Information Collection

Biologic Specimen Collection Kit

IC 187391 under ICR 201004-0920-011 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att Q_Cheek Cell Letter.doc	Other-word
Att O_Written Consent for Cheek Cells.doc Informed Consent	IC Document
Att R_Cheek Cell Instructions.doc Instructions	IC Document

IC Title:

Biologic Specimen Collection Kit

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 247b-4 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-word			Att Q_Cheek Cell Letter.doc		No	No	Fillable Printable

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: 73 FR 6727

Number of Respondents: 10,800

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	Previously Approved
Annual Number of Responses for this IC	10,800	10,800
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Informed Consent	Att O_Written Consent for Cheek Cells.doc	11/19/2008
Instructions	Att R_Cheek Cell Instructions.doc	11/19/2008

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