National Institute of Standards & Technology (NIST)
SRM Customer Questionnaire
<SRM 1849a Infant/Adult Nutritional Formula>
NIST is conducting this survey of recent customers to better design SRM products in the future. You are receiving this questionnaire as a customer of NIST who has purchased at least one unit of <SRM 1849a Infant/Adult Nutritional Formula> in the past 5 years.
Customer Information
Laboratory Name: Click here to enter text.
Laboratory Location: Click here to enter text.
Respondent Name: Click here to enter text.
Respondent Email: Click here to enter text.
Respondent Phone: Click here to enter text.
☐ I am willing to be contacted by NIST staff via email and/or phone to provide additional information.
Which of the following best describe(s) your laboratory? Check all that apply.
☐ Academic laboratory
☐ Government laboratory
☐ Food manufacturer (QA/QC) laboratory
☐ Third-party testing laboratory
☐ Research and development
☐ Other (please describe): Click here to enter text.
Which of the following best describe(s) your general research area or interests? Check all that apply.
☐ Nutrition labeling
☐ Food safety/contaminants
☐ Food research (general)
☐ Dietary supplements research (general)
☐ Other (please describe): Click here to enter text.
Use of <SRM 1849a Infant/Adult Nutritional Formula>
For which of the following analytes or groups of analytes has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some categories may be removed if there are no assigned values in the SRM being queried.
☐ Cholesterol
☐ Elements
☐ Toxic Elements/Contaminants
☐ Water-Soluble Vitamins
☐ Fat-Soluble Vitamins
☐ Carotenoids
☐ Proximates
☐ Fatty Acids
☐ Amino Acids
☐ Sugars
☐ Other (e.g., cholesterol, catechins, xanthines, flavonoids)
For every box selected in response to question 1, up to ten follow-up questions will be generated as described below.
For which of the following elements has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
Nutritional Elements
☐ Calcium
☐ Copper
☐ Iron
☐ Magnesium
☐ Manganese
☐ Phosphorus
☐ Potassium
☐ Sodium
☐ Zinc
Trace Minerals
☐ Chromium
☐ Molybdenum
☐ Selenium
Other Elements
☐ Aluminum
☐ Antimony
☐ Barium
☐ Boron
☐ Bromine
☐ Cerium
☐ Cesium
☐ Chlorine
☐ Cobalt
☐ Europium
☐ Fluoride
☐ Gadolinium
☐ Gold
☐ Hafnium
☐ Hydrogen
☐ Iodine
☐ Lanthanum
☐ Lithium
☐ Neodymium
☐ Nickel
☐ Nitrogen
☐ Rubidium
☐ Samarium
☐ Scandium
☐ Silicon
☐ Silver
☐ Strontium
☐ Sulfur
☐ Terbium
☐ Thorium
☐ Tin
☐ Titanium
☐ Tungsten
☐ Uranium
☐ Vanadium
☐ Ytterbium
For which of the following toxic elements/contaminants has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Arsenic
☐ Cadmium
☐ Lead
☐ Mercury
☐ Dimethylarsinic acid (DMA)
☐ Inorganic arsenic (iAs)
☐ Monomethylarsonic acid (MMA)
☐ Methylmercury
☐ Acrylamide
☐ Aflatoxin B1
☐ Aflatoxin B2
☐ Total Aflatoxins
For which of the following water-soluble vitamins has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Ascorbic Acid (Vitamin C)
☐ Biotin
