, please tell us the kind of improvements needed.

5. Please provide the following:

Your work contact Information

Your Position:

Your Work Location (City/State):

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Restea, Elisa (CDC/CGH/DGHP) (CTR) (CDC)
File Modified	0000-00-00
File Created	2021-01-22