Cyclosporiasis National Hypothesis Generating Questionna

Dear Interviewer,
Thank you for using the Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ). Before the survey questions begin
you will be asked to confirm that the interviewee has a laboratory-confirmed case of cyclosporiasis, and provide information about
yourself (the interviewer) and whether the case-patient has been previously interviewed about his/her illness. You will begin
reading the survey question prompts to the case-patient on the page entitled "Section 1: Demographic Information."

Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/xxxx

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PLEASE NOTE: if you elect to save and "Finish later and then "Exit Survey", you must use the URL and passcode provided to re­
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enter the survey. Do not click "Begin Survey on the survey homepage as this will begin an entirely new survey and you will not
see any previously recorded responses.
To obtain a PDF of your survey responses press "Print" before "Submit Survey" on the last page.
For technical assistance with this survey please contact the Cyclosporiasis Surveillance Coordinator at [email protected] or
(404) 718-1057.
Thank you for your participation in this cyclosporiasis investigation.

Public reporting of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information.
An agency many not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current 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 (XXXX-XXXX)