☐ Biotin
☐ Total Biotin by Microbiological Assay
☐ Carnitine
☐ Choline
☐ Choline Ion
☐ Folates
☐ Folic Acid
☐ 5-Methyltetrahydrofolate
☐ Total Folate by Microbiological Assay
☐ Myo-inositol
☐ Riboflavin (Vitamin B2)
☐ Thiamine/Thiamine Hydrochloride (Vitamin B1)
☐ Vitamin B3
☐ Niacin
☐ Niacinamide
☐ Total Vitamin B3
☐ Total Vitamin B3 by Microbiological Assay
☐ Vitamin B5
☐ Pantothenic Acid
☐ Total Vitamin B5 by Microbiological Assay
☐ Vitamin B6
☐ Pyridoxal/Pyridoxal Hydrochloride
☐ Pyridoxamine/Pyridoxamine Dihydrochloride
☐ Pyridoxine/Pyridoxine Hydrochloride
☐ Total Vitamin B6
☐ Total Vitamin B6 by Microbiological Assay
☐ Vitamin B12
☐ Cyanocobalamin
☐ Total Vitamin B12 by Microbiological Assay
For which of the following fat-soluble vitamins has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Vitamin A
☐ Retinol
☐ Retinyl Palmitate
☐ Vitamin D
☐ Cholecalciferol (Vitamin D3)
☐ Ergocalciferol (Vitamin D2)
☐ Phylloquinone (Vitamin K)
☐ Vitamin E
☐ α-Tocopherol
☐ α-Tocopheryl Acetate
☐ Total α-Tocopherol
☐ β-Tocopherol
☐ γ-Tocopherol
☐ γ- + β-Tocopherol
☐ δ-Tocopherol
For which of the following carotenoids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ α-Carotene
☐ β-Carotene
☐ Total β-Carotene
☐ trans-β-Carotene
☐ 9-cis-β-Carotene
☐ Total β-cryptoxanthin
☐ Total Lutein
☐ Lycopene
☐ trans-Lycopene
☐ Total Lycopene
☐ Total Zeaxanthin
For which of the following proximates has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Ash
☐ Calories
☐ Carbohydrates
☐ Fat
☐ Total Fat (sum of fatty acids)
☐ Total Fat (extracted)
☐ Moisture
☐ Solids
☐ Dietary Fiber
☐ Insoluble
☐ Insoluble + High Molecular Weight Soluble
☐ Low Molecular Weight Soluble
☐ High Molecular Weight Soluble
☐ High Molecular Weight Total
☐ Soluble
☐ Total
For which of the following fatty acids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Butryic Acid (C4:0)
☐ Caproic Acid (C6:0)
☐ Caprylic Acid (C8:0)
☐ Capric Acid (C10:0)
☐ Undecanoic Acid (C11:0)
☐ Lauric Acid (C12:0)
☐ Tridecanoic Acid (C13:0)
☐ Myristic Acid (C14:0)
☐ Myristoleic Acid (C14:1 n-5)
☐ Pentadecanoic Acid (C15:0)
☐ Palmitic Acid (C16:0)
☐ Palmitoleic Acid (C16:1 n-7)
☐ trans-Palmitelaidic Acid (C16:1-9t)
☐ Hexadecadienoic Acid (C16:2)
☐ Margaric Acid (C17:0)
☐ Margaroleic Acid (C17:1 n-6)
☐ Stearic Acid (C18:0)
☐ Vaccenic Acid (C18:1 n-7)
☐ Oleic Acid (C18:1 n-9)
☐ trans-Vaccenic Acid (C18:1-11t)
☐ Elaidic Acid (C18:1-9t)
☐ Linoelaidic Acid (C18:2)
☐ 9,12-Octadecadienoic Acid (C18:2-9t)
☐ 9,12-Octadecadienoic Acid (C18:2-12t)
☐ Linoleic Acid (C18:2 n-6)
☐ α-Linolenic Acid (C18:3 n-3)
☐ γ-Linolenic Acid (C18:3 n-6)
☐ Stearidonic Acid (C18:4)
☐ Arachidic Acid (C20:0)
☐ Gadoleic Acid (C20:1 n-7)
☐ Gondoic Acid (C20:1 n-9)
☐ Eicosadienoic Acid (C20:2 n-6)
☐ Dihomo-γ-linolenic Acid (C20:3 n-6)
☐ 11,14,17-Eicosatrienoic Acid (C20:3 n-3)
☐ EPA (C20:4 n-3)
☐ Arachidonic Acid (C20:4 n-6)
☐ Heneicosanoic Acid (C21:0)
☐ Behenic Acid (C22:0)
☐ Erucic Acid (C22:1 n-9)
