Attachment A1.a. – Supplemental CureTB Program Partner Satisfaction Assessment Questionnaire 1

Form Approved

Page 1
Blue and red text are notations added after the PDF generation in
REDCap for clearance review and will not show on actual online
questionnaire.

1

OMB No. 0920-1186

Exp. Date 02/29/2024

If yes, question 2 will appear.
If no, next question is 6.

2

If other, question 3 & 4 will appear.
If any other option selected, next question is 4.

3

4

If any selected, question 5 will appear.
5

6

If yes, questions 7 will appear.
If no, next question is 9.

7

If any selected, question is 8 will appear.
8

Blue and red text are notations added after the PDF generation in
REDCap for clearance review and will not show on actual online
questionnaire.

Page 1 continued

If no, question 10 will appear.
If yes, next question is 11.

9

10
If no or partially, question 12 will appear.
11

If yes, next question is 13.

12

13

If no or partially, question 14 will appear.
If yes, next question is 15.

14

15

16

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the
time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information
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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA
(0920-1186).