Cover Letter - English 08JUL2016

Attachment 5: Survey Cover Letter

D IVISION OF CANCER PREVENTION AND CONTROL

Centers for Disease Control and Prevention

4770 Buford Highway NE, MS K-55

Atlanta, GA 30341

NAME

ADDRESS

CITY, STATE ZIP

Dear NAME:

The Federal government is interested in research on breast cancer care and treatment for young women. The Centers for Disease Control and Prevention (CDC) has contracted with the non-profit research company RTI International to conduct a survey called Breast Cancer in Young Women Survey. Your information was obtained from the [State name] registry. We would greatly appreciate it if you would take about 25 minutes to fill out the survey. The survey has questions about your insurance coverage, employment status, copayments/deductibles, and the care that you received during your breast cancer treatment. There may be parts of your cancer history you do not fully remember. To help us better understand your cancer, RTI plans to link your survey responses to information available in the cancer registry on your tumor characteristics, date of diagnosis, and stage at diagnosis and treatment. Please return the survey in the envelope included with this letter. You can also complete an online version of the survey by going to: [weblink here]. The survey is a one-time data collection effort and you will not be re-contacted after the completion of the survey.

It is your choice whether or not to do the survey. Your decision will not affect any of your health care benefits or services. There is a small potential risk of loss of privacy but we have made every effort to limit this risk as all your personal information is viewed only by authorized research staff and are stored in password protected folders. RTI will keep the information that you provide private and secure to the extent permitted by law. Some survey questions related to your breast cancer experience may cause you distress and you do not have to answer questions that make you feel uncomfortable. Your survey participation will help us to improve the care and policies for young women diagnosed with breast cancer such as yourself.

If you choose to complete and return the survey, we will send you a $10 gift card to thank you for your time.

If you have any questions, please call NAME toll-free at 1-877-XXX-XXXX, anytime from 9am to 5pm Eastern Standard Time. If you have any questions about your rights as a survey respondent, you may call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Thank you in advance for your participation.

Sincerely,

NAME

CDC TITLE

Centers for Disease Control and Prevention

Nota: Si desea recibir la versión de la encuesta en español, por favor llame al 1-877- XXX-XXXX.