☐ 13,16-Docosadienoic Acid (C22:2)
☐ DPA (C22:5 n-3)
☐ DHA (C22:6 n-3)
☐ Lignoceric Acid (C24:0)
☐ Nervonic Acid (C24:1 n-9)
☐ cis-Monounsaturated Fat
☐ cis-Polyunsaturated Fat
☐ Saturated Fat
☐ Total cis-C18:1
☐ Total cis-C18:2
☐ Total cis-C20:1
☐ Total cis-C22:4
☐ Total cis-C22:5
☐ Total trans Fat
☐ Total trans-C18:1
☐ Total trans-C18:2
☐ Total trans-C18:2 Conjugated
☐ Total ω-3 Fatty Acids
☐ Total ω-6 Fatty Acids
For which of the following amino acids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Alanine
☐ Arginine
☐ Aspartic Acid
☐ Cystine
☐ Glutamic Acid
☐ Glycine
☐ Histidine
☐ Hydroxyproline
☐ Isoleucine
☐ L-theanine
☐ Leucine
☐ Lysine
☐ Methionine
☐ Phenylalanine
☐ Proline
☐ Serine
☐ Taurine
☐ Threonine
☐ Tryptophan
☐ Tyrosine
☐ Valine
For which of the following sugars has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Fructose
☐ Glucose
☐ Lactose
☐ Maltose
☐ Sucrose
☐ Total Sugars
For which of the following other analytes has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.
☐ Anions
☐ Phosphate
☐ Sulfate
☐ Catechins
☐ Catechin
☐ Catechin Monomers
☐ Epicatechin
☐ Epicatechin Gallate
☐ Epigallocatechin
☐ Epigallocatechin Gallate
☐ Gallocatechin Gallate
☐ Gallic Acid
☐ Gallocatechin
☐ Epigallocatechin Methylgallate
☐ Cholesterol
☐ Isoflavones
☐ Daidzein
☐ Daidzin
☐ Genistein
☐ Genistin
☐ Glycitein
☐ Glycitin
☐ Flavonoid Aglycones
☐ Quercetin
☐ Kaempferol
☐ Isorhamnetin
☐ Total
☐ Naphthodianthrones
☐ Hypericin
☐ Pseudohypericin
☐ Organic Acids
☐ Ascorbic Acid
☐ Citric Acid
☐ Galacturonic Acid
☐ Glycolic Acid
☐ Isocitric Acid
☐ Malic Acid
☐ Oxalic Acid
☐ Quinic Acid
☐ Shikimic Acid
☐ Tartaric Acid
☐ Phytosterols
☐ Campesterol
☐ β-Sitosterol
☐ Stigmasterol
☐ Cycloartenol
☐ Brassicasterol
☐ Lupeol
☐ Xanthines
☐ Caffeine
☐ Theobromine
☐ Theophylline
☐ L-theanine
☐ Terpene Lactones
☐ Ginkgolide A
☐ Ginkgolide B
☐ Ginkgolide C
☐ Ginkgolide J
☐ Bilobalide
☐ Total Antioxidant Capacity
☐ Total Polyphenols
☐ Total Procyanidins
Please list any other analytes or analyte groups that would be beneficial to have assigned in <SRM 1849a Infant/Adult Nutritional Formula>. Click here to enter text.
Please describe other ways that <SRM 1849a Infant/Adult Nutritional Formula> could better suit your needs. Click here to enter text.
Please describe other ways that <SRM 1849a Infant/Adult Nutritional Formula> could better suit your needs. Click here to enter text.
The coordinators of the NIST Food and Nutrition Reference Materials Program thank you for your participation in this questionnaire.
This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 15 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. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Melissa Phillips, NIST, 100 Bureau Drive, Gaithersburg, MD 20899-8392; Email: [email protected].
OMB Control No. 0693-0033
Expiration Date: 03/31/2016
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Phillips, Melissa M. |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |