EQUIP Data Submission Form

International Iodine Network

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Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/20xx

EQUIP Program
Data Submission - Round 57

Submit EQUIP
Program Data
Laboratory ID: E-026

View EQUIP Program
Reports
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Method (Please check all that apply or describe below):
Ammonium Persulfate Digestion with spectrophotometric detection of the
Sandell-Kolthoff reaction

Chloric Acid Digestion with spectrophotometric detection of the SandellKolthoff reaction
Chloric Acid Digestion using ferroin as a timed indicator of the SandellKolthoff reaction
ICP-MS
Automated Urinary Iodine System:
What system?
What sample pretreatment?

Other (please describe):

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Calibration Range

Limit of Detection (LOD)

Sample Results
Please run these samples in the same way as you would routine patient samples.
Run in duplicate and, if possible, over a period of three different runs or days.
Record all results in µg/L with one decimal place.
Run/Pool

Result 1
(µg/L)

Result 2
(µg/L)

Date
(Month/Day/Year)

Run 1
Pool UI 180705

12

Pool UI 180710

12

Pool UI 180712

12

Pool UI 180788

12

Run 2
Pool UI 180705

12

Pool UI 180710

12

https://www2a.cdc.gov/nceh/DLS/itndatasubmission/submitdata.asp

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12/3/2020

International Iodine Network

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Pool UI 180712

12

Pool UI 180788

12

Run 3
Pool UI 180705

12

Pool UI 180710

12

Pool UI 180712

12

Pool UI 180788

12

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Comments

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Submit
Centers for Disease Control and Prevention
National Center for Environmental Health
Division of Laboratory Sciences

CDC estimates the average public reporting burden for this collection of information as 10 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-xxxx).

https://www2a.cdc.gov/nceh/DLS/itndatasubmission/submitdata.asp

12/3/2020