Form 1.n Survey

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

Blood Collection Information Sheet

Blood collection
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We will be collecting 20 milliliters of blood (4 tablespoons) using procedures
similar to those used in doctors’ offices.

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We will insert a needle into a vein in your arm with a needle and collect three
tubes of blood.

•

We will measure levels of several chemicals in your blood that may be there as a
result of being exposed to things in the environment. Specifically, we will
measure:

•

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Persistent organic compounds (PCBs and pesticides)

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Perfluorinated chemicals (PFOA and PBDE)

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Metals (lead, mercury and cadmium)

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Cotinine (by-product of nicotine)

We will also measure serum fats such as cholesterol and triglycerides.

Public reporting burden for this collection of information is estimated to average 8 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.