Information Collection

Biosamples

IC 178556 under ICR 200702-0920-001 · OMB 0920-0741.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0741 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E.20 Buccal IC bioDad.doc	Other-Biosample Informed Consent (Da
Appendix E.21 Buccal Transmittal Form.doc	Other-Cheek Swab Sample Record Sheet
Appendix R.2 Blood Draw form.pdf	Other-Blood Draw Information Form
Appendix E 20 Buccal IC bioMom.doc	Other-Biosample Informed Consent (Mo
Appendix E.7 Biosample FAQs.doc Frequently Asked Questions on Biosampling	IC Document
Appendix E.19 Buccal Swab Instructions.doc How to Collect Cheek Cell Samples	IC Document
Appendix R.1 Shipping and Handling of Biosamples.doc Summary of Biosample Shipping, Processing, and Storage	IC Document

IC Title:

Biosamples

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cheek Swab Sample Record Sheet	Appendix E.21 Buccal Transmittal Form.doc	Yes	Yes	Printable Only
Other-Biosample Informed Consent (Dad)	Appendix E.20 Buccal IC bioDad.doc	Yes	Yes	Printable Only
Other-Blood Draw Information Form	Appendix R.2 Blood Draw form.pdf	Yes	Yes	Printable Only
Other-Biosample Informed Consent (Mom)	Appendix E 20 Buccal IC bioMom.doc	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 30,078

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30,078	30,078
Annual IC Time Burden (Hours)	12,362	12,362
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Frequently Asked Questions on Biosampling	Appendix E.7 Biosample FAQs.doc	06/05/2007
How to Collect Cheek Cell Samples	Appendix E.19 Buccal Swab Instructions.doc	06/05/2007
Summary of Biosample Shipping, Processing, and Storage	Appendix R.1 Shipping and Handling of Biosamples.doc	06/05/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.