Methods of Biospecimen Collection for Women, Infants and Children

Biospecimen and Physical Measurements Formative Research Methodology Studies for the National Children?s Study (NICHD)

A.5 LOI3-BIO-0 Brief Questionnaire

Methods of Biospecimen Collection for Women, Infants and Children

OMB: 0925-0647

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A.5 BRIEF QUESTIONNAIRE OMB #: 0925-0647

EXPIRATION DATE: 01/31/2015


Analysis of Environmental Chemicals in Dried Blood Spots

Participant Questionnaire



How old are you?

_________ years.





What is your sex? Please circle one.

M / F

Public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0647). Do not return the completed form to this address.


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