Information Collection

LOI2-BIO-19 - Integration of salivary analytes into the NCS: Evaluation of Feasibility, Efficiency, and Benefits

IC 203890 under ICR 201109-0925-001 · OMB 0925-0647.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2.3 LOI2-BIO-19 - Integration of salivary analytes into the NCS: Evaluation of Feasibility, Efficiency, and Benefits	Form and Instruction
Attach S1 Goal 2_Home Visit Saliva Collection Guide.docx	Instruction
Attach S3 Goal 2_Saliva Collection Diagrams.docx	Instruction
Attach S4 Goal 2_Saliva Collection Do's and Don'ts.docx	Instruction
Attach S5 Goal 2_Sample Shipping Instructions.docx	Instruction
1.1 Goal 1 Telephone Screening Script Attach 1b Goal 1_TelephoneScreeningScript.docx	Form and Instruction
2.1 Goal 2 Telephone Screening Script Attach 2a Goal 2_TelephoneScreeningScript.docx	Form and Instruction
2.3 Goal 2 Follow-Up Telephone Interview Attach 2d Goal 2_ Follow Up Telephone Interview.docx	Form and Instruction
2.4 Goal 2 Saliva Collection Log Attach S2 Goal 2_DemoMotherInfantChild Saliva Collection Sheets.docx	Form and Instruction
2.2 Goal 2 Home Visit Demographics Attach 2c Goal 2_Home Visit Demographics Questionnaire.docx	Form and Instruction
1.3 Goal 1 Demographic and Health Attach 1d Goal 1_Demographic Health Behavior Questionnaire.doc	Form and Instruction
Attach 1a Goal 1_Exemplar Recruitment Flyer.docx Goal 1 Exemplar Recruitment Flyer	IC Document
Attach 1c Goal 1_Consent Form.docx Goal 1 Consent Form	IC Document
Attach 1e Goal 1_IRB Protocol.docx Goal 1 IRB Protocol	IC Document
Attach 1f Goal 1_IRB Approval.pdf Goal 1 IRB Approval Letter	IC Document
Attach 2b Goal 2_Consent Form.docx Goal 2 Consent Form	IC Document
Attach 2e Goal 2_IRB Protocol.docx Goal 2 IRB Protocol	IC Document
Attach 2f Goal 2_IRB Approval Letter.pdf Goal 2 IRB Approval Letter	IC Document
Attach S6 Goal 2_Saliva Kit Choking Hazard Warning.docx Goal 2 Saliva Kit Choking Hazard Warning	IC Document
LOI2-BIO-19 I &II OIRA Template_Final_20120817.doc Goal 1 and Goal 2 OIRA Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

LOI2-BIO-19 - Integration of salivary analytes into the NCS: Evaluation of Feasibility, Efficiency, and Benefits

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2.3	Goal 2 Follow-Up Telephone Interview	Attach 2d Goal 2_ Follow Up Telephone Interview.docx	Yes	Yes	Paper Only
Instruction			Attach S1 Goal 2_Home Visit Saliva Collection Guide.docx	Yes	Yes	Paper Only
Form and Instruction	2.4	Goal 2 Saliva Collection Log	Attach S2 Goal 2_DemoMotherInfantChild Saliva Collection Sheets.docx	Yes	Yes	Fillable Printable
Instruction			Attach S3 Goal 2_Saliva Collection Diagrams.docx	Yes	Yes	Paper Only
Instruction			Attach S4 Goal 2_Saliva Collection Do's and Don'ts.docx	Yes	Yes	Paper Only
Instruction			Attach S5 Goal 2_Sample Shipping Instructions.docx	Yes	Yes	Paper Only
Form and Instruction	1.3	Goal 1 Demographic and Health	Attach 1d Goal 1_Demographic Health Behavior Questionnaire.doc	Yes	Yes	Fillable Fileable
Form and Instruction	2.2	Goal 2 Home Visit Demographics	Attach 2c Goal 2_Home Visit Demographics Questionnaire.docx	Yes	Yes	Fillable Printable
Form and Instruction	1.1	Goal 1 Telephone Screening Script	Attach 1b Goal 1_TelephoneScreeningScript.docx	Yes	Yes	Paper Only
Form and Instruction	2.1	Goal 2 Telephone Screening Script	Attach 2a Goal 2_TelephoneScreeningScript.docx	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

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: 442

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	2,362	0	0	0	0	0
Annual IC Time Burden (Hours)	495	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
Goal 1 Exemplar Recruitment Flyer	Attach 1a Goal 1_Exemplar Recruitment Flyer.docx	08/09/2012
Goal 1 Consent Form	Attach 1c Goal 1_Consent Form.docx	08/14/2012
Goal 1 IRB Protocol	Attach 1e Goal 1_IRB Protocol.docx	08/14/2012
Goal 1 IRB Approval Letter	Attach 1f Goal 1_IRB Approval.pdf	08/14/2012
Goal 2 Consent Form	Attach 2b Goal 2_Consent Form.docx	08/14/2012
Goal 2 IRB Protocol	Attach 2e Goal 2_IRB Protocol.docx	08/14/2012
Goal 2 IRB Approval Letter	Attach 2f Goal 2_IRB Approval Letter.pdf	08/14/2012
Goal 2 Saliva Kit Choking Hazard Warning	Attach S6 Goal 2_Saliva Kit Choking Hazard Warning.docx	08/14/2012
Goal 1 and Goal 2 OIRA Template	LOI2-BIO-19 I &II OIRA Template_Final_20120817.doc	08/17/2012

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