1 Survey

Appendix A A.2.3.e–1

OMB #: _______________

Expiration Date: ________

How To Prepare for Your Next Appointment

You are scheduled for a home visit on (date of visit) at (time of visit).

Because we may be collecting air, water, and dust samples we would like to ask that before our visit you:

• Do NOT wash bedding or linens for at least a week before the visit.

• Do NOT vacuum, dust, or sweep your floors for at least 3 days before the visit.

• Do NOT change any water filters you may have.

• Do NOT do any seasonal cleaning of any wood, pellet, or coal stoves or fireplaces that you may have.

If you use any pesticide products for insects, please gather the containers for all of the pesticide products you have used since our last visit. Our staff would like to look at the labels during the visit.

Our data collectors would also like to look at the labels for any prescription and non-prescription medicines, and any vitamins, minerals, herbals, and other dietary supplements you have given your baby since our last visit. Please gather the containers and have them available during the visit.

Also, have your Infant Medical Care Log available so that you can refer to it during the interview.

For a few of the measures, the data collector will need access to your shoulder and upper back area.

• If you own one, please wear a sleeveless, loose-fitting shirt.

If you have any further questions about how to prepare for this Study visit, you may contact your Study Center at xxx-xxx-xxxx.

12-Month Visit