Word Data Collection Instrument

Attachment D: Data Collection Instrument (Word version)

Form approved
OMB No. 0920-0879
Expiration Date: 04/30/2017

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hank you for participating in our short data collection on Customer Satisfaction of our CDC Infectious Diseases Reference Laboratories. This assessment does not include satisfaction of surveillance testing or outbreak investigations. Click ‘Next’ to continue.

‘Public reporting burden of this collection of information is estimated to average 10 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).’

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Section I.
How would you rate the following aspects of CDC's infectious diseases (ID) reference laboratory services? (This assessment of customer satisfaction does not include surveillance testing or outbreak investigations)

	Very Poor	Poor	Good	Very Good	Not Applicable
Convenience: Ease of obtaining information about services offered? Forms: Ease of using current specimen submission form Timeliness: Was it [service, results?] delivered within the time promised? Reports: ease of reading and interpreting laboratory results Accessibility: ease of reaching someone to interpret results? Overall: Overall impression of CDC’s ID reference laboratory services

Section II.
Your responses to the 2012 Customer Satisfaction Survey guided several process improvements to the services CDC infectious diseases reference laboratories offer. How useful have these new services been to you?

	Not useful at all	Slightly useful	Moderately useful	Very useful	Extremely useful
Infectious Diseases Laboratory Test Directory Downloadable Specimen Submission Form Email delivery of encrypted reports

Enter specific comments on these new services below (1000 character limit).

Section III. 

10. What customer service areas need improvement. Check all that apply.

Infectious Diseases Laboratory Test Directory Downloadable Specimen Submission Form Email delivery of encrypted reports Infectious Diseases Laboratory Information website

Help Desk for submitting specimens Other (Please specify) None requested

Enter specific comments where improvements are needed (1000 character limit).

Section IV.

Your Information

Position:

City/State:

Email Address (Optional):