Information Collection

Methods of Biospecimen Collection for Women, Infants and Children

IC 201426 under ICR 201109-0925-001 · OMB 0925-0647.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A.5 LOI3-BIO-0 Brief Questionnaire.docx	Instruction
A.6 LOI3-BIO-0 Protocol Description.docx	Instruction
A.7 LOI3-BIO-0 Biospecimen Processing Protocol Description.doc	Instruction
B.3 LOI2-BIO-20 IRB Protocol.doc	Instruction
C.3 LOI2-BIO-24 Exemplar Protocol.pdf	Instruction
A.2 LOI3-BIO-0 Consent for ParentGuardian of Participant.doc A.2 LOI3-BIO-0 Consent for Parent Guardian of Participant	IC Document
A.3 LOI3-BIO-0 Consent for Adult Participant.doc A.3 LOI3-BIO-0 Consent for Adult Participant	IC Document
A.4 LOI3-BIO-0 Child Assent.doc A.4 LOI3-BIO-0 Child Assent	IC Document
A.8 LOI3-BIO-0 IRB Approval Letter.pdf A.8 LOI3-BIO-0 IRB Approval Letter	IC Document
B.2 LOI2-BIO-20 Exemplar Consent Form.docx B.2 LOI2-BIO-20 Exemplar Consent Form	IC Document
B.4 LOI2-BIO-20 IRB Approval Letters.pdf B.4 LOI2-BIO-20 IRB Approval Letters	IC Document
C.2 LOI2-BIO-24 Exemplar Consent Form.pdf C.2 LOI2-BIO-24 Exemplar Consent Form	IC Document
C.4 LOI2-BIO-24 IRB Approval Letters.pdf C.4 LOI2-BIO-24 IRB Approval Letters	IC Document
C 1 LOI2-BIO-24 OIRA Template v2.docx LO12 BIO -24 OIRA template	IC Document
A 1 LOI3-BIO-0 OIRA Template v2.docx LO12 BIO 0 OIRA template	IC Document
B 1 LOI2-BIO-20 OIRA Template (2) v2.docx LO12 BIO 20 OIRA template	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	A.7 LOI3-BIO-0 Biospecimen Processing Protocol Description.doc	Yes	Yes	Paper Only
Instruction	A.5 LOI3-BIO-0 Brief Questionnaire.docx	Yes	Yes	Paper Only
Instruction	A.6 LOI3-BIO-0 Protocol Description.docx	Yes	Yes	Paper Only
Instruction	B.3 LOI2-BIO-20 IRB Protocol.doc	Yes	Yes	Paper Only
Instruction	C.3 LOI2-BIO-24 Exemplar Protocol.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,125	0	0	0	0	0
Annual IC Time Burden (Hours)	234	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A.2 LOI3-BIO-0 Consent for Parent Guardian of Participant	A.2 LOI3-BIO-0 Consent for ParentGuardian of Participant.doc	02/15/2012
A.3 LOI3-BIO-0 Consent for Adult Participant	A.3 LOI3-BIO-0 Consent for Adult Participant.doc	02/15/2012
A.4 LOI3-BIO-0 Child Assent	A.4 LOI3-BIO-0 Child Assent.doc	02/15/2012
A.8 LOI3-BIO-0 IRB Approval Letter	A.8 LOI3-BIO-0 IRB Approval Letter.pdf	02/15/2012
B.2 LOI2-BIO-20 Exemplar Consent Form	B.2 LOI2-BIO-20 Exemplar Consent Form.docx	02/15/2012
B.4 LOI2-BIO-20 IRB Approval Letters	B.4 LOI2-BIO-20 IRB Approval Letters.pdf	02/15/2012
C.2 LOI2-BIO-24 Exemplar Consent Form	C.2 LOI2-BIO-24 Exemplar Consent Form.pdf	02/15/2012
C.4 LOI2-BIO-24 IRB Approval Letters	C.4 LOI2-BIO-24 IRB Approval Letters.pdf	02/15/2012
LO12 BIO -24 OIRA template	C 1 LOI2-BIO-24 OIRA Template v2.docx	04/26/2012
LO12 BIO 0 OIRA template	A 1 LOI3-BIO-0 OIRA Template v2.docx	04/26/2012
LO12 BIO 20 OIRA template	B 1 LOI2-BIO-20 OIRA Template (2) v2.docx	04/26/2012

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