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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
LOI2-BIO-19 - Integration of salivary analytes into the NCS: Evaluation of Feasibility, Efficiency, and Benefits
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
Form and Instruction
1.1
Goal 1 Telephone Screening Script
Attach 1b Goal 1_TelephoneScreeningScript.docx
Yes
Yes
Paper Only
Form and Instruction
2.1
Goal 2 Telephone Screening Script
Attach 2a Goal 2_TelephoneScreeningScript.docx
Yes
Yes
Paper Only
Form and Instruction
2.3
Goal 2 Follow-Up Telephone Interview
Attach 2d Goal 2_ Follow Up Telephone Interview.docx
Yes
Yes
Paper Only
Instruction
Attach S1 Goal 2_Home Visit Saliva Collection Guide.docx
Yes
Yes
Paper Only
Form and Instruction
2.4
Goal 2 Saliva Collection Log
Attach S2 Goal 2_DemoMotherInfantChild Saliva Collection Sheets.docx
Yes
Yes
Fillable Printable
Instruction
Attach S3 Goal 2_Saliva Collection Diagrams.docx
Yes
Yes
Paper Only
Instruction
Attach S4 Goal 2_Saliva Collection Do's and Don'ts.docx
Yes
Yes
Paper Only
Instruction
Attach S5 Goal 2_Sample Shipping Instructions.docx
Yes
Yes
Paper Only
Form and Instruction
2.2
Goal 2 Home Visit Demographics
Attach 2c Goal 2_Home Visit Demographics Questionnaire.docx
Yes
Yes
Fillable Printable
Form and Instruction
1.3
Goal 1 Demographic and Health
Attach 1d Goal 1_Demographic Health Behavior Questionnaire.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Science and Innovation
Subfunction:
Scientific and Technological Research and Innovation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
442
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
2,362
0
0
0
0
0
Annual IC Time Burden (Hours)
495
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Goal 1 Exemplar Recruitment Flyer
Attach 1a Goal 1_Exemplar Recruitment Flyer.docx
08/09/2012
Goal 1 Consent Form
Attach 1c Goal 1_Consent Form.docx
08/14/2012
Goal 1 IRB Protocol
Attach 1e Goal 1_IRB Protocol.docx
08/14/2012
Goal 1 IRB Approval Letter
Attach 1f Goal 1_IRB Approval.pdf
08/14/2012
Goal 2 Consent Form
Attach 2b Goal 2_Consent Form.docx
08/14/2012
Goal 2 IRB Protocol
Attach 2e Goal 2_IRB Protocol.docx
08/14/2012
Goal 2 IRB Approval Letter
Attach 2f Goal 2_IRB Approval Letter.pdf
08/14/2012
Goal 2 Saliva Kit Choking Hazard Warning
Attach S6 Goal 2_Saliva Kit Choking Hazard Warning.docx
08/14/2012
Goal 1 and Goal 2 OIRA Template
LOI2-BIO-19 I &II OIRA Template_Final_20120817.doc
08/17/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.