Potential Additional Questions

Attachment 4C - Potential additional questions.docx

[NCEZID] Traveler-based Genomic Surveillance

Potential Additional Questions

OMB: 0920-1406

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Mass Gathering

  1. Have you attended any events in Australia/New Zealand associated with the 2023 FIFA Women’s World Cup?

    1. Yes

    2. No

    3. Prefer not to answer

  2. Have you attended any events in France associated with the 2024 Olympic Games?

    1. Yes

    2. No

    3. Prefer not to answer

  3. Did you perform Hajj in Saudi Arabia?

    1. Yes

    2. No

    3. Prefer not to answer

  4. Did you perform Umrah in Saudi Arabia?

    1. Yes

    2. No

    3. Prefer not to answer

  5. Did you attend any other large events (>10,000 people) during your travel?

    1. Yes

    2. No

    3. Prefer not to answer

    4. If YES, what was the event and the country?




Other

  1. Did you take a COVID-19 test in the 2 days before your flight? (Single select)

    1. Yes, antigen test

    2. Yes, PCR or other molecular test

    3. Yes, not sure what type

    4. No

    5. Prefer not to answer

  2. Are you currently experiencing, or have you experienced ____ symptom in the last 10 days?

    1. Yes

    2. No

    3. Prefer not to answer

  3. Have you received a flu vaccine in the last 12 months?

    1. Yes

    2. No

    3. Don’t Know

  4. If yes, what was the date of your last flu vaccine?

    1. Month, Year

    2. Don’t remember

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSmith, Teresa (CDC/DDID/NCEZID/DGMQ)
File Modified0000-00-00
File Created2023-09-07

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