Data Reporting Page

Form Approved
OMB No. 0920-0879
Exp. Date 01/31/2021

Attachment A - Pilot Online Data Collection for SMA PT Screenshot of Reporting Page
Home (/) > Spinal Muscular Atrophy (SMAPT)

Spinal Muscular Atrophy (SMAPT)
Participating laboratories must generate and submit their own results and must not share NSQAP Pilot PT test results or specimens with any
other laboratory under ANY circumstance, even if the laboratory normally sends specimens to referral laboratories for routine or confirmatory
testing. If participants are found to have falsified or shared results or specimens, the NSQAP committee will convene to discuss response
actions for the participant which may include termination from the program.

Select Method Code from drop-down menu:

—



Select DNA Extraction Method from drop-down menu:

—



SMN1 assay primer and probe information
SMN1 probe sequence including dye and quencher:

SMN1 forward amplficiation primer sequence:

SMN1 reverse amplficiation primer sequence:

Reference Gene assay primer and probe information
Reference gene probe sequence including dye and quencher:

Reference gene forward amplficiation

Reference gene reverse amplficiation

Data Entry
20P1701

SMN1 Exon 7

—

—

20P1702

SMN1 Exon7

—

—

20P1703

SMN1 Exon7

—

—

20P1704

SMN1 Exon7

—

—

20P1705

SMN1 Exon7

—

—

Clinical Assessment Code

Comments

Clinical Assessment Code

Comments

Clinical Assessment Code

Comments

Clinical Assessment Code

Comments

Clinical Assessment Code

Comments

Submit

CDC estimates the average public reporting burden for this collection of information as 6 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, Georgia 30333;
ATTN: PRA (0920-0879).

1/1