Developmental Projects and Special Studies

Attachment 2b

National Health and Nutrition Examination Survey (NHANES)

Blood Draw – Infants (0 to less than 12 months) Pilot Study

Form Approved

OMB No. 0920-0950

Assurance of Confidentiality - We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note). This law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security weaknesses. If information sent through government networks triggers a cyber-threat indicator, the information may be intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the government.

Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333. ATTN: PRA (0920-0950).

Exp. Date: 12/31/2019

This attachment represents the burden for the heel stick (0 to less than 6 months) and for the finger stick

(6 months to less than 12 months). Depending on age, the infants will have either a heel stick or finger stick,

not both.

Blood Draw – Infants (0 to less than 11 months) Pilot Study

Heel Stick Blood Collection into Microtainer^®

The heel stick is performed on the lateral or medial portions of the foot (left and right); never the central area of the foot, the arch, or the back of the heel.

Use of trade names and commercial sources is for identification only and does not imply an endorsement by the U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC).

Finger Stick Blood Collection into Microtainer^®

The finger stick will be on the patient’s middle finger or ring finger.

Use of trade names and commercial sources is for identification only and does not imply an endorsement by the U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC).