Consent for Bloodspot Retrieval

Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Consent for Bloodspot Retrieval Form and Instruction
Consent for Bloodspot Release AttO1_BloodspotConsent_English.pdf Form and Instruction
Consent for Bloodspot Retrieval - Spanish AttO2_BloodspotConsent_Spanish.pdf Form and Instruction
Consent for Bloodspot Retrieval - Multiples AttP1_BloodspotConsent_Multiples_English.pdf Form and Instruction
Consent for Bloodspot Retrieval - Multiples - Spanish AttP2_MultiplesConsent_Spanish.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Consent for Bloodspot Retrieval	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Consent for Bloodspot Release	AttO1_BloodspotConsent_English.pdf	Yes	No	Paper Only
Form and Instruction	none	Consent for Bloodspot Retrieval - Spanish	AttO2_BloodspotConsent_Spanish.pdf	Yes	No	Paper Only
Form and Instruction	none	Consent for Bloodspot Retrieval - Multiples	AttP1_BloodspotConsent_Multiples_English.pdf	Yes	No	Paper Only
Form and Instruction	none	Consent for Bloodspot Retrieval - Multiples - Spanish	AttP2_MultiplesConsent_Spanish.pdf	Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 1,375	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,375	1,375
Annual IC Time Burden (Hours)	344	344
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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