Att 5._Introduction email with survey

Form Approved

OMB No. 0920-XXXX

Exp. Date: XX/XX/20XX

Dear Dr. [insert name],

In the past, you have consulted with CDC’s Rickettsial Zoonoses Branch about the clinical care and management of a complicated chronic Q fever case. Q fever is a nationally notifiable disease; the current surveillance system collects minimal information on the clinical findings and risk factors for chronic Q fever. We have developed an enhanced clinical surveillance tool to gather more detailed and specific clinical data chronic Q fever to better understand its presentation, management, and long-term outcomes. This information will allow for better characterization of chronic Q fever in the United States.

Your participation in this survey is strictly voluntary and you may stop at any time. All information collected will remain anonymous; we will not collect any personally identifiable information, such as your patient’s name or contact information. There are no negative consequences to you should you decline to participate or not complete the survey in its entirety. You may continue to consult with CDC’s Rickettsial Zoonoses Branch regardless of your participation in enhanced surveillance.

This survey should take you approximately 20 minutes to complete.

The survey may be accessed at https://airc.cdc.gov/surveys/?s=EK8HNTW8P4

If you have any questions or concerns about completing this survey, please contact: 404-639-1075 or [email protected].

The Rickettsial Zoonoses Branch thanks you for your time and involvement.

Centers for Disease Control and Prevention

National Center for Emerging and Zoonotic Infectious Diseases

Division of Vector-Borne Diseases

Rickettsial Zoonoses Branch

Public reporting burden of this collection of information is estimated to average 20 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-XXXX