Information Collection

Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)

IC 202211 under ICR 201205-0925-002 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 16.2 Survey Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)	Form and Instruction
Form 16.1 Survey Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)	Form and Instruction
Form 16.5 Survey Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)	Form and Instruction
Form 16.3 Survey Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)	Form and Instruction
Form 16.4 Survey Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)	Form and Instruction
16.2 Survey 6, 12 MO Child Urine Collection Instrument 20120413.docx	Form and Instruction
16.1 Survey 1, 3 MO Breast Milk Collection SAQ 20120413.docx	Form and Instruction
16.5 Survey 12 MO Child Saliva SAQ 20120413.docx	Form and Instruction
16.3 Survey 12 MO Child Blood Instrument 20120413.docx	Form and Instruction
16.4 Survey 12 MO Child Saliva Instrument 20120413.docx	Form and Instruction
1, 3 MO Breast Milk Collection Instructions 20120413.docx Biospecimen Breast Millk Collection Instruments (1, 3 MO)	IC Document
6, 12 MO Child Urine Collection Instructions 20120413.docx Biospecimens Child Urine Collection Instructions (6, 12 MO)	IC Document
12 MO Child Saliva Instructions 20120413.docx 12 MO Child Saliva Collection Instructions (12 MO)	IC Document

IC Title:

Biospecimen Sample Collection - Mother / Baby (PB, EH, TT-LI)

Agency IC Tracking Number:

Is this a Common Form? No

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	16.2	Survey	6, 12 MO Child Urine Collection Instrument 20120413.docx	Yes	Yes	Paper Only
Form and Instruction	16.1	Survey	1, 3 MO Breast Milk Collection SAQ 20120413.docx	Yes	Yes	Fillable Printable
Form and Instruction	16.5	Survey	12 MO Child Saliva SAQ 20120413.docx	Yes	Yes	Fillable Printable
Form and Instruction	16.3	Survey	12 MO Child Blood Instrument 20120413.docx	Yes	Yes	Paper Only
Form and Instruction	16.4	Survey	12 MO Child Saliva Instrument 20120413.docx	Yes	Yes	Paper Only

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: 761

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 Agency Discretion
Annual Number of Responses for this IC	3,044	3,044
Annual IC Time Burden (Hours)	1,142	1,142
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Biospecimen Breast Millk Collection Instruments (1, 3 MO)	1, 3 MO Breast Milk Collection Instructions 20120413.docx	04/16/2012
Biospecimens Child Urine Collection Instructions (6, 12 MO)	6, 12 MO Child Urine Collection Instructions 20120413.docx	04/16/2012
12 MO Child Saliva Collection Instructions (12 MO)	12 MO Child Saliva Instructions 20120413.docx	04/16/2012

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