Enhanced Household: Pregnancy Visit 2 Interview

OMB Control Number: 0925-0593

Expiration Date: 07/31/2013

Tap Water Collection Instructions, Phase II

National Children’s Study

Tap Water Collection Instructions

Insert Cover Photo

To be done Monday through Thursday.

The purpose is to send us samples for analysis of your home tap water.

Instructions for tap water sample
Remove contents of the water sample for kit (Photo 1).	Put on disposable gloves. Gloves are to protect the water sample from the soap or oil on your hands. Place the ice packs provided into your freezer.
Photo 1. Water sample for tap water kit contents.

Write the date and mark the day of the week on the water sample packing slip for the tap water kit with the marking pen provided (questions 2 and 3). Go to the kitchen faucet. Open the plastic-lined towel and place it on the counter next to your sink. Lay out all bottles that are included in the tap water collection kit.	Photo 2. Plastic lined towel with tap water collection bottles
Turn on your water to a steady stream (about halfway) on cold and run for five minutes. Hold the first bottle upright and carefully unscrew the lid. Do not rinse the bottle. Do not pour out anything that is inside the bottle. Place the bottle under the water and slowly fill. Swirl the bottle as you are filling. Fill the bottle to the shoulder of the bottle with water. Do not fill the bottle completely full. Replace cap. Fill the other bottles. Place the bottles in the foam sleeve. Place the samples into the insulated box we provided. Remove the ice packs from your freezer. Place the ice packs into the insulated box, surrounding the bottles.	Photo 3a. Bottle filling with water Photo 3b. Two bottles filled to the shoulder with water
Put on the foam lid and seal the insulated box with the provided tape (Photo 11).	Photo 11. Place sample in FedEx box.
Call FedEx to schedule a pick up (1-800-463-3399) for the next day or bring to a FedEx office the same day. This is prepaid. There will be no charge to you. Write the date that the tap water sample kit will be picked up or dropped off on the prepaid, addressed FedEx label and attach it to the insulated box (Photo 12).	Photo 12. Ensuring label is attached to FedEx box.

Thank you for participating in the National Children’s Study.

Insert local contact information label here.

Public reporting burden for this collection of information is estimated to average 15 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.

DPSCT301.00EN