Zika MAC-ELISA QC Data Form

OMB Control No. 0920-0881
Expiration Date: 3/31/2020
Generic Information Collection Request
Zika MAC-ELISA QC data summary (below) should be emailed to [email protected] within 30 days
Name of Laboratory Director:

________________________________________

Name of Laboratory:

________________________________________

Email address for Lab Director/POC:

________________________________________

Telephone number for Lab Director/POC:

________________________________________

Address of Laboratory:

________________________________________
________________________________________
________________________________________
________________________________________

Signature to confirm implementation of Zika MAC-ELISA QC checks as defined in LRN Broadcast Emails dated
August 2nd, 2017 and August 29th, 2017 and accuracy of the information reported below.

Name (print and sign)

Date

Data collection:
Negative Control P/N ratio – number of repeats used within the calculations -

_______________

__________________ __________________ __________________
Mean

SD

Calibration Control Serum – number of repeats used within the calculations -

99% CI (mean ± 3*SD)
_______________

__________________ __________________ __________________
Mean

SD

Positive Control P/N ratio – number of repeats used within the calculations -

99% CI (mean ± 3*SD)
_______________

__________________ __________________ __________________
Mean

SD

99% CI (mean ± 3*SD)

Public reporting burden of this collection of information is estimated to average 5 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 0920-0881