Information Collection

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

IC 193560 under ICR 201211-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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
10.2 Survey TWF Participant Collect SAQ 20120413.docx	Form and Instruction
10.5 Survey Attach B19. Biospecimen Adult Blood Instrument.docx	Form and Instruction
10.6 Survey Attach B20. Biospecimen Adult Urine Instrument.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:

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	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	10.2	Survey	TWF Participant Collect SAQ 20120413.docx	Yes	Yes	Fillable Printable
Form and Instruction	10.5	Survey	Attach B19. Biospecimen Adult Blood Instrument.docx	Yes	Yes	Paper Only
Form and Instruction	10.6	Survey	Attach B20. Biospecimen Adult Urine Instrument.docx	Yes	Yes	Paper Only

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,912	2,912
Annual IC Time Burden (Hours)	2,912	2,912
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.