12 MO Child Saliva Collection Instructions (12 MO)

OMB #: 0925-0593

OMB Expiration Date: 07/31/ 2013

Biospecimen Child Saliva Collection Instructions

The National Children’s Study

Child Saliva Collection Instructions

This National Children’s Study (NCS) Child Saliva Collection Kit contains everything you will need to provide a sample of your child’s saliva:

• 1 Oragene DISCOVER Saliva Collection kit, with pre-labeled outer plastic case

• 1 Clear re-sealable biohazard bag, with absorbent pad

• 1 Shipping box, with address label

• 1 Child Saliva Collection Instruction Sheet

• 1 Child Saliva Collection Self Administered Questionnaire (SAQ)

IMPORTANT NOTES

• DO NOT touch the tip of the sponge or the inside of the funnel or lid.

• Please be sure to complete the Child Saliva Collection SAQ.

• If the sample collection was not completed, please explain why on the Child Saliva Collection SAQ.

Instructions for collection:

1. Follow the directions on the Oragene DISCOVER package insert in the kit. These instructions are also provided on the back of this page.

2. The package insert refers to your child as ‘donor’.

3. Once the saliva collection is completed and the tube is capped and mixed, place the closed collection tube back into the labeled plastic case.

4. Place the labeled plastic case into the resealable plastic bag with absorbent pad and seal the plastic bag. Throw away the rest of the supplies in the trash.

5. Complete the Child Saliva Collection SAQ.

6. Place the sealed bag and the completed Child Saliva Collection SAQ into the shipping box.

7. Place the shipping airbill on the box.

8. Ship the box as soon as you are able, within one week of collection.

IF YOU HAVE ANY QUESTIONS PLEASE CALL THE LOCAL CONTACT NUMBER LOCATED ON THE LAST PAGE

THANK YOU FOR PROVIDING THIS SALIVA SAMPLE!

Instructions:

Insert local contact information label here.

Public reporting burden for this collection of information is estimated to average 5 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, ATTN: PRA (0925-0593). Do not return the completed form to this address.

BIO Child Saliva Collection Instructions (EHPBHI), MDES 3.0 Spring 2012, V1.0 1