With the emergence of electronic data collection and efforts to reduce respondent burden, the use of item banks to measure health related constructs – especially within federally funded (NIH) research – has become more mainstream. Following the use and acceptance of Computer Adaptive Testing (CAT) in educational testing, item banks in health status assessment allow for better measurement of a construct across the measurement continuum. As with standard static questionnaires used in outcomes assessment, there is a need for multilingual translations of item banks in order to establish and compare item hierarchies across varying languages and cultures.  Translation and validation of items contained in item banks presents interesting scientific opportunities for cross-cultural health assessment, but there are also attendant challenges to be addressed. This presentation will give a brief overview of the benefits of computer adaptive testing while outlining the most salient issues related to the evaluation of item difficulty and hierarchy. It will also highlight differences and unique challenges brought about by translating item banks. Topics such as maintaining consistent terminology, recall period and verb tense will be addressed and examples from our experience will be provided.   Appropriate translation methodology, copyright issues and the role of both qualitative and quantitative data in the process will also be discussed as well as brief examples of how items that are similar linguistically and conceptually may have different item parameters in different languages.