Longitudinal Investigation of Fertility and the Environment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1b Survey	Form and Instruction	Modified	Available
Form 1.o Survey	Form and Instruction	New	Available
Form 1.n Survey	Form and Instruction	New	Available
Form 1.m Survey	Form and Instruction	New	Available
Form 1.l Survey	Form and Instruction	New	Available
Form 1k Survey	Form and Instruction	New	Available
Form 1j Survey	Form and Instruction	New	Available
Form 1i Survey	Form and Instruction	New	Repair queued
Form 1h Survey	Form and Instruction	New	Available
Form 1g Survey	Form and Instruction	New	Available
Form 1f Survey	Form and Instruction	New	Repair queued
Form 1e Survey	Form and Instruction	New	Available
Form 1c Survey	Form and Instruction	New	Available
Form 1.d Survey	Form and Instruction	New	Available
LIFE Study Supporting Statement Part B _3_25_08_.pdf	Supporting Statement B	Uploaded 2008-03-25	Available
Attachment 1.a. Data Collection Schedule.pdf	Supplementary Document	Uploaded 2008-03-26	Available
4.d. Illustrations of Data Collection Devices.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 4.b. Summary of Published Prospective Pregnancy Studies with Preconception Enrollment.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 4.a. Listing of Testing, Analytes & Metals to be Measured by Matrix and Required Volume.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 2.b. Study Brochure.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 2.a. Example Letter of Introduction.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 2.c. Informed Consent Document (Texas).pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 4.c. Summary of Public Comments and Response by the NICHD.pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 2.c. Informed Consent Documents (Michigan).pdf	Supplementary Document	Uploaded 2008-03-26	Available
Attachment 3_Texas_IRB.pdf	Supplementary Document	Uploaded 2008-03-25	Available
Attachment 3_Texas_Reliance.pdf	Supplementary Document	Uploaded 2008-03-25	Available
Attachment 3_RTI_Reliance.pdf	Supplementary Document	Uploaded 2008-03-25	Available
Attachment 3_RTI_IRB.pdf	Supplementary Document	Uploaded 2008-03-25	Available
Attachment 3_EMMES_IRB.pdf	Supplementary Document	Uploaded 2008-03-25	Available
LIFE Study Supporting Statement Part A _3_25_08_.pdf	Supporting Statement A	Uploaded 2008-03-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7467	Female/screening instrument	Form and Instruction	Modified	Survey
184318	Urine specimen	Form and Instruction	New	Survey
184317	Blood specimen	Form and Instruction	New	Survey
184316	Pregnancy test	Form and Instruction	New	Survey
184315	Fertility monitor	Form and Instruction	New	Survey
184314	Semen specimen	Form and Instruction	New	Survey
184313	High fertility saliva sample	Form and Instruction	New	Survey
184312	Baseline saliva sample	Form and Instruction	New	Survey
184311	Pregnancy journal	Form and Instruction	New	Survey
184310	Male time to pregnancy journal	Form and Instruction	New	Survey
184309	Female time to pregnancy journal	Form and Instruction	New	Survey
184308	Male/baseline questionnaire	Form and Instruction	New	Survey
184307	Male/screening instrument	Form and Instruction	New	Survey
184306	Female/baseline questionnaire	Form and Instruction	New	Survey

ICR Details

OMB Control No: 0925-0543	ICR Reference No: 200803-0925-006
Status: Historical Active	Previous ICR Reference No: 200610-0925-004
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Longitudinal Investigation of Fertility and the Environment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/31/2008
Terms of Clearance: OMB understands that there are no new forms, no changes of any kind to the study protocol. Burden is essentially reduced as NIH is now targeting 500 not 800 couples. The study currently has 430 couples. NIH is just requesting a few additional months to make up for Hurricane Rita and the floods that temporarily closed down the Texas site.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2009	06/30/2010	06/30/2008
Responses	7,000	0	1,000
Time Burden (Hours)	1,110	0	15,380
Cost Burden (Dollars)	0	0	0

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Abstract: Consistent with the NICHD's mission, this cohort study comprising couples desiring pregnancy will assess the relation between persistent environmental agents and lifestyle factors suspected of being reproductive and developmental toxicants.

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Authorizing Statute(s): US Code: 42 USC 285g Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 2925	01/16/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 15162	03/21/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Baseline saliva sample	1i	Survey
Blood specimen	1.n	Survey
Female time to pregnancy journal	1f	Survey
Female/baseline questionnaire	1.d	Survey
Female/screening instrument	1b	Survey
Fertility monitor	1.l	Survey
High fertility saliva sample	1j	Survey
Male time to pregnancy journal	1g	Survey
Male/baseline questionnaire	1e	Survey
Male/screening instrument	1c	Survey
Pregnancy journal	1h	Survey
Pregnancy test	1.m	Survey
Semen specimen	1k	Survey
Urine specimen	1.o	Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,000	1,000	0	6,000	0	0
Annual Time Burden (Hours)	1,110	15,380	0	-14,270	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a revision of a currently approved collection. Fewer respondents are needed to complete the study.

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Annual Cost to Federal Government: $3,811,192

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/31/2008

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