60M_ChildTeethInstructions

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

Biospecimen Child Teeth Collection Instructions, Phase 2g

The National Children’s Study

Child Teeth Collection Instructions

As part of the National Children’s Study, we are asking you to collect all teeth that your child loses starting at 5 years old. Please collect and mail ONLY one tooth at a time even if your child loses more than one tooth simultaneously. When the NCS Regional Operations Center (ROC) has received your child’s tooth, you will automatically be sent another kit to collect any additional teeth that your child may have lost. DO NOT use envelopes other than the pre-labeled ones provided when mailing your child’s tooth. These envelopes have been specially stamped to prevent damage to the tooth during transit.

The supplies included in the Child Teeth Collection Kit are:

• 1 absorbent pad

• 1 bubble pouch

• 1 pre-labeled return envelope

A Child Teeth Self-Administered Questionnaire (SAQ) will be provided to record information about the collection.

Collection Instructions

1. Starting at age 5 years old, monitor your child to determine if any teeth are about to be shed.

2. When a tooth has fallen out, as soon as possible wrap the tooth in the absorbent pad provided with the kit.

3. Place the wrapped tooth into the bubble pouch and seal.

4. Complete the Child Teeth SAQ.

5. Mail the tooth back along with a completed SAQ in the pre-labeled envelope provided in the kit as soon as possible after collection.

6. If you have collected more than one tooth or your child loses another tooth while you are waiting for an additional kit to be sent to you, wrap the collected tooth in regular tissue paper and store it in a cool dry place. Upon receipt of a new kit, follow steps 2 to 6 above to return your child’s tooth to the NCS ROC.

Please call the Regional Operations Center number located on the last page, if you have any questions.

Thank you for providing this sample!

For Office Use Only:

Click here to insert Respondent ID.

Click here to insert Child Participant ID.

Click here to insert ROC contact information.

BIO Child Teeth Collection Instructions, MDES 4.0, V1.0 1