CureTB Partner Feedback (at completion of referred patient's treatment)

Form Approved
OMB No. 0920-1186

Exp. Date 02/29/2024
Blue text are notations added after the PDF generation in REDCap for
clearance review and will not show on actual online questionnaire.

1

If no or partially, questions 2 will appear.
If yes, next question is 3.

2

3

If no or Don’t know/remember,
questions 4 will appear.
If yes, next question is 5.

4

5

CDC estimates the average public reporting burden for this collection of information as 6 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).