B.1.4 LOI3-BIO-02-C Exemplar Visit Information Sheet (for NCS Vanguard Study Participants)

ATTACHMENT B.1.4 OMB NUMBER 0925-0593

LOI3-BIO-02 & 05 VISIT INFORMATION SHEET FOR NCS VANGUARD STUDY PARTICIPANTS EXPIRATION DATE: 7/31/2013

National Children’s Study Visit Information Sheet: LOI3-BIO-02-C

Thank you for participating in the National Children’s Study. When you joined the Study, we explained what it means to take part in this important research effort. This sheet gives more details about what we would like to do during this visit.

What will happen during today’s visit?

• This collection is part of a methods study that will examine the most efficient ways to test and store breast milk for environmental exposures. This collection will take about 30 minutes to complete. We will provide you with collection containers and instructions to collect your breast milk.

• We will also ask you some questions about your experience breast feeding, the food that you eat, and chemicals that may be used in your home. The interview will take about 15 minutes.

Will I receive money for taking part in today’s visit?

• To thank you for your time, we will give you $25 for today’s visit.

What if I have questions about this visit?

• If you have any questions about this visit, you can ask the Study representative you are talking with today. If he or she can’t answer a question, we will give you the name and phone number of someone from our local office who can.

Please remember:

• Whether or not you join the breast milk methods study is your choice. You can stay in the National Children’s Study even if you decide not to join the breast milk methods study.

• If you leave the Study, you can rejoin it later.

• You can decide whether or not you want to stay in the Study.

• If you leave the Study, we will not ask you for any new information, but we will keep using the information you have already given us. We will keep everything that you tell us confidential.

• If we learn that you or someone else is harming you, your child, or others around you, we may be required by law to report this to the police or a social services agency in your community.

• This is a research study and we cannot give you medical advice. None of the Study visits take the place of your regular doctor or clinic visits.

• We will contact you later to arrange for future visits with you and your child/the child you take care of.

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.