Information Collection

Biologic Specimen Collection

IC 187391 under ICR 201312-0920-002 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AttR_SalivaInstructionsChild_Nov5.docx	Instruction
AttQ_SalivaInstructionsParent_Oct23.docx	Instruction
Consent AttL_SalConsentFrm_Nov8.docx	Form
AttVSalThankYouLtr_Nov5.docx V - Thank you letter	IC Document
AttU_SalIntroLtrLiving_Nov5.doc U - Saliva collection letter	IC Document

IC Title:

Biologic Specimen Collection

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 247b-4 (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Instruction			AttR_SalivaInstructionsChild_Nov5.docx	No	No	Paper Only
Form	none	Consent	AttL_SalConsentFrm_Nov8.docx	Yes	No	Paper Only
Instruction			AttQ_SalivaInstructionsParent_Oct23.docx	No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 73 FR 6727

Number of Respondents: 5,775

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	Previously Approved
Annual Number of Responses for this IC	5,775	-5,025	10,800
Annual IC Time Burden (Hours)	1,444	-356	1,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
V - Thank you letter	AttVSalThankYouLtr_Nov5.docx	12/02/2013
U - Saliva collection letter	AttU_SalIntroLtrLiving_Nov5.doc	12/02/2013

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