Poliovirus Containment Survey 2024 PI Name First Last Date MM slash DD slash YYYY Samples or Specimens of Human OriginCheck all types of samples that your lab collects or stores. Respiratory secretion specimens collected for any purpose Fecal specimens, collected for any purpose Unfixed tissue samples (including autopsy), for any purpose None of the above Samples or Specimens of Environmental OriginCheck all types of samples that your lab collects or stores. Wastewater Concentrated sewage None of the above Information about the samplesWhere were the samples/specimens collected? Only in Connecticut In another state Both in and outside of the United States Only outside the United States If collected in another state, list state(s) here If collected outside U.S., list countries here For specimens collected in the United States, were any collected prior to 2000 or between June 2022 and February 2024? Yes No I don't know For specimens collected between June 2022 and February 2024, where were they collected? Rockland County NY (10901, 10913, 10920, 10952, 10954, 10956, 10960, 10965, 10970, 10977, 10989, 10994) Orange County NY (10926, 10930,10950) Not collected in either New York county Please check one of the statements below. Samples are not stored long term. (>30 days at ultralow temperature) Samples are stored long term and are included in the lab freezer inventory. CAPTCHANameThis field is for validation purposes and should be left unchanged.