Environmental Vacuum Bag Dust (VBD) Sample Distribution Script

ATTACHMENT B.9

OMB Control Number: 0925-0593

NCS Phase 2b Expiration Date: 07/31/2013

Environmental Vacuum Bag Dust (VBD) Sample Distribution Script, Phase 2b

Environmental Vacuum Bag Dust (VBD) Sample Distribution Script

(EH, PB, HI) V1.0

Event:	Pregnancy Visit 1
Participant:	Pregnant Woman
Domain:	Environmental
Type of Document:	Script
Recruitment Groups:	EH, PB, HI

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Environmental Vacuum Bag Dust (VBD) Sample Distribution Script

Here is a Vacuum Bag Dust (VBD) sample collection kit so that you may collect the vacuum bag dust sample yourself. Your collection of this sample will help us learn more about the dust in homes and if participants have problems with the procedures for collecting a vacuum bag dust sample, so that one day we may mail sample collection kits to participants directly.

To collect the vacuum bag dust sample, you will empty the dust from the most used vacuum in your home, or provide us with the vacuum bag from the most used vacuum. You will also complete the Vacuum Bag Dust Questionnaire.

You will then package the dust sample on ice packs and ship it to the designated laboratory by FedEx using the pre-paid, self-addressed Fedex label and shipping container provided.

The Vacuum Bag Dust Questionnaire will be mailed to our office by regular mail in the enclosed pre-paid, self-addressed envelope.

Please place the ice packs provided in this kit in your freezer as soon as possible. Ice-packs should be frozen when you ship the dust sample to the designated laboratory.

It is important that you complete the collection of each sample before starting the collection of the other samples. The VBD sample should be packaged and shipped to the designated laboratory in a separate shipper.

Do you have any questions about the vacuum bag dust sample collection kit?

THIS SCRIPT MAY BE MODIFIED AS APPROPRIATE IF OTHER ENVIRONMENTAL SAMPLE COLLECTION KITS ARE BEING DISTRIBUTED AT THIS VISIT.

Public reporting burden for this collection of information is estimated to average 5 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 (0925-0593). Do not return the completed form to this address.