Survey Instrument - Screenshots

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis Drug
Susceptibility Testing
Attachment 8
Survey Instrument Web Shots

form Approved
0MB NO. 0920-0600
Expintion Date: 03/3112019
Drug Susceptibility Test Results for M. tuberculosis Complex Isolates from the
CDC Model Performance Evaluation Program
Public reporting burden ofthis colloclion of inform.stior is estimo\ed toaver.age 30 minutes per resp;ose, including the lime
(Of ,ev1eITT09 1nsm.1Coons. sean:r11ng exlstill!) oats soufOOS. oaUler1no ana ma1ota1n1ng tile Cl&ta oeeo-eo. 81'1(1 con-.>leorden 10 COC!A.TSOR
Reports Cle1mmce OffJ::er: 1600 Clifton Rood NE,MS0.74, Atlanta, Georgia 30333; Attn: OIJIB.PRA(0920.0600)

Instructions
Aseparate S!ICY&Y $boUIC1hotoroPltt&d for ucb CQDYPDIIOMI d[IIQst!SPeP!lbility test me«hOO USfd
(i.$., one ror MGIT, one tor agar proportiOO, ana one tor sensitilra).
· Pl�se do not oombloe separate rnelhOds in one submiss5on.
Moiecu1ar results, if performed, ShoulCI oory 1>e enrered w1th tile first survey compOetea.
• All rest.its fer a survey mu.st be en1erec:1 at 01e time.
· For questions or comments. o:mt.,ct IBJ..1PEP@odc goy

Instruct.ions
· A separate survey should be completed tor ueh conventional drug susceptiblllty tut method used
(i.e .• one for MGIT, one for agar proportion, an(I one for Sensitilre).
• Please do not oombine separate rnetnocts rn one submission.
,,t::1iecu1ar results, if performed, ShoulCI oory !>El eniered w1th tile first survey comP69:tOO.
• AH ,esuirs for a survey must l>8 enteFile Typeapplication/pdfAuthorMitchell YakrusFile Modified2018-10-31File Created2018-09-11