Information Collection

Provider-Based: Pregnancy Visit 1 Blood and Urine Collection

IC 196503 under ICR 201103-0925-001 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Form 36.1 Provider-Based: Pregnancy Visit 1 Blood and Urine Collection Form and Instruction
Urine Collection Instructions 20110211.doc Instruction
Pre-visit Information for Fasting Blood Urine Vacuum Collection 20110211.doc Instruction
Pre-Visit Information for Non Fasting Venous Blood Adult Urine Vacuum Collection 20110211.doc Instruction
Pre-Visit Instructions for Blood and Urine Collection 20110211.doc Instruction
36.1 Survey Biospecimens Urine Instrument 20110211.docx Form and Instruction
36.2 Survey Biospecimens Blood Instrument 20110211.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Provider-Based: Pregnancy Visit 1 Blood and Urine Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	36.1	Survey	Biospecimens Urine Instrument 20110211.docx	Yes	Yes	Paper Only
Instruction			Urine Collection Instructions 20110211.doc	Yes	Yes	Paper Only
Form and Instruction	36.2	Survey	Biospecimens Blood Instrument 20110211.doc	Yes	Yes	Paper Only
Instruction			Pre-visit Information for Fasting Blood Urine Vacuum Collection 20110211.doc	Yes	Yes	Paper Only
Instruction			Pre-Visit Information for Non Fasting Venous Blood Adult Urine Vacuum Collection 20110211.doc	Yes	Yes	Paper Only
Instruction			Pre-Visit Instructions for Blood and Urine Collection 20110211.doc	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 415	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	415	415
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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