Form 1i Survey

OMB# 0925-0543
Exp. 06/30/2010
Baseline Saliva Collection
This packet contains everything that you will need to provide us with a saliva sample.
Please collect the saliva sample as soon as you wake up tomorrow morning. You may
find it helpful to place the collection container next to your bed so that you will be
reminded to obtain the sample as soon as you awaken. The sample should be collected
before eating, drinking (besides water), smoking, or brushing your teeth. These
substances could contaminate the sample.
To collect the sample:
1) Remove the cotton roll from the enclosed collection tube.
2) Place the cotton roll in your mouth and lightly chew on it until the cotton is wet
(about 2 or 3 minutes).
3) Place the wet roll back in the collection tube and replace the cap.
4) Insert the sealed collection tube into the crush-proof mailing container.
5) Complete the attached form.
6) Place the container and the form in the postage paid envelope and mail
immediately.

Thank you for your time and cooperation!
----------------------------------------Please Return with Sample------------------------------------Participant ID number: Date:
Time of awakening: AM/PM (circle one)
Time of sample collection: AM/PM (circle one)
Comments: