Information Collection

Adult-Focused Biospecimen Collection (Birth)

IC 210024 under ICR 201401-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 32.2 Adult-Focused Biospecimen Collection (Birth)	Form and Instruction
32.2 Survey AdultUrineInstrument.docx	Form and Instruction
32.3 Survey AdultMicrobiomeSwabInstrument.docx	Form and Instruction
32.5 Survey BreastMilkSAQ.docx	Form and Instruction
32.7 Survey BreastMilkKitDistributionInstrument.docx	Form and Instruction
32.8 Survey BreastMilkPickUpInstrument.docx	Form and Instruction
32.4 Survey Birth_CordBloodInstrument.docx	Form and Instruction
32.6 Survey Birth_PlacentaInstrument.docx	Form and Instruction
32.9 Survey Birth_AdultBiospecimenPickUpInstrument.docx	Form and Instruction
32.10 Survey AdultBloodPreScreeningInstrument.docx	Form and Instruction
32.1 Survey AdultBloodInstrument.docx	Form and Instruction
BreastMilkKitLetter.docx BreastMilkKitLetter	IC Document
AdultUrineInstructions.doc AdultUrineInstructions	IC Document
BreastMilkInstructions.docx BreastMilkInstructions	IC Document
AdultMicrobiomeRectalSwabInstructions.docx AdultMicrobiomeRectalSwabInstructions	IC Document

IC Title:

Adult-Focused Biospecimen Collection (Birth)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	32.2	Survey	AdultUrineInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.3	Survey	AdultMicrobiomeSwabInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.5	Survey	BreastMilkSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	32.7	Survey	BreastMilkKitDistributionInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.8	Survey	BreastMilkPickUpInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.4	Survey	Birth_CordBloodInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.6	Survey	Birth_PlacentaInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.9	Survey	Birth_AdultBiospecimenPickUpInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.10	Survey	AdultBloodPreScreeningInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	32.1	Survey	AdultBloodInstrument.docx	Yes	Yes	Paper Only

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: 253

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
Annual Number of Responses for this IC	253	253
Annual IC Time Burden (Hours)	358	358
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
BreastMilkKitLetter	BreastMilkKitLetter.docx	11/06/2013
AdultUrineInstructions	AdultUrineInstructions.doc	11/07/2013
BreastMilkInstructions	BreastMilkInstructions.docx	11/07/2013
AdultMicrobiomeRectalSwabInstructions	AdultMicrobiomeRectalSwabInstructions.docx	11/07/2013

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