OBJECTIVES: Translation and linguistic validation of questionnaires for paper or electronic administration require similar procedures.  Both modalities share a common difficulty:  how to best utilize existing processes to accommodate Indian languages. Working with Indian language instruments can be daunting, even without the compounded effect of managing both ePRO and linguistic validation together.  This paper seeks to enumerate the challenges associated with the intersection of Indian languages, linguistic validation, and electronic administration and recommends the use of a specialized checklist to avoid escalating potential difficulties. METHODS: A case study was performed to explore the complexity of these processes.  A Fibromyalgia e-diary and corresponding paper diary were translated into four Indian languages and three non-Indian languages with varying levels of linguistic difficulty.  This allowed for a multidimensional analysis of issues faced in translation for ePRO versus paper administration, and translation for Indian versus non-Indian settings. RESULTS:  During linguistic validation, difficulties arise pertaining to font and formatting requirements, localization of colloquial terms and phrases and maintaining concept equivalency while respecting cultural appropriateness.  Preparing an ePRO for use involves thorough analysis of existing instrument versions and possible modification of instructions, response sets or questionnaire format to accommodate technology or screen size limitations. A holistic approach of quality assurance should be employed, including multiple rounds of proofreading. When preparing an Indian language for electronic administration one must take even more care, accounting for the factors listed above as well as considering software font-testing prior to production, and additional proofreading steps. CONCLUSIONS:  Linguistic validation of ePRO questionnaires for use in Indian settings presents special challenges. Evidence suggests that additional consideration must be exercised early on in order to avoid compounded difficulties and delays later in the process.  In such cases, the use of a checklist is recommended to assist in preempting future difficulties within the project.