Information Collection

Biospecimen Collection

IC 203352 under ICR 201207-0925-002 · OMB 0925-0671.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0671 can be found here:

Documents and Forms

Document Name Document Type
Form 3.1 Biospecimen Collection Form and Instruction
Attach 19. Saliva Collection Participants Manual.docx Instruction
3.1 Saliva Specimen Log Attach 21. Saliva Specimen Log.doc Form and Instruction
Note-to-File - Burden for IC #3.docx Note-to-File - Burden for IC #3 IC Document
Attach 14. Study Hair Collection Protocol.docx Hair Collection Protocol IC Document
Attach 15. Study Visit 1 Blood Requisition Form.docx Visit 1 Blood Requisition Form IC Document
Attach 16. Study Visit 2 Blood Requisition Form.docx Visit 2 Blood Requisition Form IC Document
Attach 17. Visit 1 Blood Processing Protocol.doc Visit 1 Blood Processing Protocol IC Document
Attach 18. Visit 2 Blood Processing Protocol.docx Visit 2 Blood Processing Protocol IC Document
Attach 20. Saliva Processing Protocol.docx Saliva Processing Protocol IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Biospecimen Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3.1	Saliva Specimen Log	Attach 21. Saliva Specimen Log.doc		Yes	Yes	Fillable Printable
Instruction			Attach 19. Saliva Collection Participants Manual.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: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24,500	24,500
Annual IC Time Burden (Hours)	2,438	2,438
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Note-to-File - Burden for IC #3	Note-to-File - Burden for IC #3.docx	07/17/2012
Hair Collection Protocol	Attach 14. Study Hair Collection Protocol.docx	07/17/2012
Visit 1 Blood Requisition Form	Attach 15. Study Visit 1 Blood Requisition Form.docx	07/17/2012
Visit 2 Blood Requisition Form	Attach 16. Study Visit 2 Blood Requisition Form.docx	07/17/2012
Visit 1 Blood Processing Protocol	Attach 17. Visit 1 Blood Processing Protocol.doc	07/17/2012
Visit 2 Blood Processing Protocol	Attach 18. Visit 2 Blood Processing Protocol.docx	07/17/2012
Saliva Processing Protocol	Attach 20. Saliva Processing Protocol.docx	07/17/2012

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