Resident Saliva Collection

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1004 can be found here:

Documents and Forms

Document Name Document Type
Resident Saliva Collection Form and Instruction
Saliva Collection Att 10A(e) Protocol for Saliva Collection_8 29 2012.docx Form and Instruction
Att 10A-1(e)_Child Assent Saliva Sample.docx Child Assent - English IC Document
Att 10A-1(s)_Child Assent Saliva Sample_8 30 2012.docx Child Assent - Spanish IC Document

Information Collection (IC) Details

IC Title:	Resident Saliva 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	none	Saliva Collection	Att 10A(e) Protocol for Saliva Collection_8 29 2012.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	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	1,500	1,500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Child Assent - English	Att 10A-1(e)_Child Assent Saliva Sample.docx	09/27/2012
Child Assent - Spanish	Att 10A-1(s)_Child Assent Saliva Sample_8 30 2012.docx	09/27/2012

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