Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS)

Provider-Based Sampling Feasibility Study for the Vanguard (Pilot) Study and Data Collection Updates for the National Children's Study (NICHD)

OMB: 0925-0593

IC ID: 193560

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Form 10.3 Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS) Form and Instruction
10.3 Survey TWQ Participant Collect SAQ 20120413.docx Form and Instruction
10.4 Survey VBD Participant Collect SAQ 20120413.docx Form and Instruction
10.1 Survey Biospecimens Blood and Urine Instruments 20120413.docx Form and Instruction
10.2 Survey TWF Participant Collect SAQ 20120413.docx Form and Instruction
TWF Sample Distribution Script 20120413.docx TWF Sample Distribution Script IC Document
TWQ Sample Distribution Script 20120413.docx TWQ Sample Distribution Script IC Document
VBD Sample Distribution Script 20120413.docx VBD Sample Distribution Script IC Document
Note to File - Biological and Environmental Sample Collection (Prenatal).docx Biological and Environmental Sample Collection (Prenatal) IC Document
Pre-visit Information for Fasting Blood Urine Vacuum Collection 20110211.doc Pre-Visit Instructions for Fasting Blood, Urine, and Vacuum Collection IC Document
Pre-Visit Information for Non Fasting Venous Blood Adult Urine Vacuum Collection 20110211.doc Pre-Visit Instructions for Non Fasting Venous Blood, Adult Urine, and Vacuum Collection IC Document
Pre-Visit Instructions for Blood and Urine Collection 20110211.doc Pre-Visit Information for Blood and Urine Collection IC Document
Urine Collection Instructions 20110211.doc Urine Collection Instructions IC Document
Vacuum Bag Participant Instructions 20110211.doc Vacuum Bag Participant Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Biological and Environmental Sample Collection (Prenatal) (PB, EH, TT-HI, PBS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10.3	Survey	TWQ Participant Collect SAQ 20120413.docx	Yes	Yes	Fillable Printable
Form and Instruction	10.4	Survey	VBD Participant Collect SAQ 20120413.docx	Yes	Yes	Fillable Printable
Form and Instruction	10.1	Survey	Biospecimens Blood and Urine Instruments 20120413.docx	Yes	Yes	Paper Only
Form and Instruction	10.2	Survey	TWF Participant Collect SAQ 20120413.docx	Yes	Yes	Fillable Printable

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: 1,456	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,912	-6,385	9,297
Annual IC Time Burden (Hours)	2,912	588	2,324
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
TWF Sample Distribution Script	TWF Sample Distribution Script 20120413.docx	04/13/2012
TWQ Sample Distribution Script	TWQ Sample Distribution Script 20120413.docx	04/13/2012
VBD Sample Distribution Script	VBD Sample Distribution Script 20120413.docx	04/13/2012
Biological and Environmental Sample Collection (Prenatal)	Note to File - Biological and Environmental Sample Collection (Prenatal).docx	04/13/2012
Pre-Visit Instructions for Fasting Blood, Urine, and Vacuum Collection	Pre-visit Information for Fasting Blood Urine Vacuum Collection 20110211.doc	04/16/2012
Pre-Visit Instructions for Non Fasting Venous Blood, Adult Urine, and Vacuum Collection	Pre-Visit Information for Non Fasting Venous Blood Adult Urine Vacuum Collection 20110211.doc	04/16/2012
Pre-Visit Information for Blood and Urine Collection	Pre-Visit Instructions for Blood and Urine Collection 20110211.doc	04/16/2012
Urine Collection Instructions	Urine Collection Instructions 20110211.doc	04/17/2012
Vacuum Bag Participant Instructions	Vacuum Bag Participant Instructions 20110211.doc	04/17/2012

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