Form 1k Survey

OMB# 0925-0543
Exp. 06/30/2010

Semen Specimen Collection
Opening the kit
• Remove the freezer pack from the kit and place it in your freezer with the printed side
up for at least 12 hours prior to collecting the specimen.
Collecting the specimen
• To ensure overnight delivery to the CDC laboratory during normal business hours, the
specimen must be collected before noon Monday-Thursday.
• Remove the lid from the glass jar prior to collection.
• Masturbate directly into the glass jar. Do not use any lubricant. Do not collect the
specimen by withdrawing during intercourse.
• You will notice a small button attached to the side of the jar (see photo on the back of
this page). This is a digital thermometer that will record the temperature of the
specimen during shipping. Do not remove it. If it becomes detached, please put it
inside the baggie with the jar.
• Fill out the label on the jar with the time, date, and whether some of the specimen was
lost (spilled or missed container). Semen droplets left behind after collection are
not important and should not be noted.
• Once the specimen is collected, remove the glass straw from the heat-sealed bag. Tilt
the specimen jar and place the open end of the straw into the specimen. Allow the
straw to be in contact with the specimen for 20 seconds. Then allow the straw to
fall to the side of the specimen jar so that the lid will fit on the jar.
Shipping the specimen
• After placing specimen into shipping container as shown in the photos on the back of
this page, immediately telephone Federal Express at (800) 463-3339. They will
make arrangements for the specimen to be picked up the same day.
• After calling Federal Express, it is important to call the CDC laboratory at (800) 8700201 to let them know to expect your specimen. You will be asked to leave a
voice message stating your ID number and the date.
When the laboratory receives your specimen, it will be evaluated for amount of semen,
sperm count, sperm shape, and sperm movement (how far the sperm have swum into the
glass straw). Other biochemical research tests of sperm chromatin and proteins will also
be done.
Public reporting burden for this collection of information is estimated to average 20 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. 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: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974.

OMB# 0925-0543
Exp. 06/30/2010

Semen collection jar with external thermometer.

Tightly closed specimen jar should be placed in the
baggie with the absorbent cloths for shipping.

Baggie should be placed inside the foam holder on
top of the ice pack inside the Styrofoam container.

OMB# 0925-0543
Exp. 06/30/2010

Place the Styrofoam lid on the box.
The Styrofoam container is placed in the shipping
box.