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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Methods of Biospecimen Collection for Women, Infants and Children
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
A.5 LOI3-BIO-0 Brief Questionnaire.docx
Yes
Yes
Paper Only
Instruction
A.6 LOI3-BIO-0 Protocol Description.docx
Yes
Yes
Paper Only
Instruction
A.7 LOI3-BIO-0 Biospecimen Processing Protocol Description.doc
Yes
Yes
Paper Only
Instruction
B.3 LOI2-BIO-20 IRB Protocol.doc
Yes
Yes
Paper Only
Instruction
C.3 LOI2-BIO-24 Exemplar Protocol.pdf
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
750
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,125
0
0
0
0
0
Annual IC Time Burden (Hours)
234
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
A.2 LOI3-BIO-0 Consent for Parent Guardian of Participant
A.2 LOI3-BIO-0 Consent for ParentGuardian of Participant.doc
02/15/2012
A.3 LOI3-BIO-0 Consent for Adult Participant
A.3 LOI3-BIO-0 Consent for Adult Participant.doc
02/15/2012
A.4 LOI3-BIO-0 Child Assent
A.4 LOI3-BIO-0 Child Assent.doc
02/15/2012
A.8 LOI3-BIO-0 IRB Approval Letter
A.8 LOI3-BIO-0 IRB Approval Letter.pdf
02/15/2012
B.2 LOI2-BIO-20 Exemplar Consent Form
B.2 LOI2-BIO-20 Exemplar Consent Form.docx
02/15/2012
B.4 LOI2-BIO-20 IRB Approval Letters
B.4 LOI2-BIO-20 IRB Approval Letters.pdf
02/15/2012
C.2 LOI2-BIO-24 Exemplar Consent Form
C.2 LOI2-BIO-24 Exemplar Consent Form.pdf
02/15/2012
C.4 LOI2-BIO-24 IRB Approval Letters
C.4 LOI2-BIO-24 IRB Approval Letters.pdf
02/15/2012
LO12 BIO -24 OIRA template
C 1 LOI2-BIO-24 OIRA Template v2.docx
04/26/2012
LO12 BIO 0 OIRA template
A 1 LOI3-BIO-0 OIRA Template v2.docx
04/26/2012
LO12 BIO 20 OIRA template
B 1 LOI2-BIO-20 OIRA Template (2) v2.docx
04/26/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.