NoiseMonitorShippingInstructions

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

Environmental Noise Monitor Shipping Instructions, Phase 2g

The National Children’s Study

Noise Monitor Shipping Instructions

Instructions for Returning Environmental Noise Monitor

1. Call FedEx (1-800-463-3339 or 1-800-GO- FEDEX) to schedule a pickup.

2. Have the following information ready when you call FedEx for FedEx Express (overnight delivery) shipment:

1. Your name

2. Address for pick-up

3. Approximate weight of the shipment

4. Date of pick-up

5. Time of pick-up

6. Exact location where the shipment will be picked-up

7. The FedEx account number to use for this prepaid shipment

Please refer to the pre-filled FedEx airbill for the approximate weight of the shipment and FedEx account number.

Photo x. Noise monitor stand with text indicating each part

On the day the noise monitor is taken down, measure the distance of the microphone from the wall and height of the microphone from the floor (Questions 9 and 10, Photos x and x), if required. When taking the measurements, measure from the top of the microphone using the measuring tape.

Photo x. Measuring the distance of the microphone from the wall

On the Noise Measurement Self-Administered Questionnaire (SAQ), write the date, mark the day of the week, and write the time when you took down the noise monitor (Questions 1, 2, and 3). Complete rest of the questions and make sure all the questions are answered.

Photo x: Measuring the height of the microphone from the floor

5. Carefully unfasten the microphone from the stand (Photo x) and disconnect the cable from the case (Photo x). Do not use excessive force. Remove the stand from the case as shown in Photo x.

Photo x: Unfastening the microphone from the stand

Photo x: Disconnecting the microphone cable from the case

Wrap the microphone with bubble wrap. Place the stand, microphone, and electrical cord (if applicable) in the smaller shipping box (Photo x).

Photo x: Removing the stand from the case

7. Place the completed questionnaire in the resealable plastic bag and place it in the box along with the stand, microphone and electrical cord (if applicable) as shown in Photo x. Close and seal the box.

Photo x: Smaller shipping box with microphone cable, stand, and electrical cord

Photo x: Smaller shipping box with microphone cable, stand, electrical cord, and completed questionnaire

Place the locked noise monitor case and the sealed box containing the stand, microphone, completed questionnaire, and electrical cord (if applicable) inside the shipper. Fill the extra space with the packing material provided. Close and seal the shipper (Photo x).

Photo x: Sealed smaller shipping box and locked noise case in the shipper

9. Leave the sealed shipper for FedEx to pick up at a location you provided when you called the FedEx to schedule a pick-up.

The shipment will be shipped to the address indicated on the prefilled FedEx label.

Photo x: The prefilled FedEx label

_{Thank you for completing the noise measurement questionnaire and for sending} back the noise monitor.

Your continued participation in the National Children’s Study is greatly appreciated.

Please contact us if you have any questions about the noise measurement and/or shipping the noise monitor.

Include the contact information (phone number, e-mail address etc.) here.

Please ship the noise monitor to the following address:

Include the address here.

For Office Use Only:

Click here to insert Respondent ID.

Click here to insert Participant ID.

Click here to insert ROC contact information.

Public reporting burden for this collection of information is estimated to average 3 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.