Feedback Form

				Form Approved
Attachment B - Pilot Online Data Collection for SMA PT Feedback Form				OMB No. 0920-0879
				Exp. Date 01/31/2021
Newborn Screening Quality Assurance Program
Spinal Muscular Atrophy (SMA) Pilot Proficiency Testing Program Customer Feedback
Instructions
1) Enter your lab code number in the lab code box
2) For questions 1 - 5 select:
"NO Improvement Needed" if you are fully satisfied (95 - 100%) or
"SOME Improvement Needed" if you are mostly satisfied (75 - 94%) or
"MUCH Improvement Needed" if you are not satisfied (<75%) or
"N/A" if unable to assess
3) If you select "SOME Improvement Needed" or "MUCH Improvement Needed", briefly describe the improvements that you think are needed.
Lab Code:
	NO Improvement Needed	SOME Improvement Needed	MUCH Improvement Needed	N/A
1. SMA PT Instruction Form
2. SMA PT Online Data Reporting Form
3. Data submission process
4. DBS Panel
5. Overall experience
6. Where improvement is needed, please provide suggestions:
Open-ended response