Water Collection

Form Approved

OMB No. 0920-xxxx

Expiration date: xx/xx/xxxx

Home Water Sample Collection Instructions for Participants

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to  CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, M/S D74, Atlanta, GA 30333, ATTN: PRA 0920-xxxx.

Please fill the enclosed tube with water from the tap you use at home most frequently for drinking. After you have filled the tube place the lid on it and close it completely by turning to the right until it is snug. Place the tube in the preaddressed postage paid envelope we have provided and drop it in the mail.

If you have questions please call us at 612-xxx-xxxx.

Thanks