NIST Food and Nutrition Standard Reference Materials (SRM) Customer Questionnaire

NIST Generic Clearance for Program Evaluation Data Collections

0693-0033-NIST-FoodNutritionSRMs-CollectionInstrument-2019-06-06

NIST Food and Nutrition Standard Reference Materials (SRM) Customer Questionnaire

OMB: 0693-0033

Document [docx]
Download: docx | pdf

National Institute of Standards & Technology (NIST)

SRM Customer Questionnaire

<SRM 1849a Infant/Adult Nutritional Formula>


NIST is conducting this survey of recent customers to better design SRM products in the future. You are receiving this questionnaire as a customer of NIST who has purchased at least one unit of <SRM 1849a Infant/Adult Nutritional Formula> in the past 5 years.


Customer Information

Laboratory Name: Click here to enter text.

Laboratory Location: Click here to enter text.

Respondent Name: Click here to enter text.

Respondent Email: Click here to enter text.

Respondent Phone: Click here to enter text.

I am willing to be contacted by NIST staff via email and/or phone to provide additional information.


Which of the following best describe(s) your laboratory? Check all that apply.

Academic laboratory

Government laboratory

Food manufacturer (QA/QC) laboratory

Third-party testing laboratory

Research and development

Other (please describe): Click here to enter text.


Which of the following best describe(s) your general research area or interests? Check all that apply.

Nutrition labeling

Food safety/contaminants

Food research (general)

Dietary supplements research (general)

Other (please describe): Click here to enter text.



Use of <SRM 1849a Infant/Adult Nutritional Formula>


  1. For which of the following analytes or groups of analytes has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some categories may be removed if there are no assigned values in the SRM being queried.

Cholesterol

Elements

Toxic Elements/Contaminants

Water-Soluble Vitamins

Fat-Soluble Vitamins

Carotenoids

Proximates

Fatty Acids

Amino Acids

Sugars

Other (e.g., cholesterol, catechins, xanthines, flavonoids)


For every box selected in response to question 1, up to ten follow-up questions will be generated as described below.


  1. For which of the following elements has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Nutritional Elements

Calcium

Copper

Iron

Magnesium

Manganese

Phosphorus

Potassium

Sodium

Zinc


Trace Minerals

Chromium

Molybdenum

Selenium






Other Elements

Aluminum

Antimony

Barium

Boron

Bromine

Cerium

Cesium

Chlorine

Cobalt

Europium

Fluoride

Gadolinium

Gold

Hafnium

Hydrogen

Iodine

Lanthanum

Lithium

Neodymium

Nickel

Nitrogen

Rubidium

Samarium

Scandium

Silicon

Silver

Strontium

Sulfur

Terbium

Thorium

Tin

Titanium

Tungsten

Uranium

Vanadium

Ytterbium




  1. For which of the following toxic elements/contaminants has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Arsenic

Cadmium

Lead

Mercury

Dimethylarsinic acid (DMA)

Inorganic arsenic (iAs)

Monomethylarsonic acid (MMA)

Methylmercury

Acrylamide

Aflatoxin B1

Aflatoxin B2

Total Aflatoxins


  1. For which of the following water-soluble vitamins has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Ascorbic Acid (Vitamin C)

Biotin

Biotin

Total Biotin by Microbiological Assay

Carnitine

Choline

Choline Ion

Folates

Folic Acid

5-Methyltetrahydrofolate

Total Folate by Microbiological Assay

Myo-inositol

Riboflavin (Vitamin B2)

Thiamine/Thiamine Hydrochloride (Vitamin B1)

Vitamin B3

Niacin

Niacinamide

Total Vitamin B3

Total Vitamin B3 by Microbiological Assay

Vitamin B5

Pantothenic Acid

Total Vitamin B5 by Microbiological Assay

Vitamin B6

Pyridoxal/Pyridoxal Hydrochloride

Pyridoxamine/Pyridoxamine Dihydrochloride

Pyridoxine/Pyridoxine Hydrochloride

Total Vitamin B6

Total Vitamin B6 by Microbiological Assay

Vitamin B12

Cyanocobalamin

Total Vitamin B12 by Microbiological Assay







  1. For which of the following fat-soluble vitamins has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Vitamin A

Retinol

Retinyl Palmitate

Vitamin D

Cholecalciferol (Vitamin D3)

Ergocalciferol (Vitamin D2)

Phylloquinone (Vitamin K)



Vitamin E

α-Tocopherol

α-Tocopheryl Acetate

Total α-Tocopherol

β-Tocopherol

γ-Tocopherol

γ- + β-Tocopherol

δ-Tocopherol

  1. For which of the following carotenoids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

α-Carotene

β-Carotene

Total β-Carotene

trans-β-Carotene

9-cis-β-Carotene

Total β-cryptoxanthin

Total Lutein

Lycopene

trans-Lycopene

Total Lycopene

Total Zeaxanthin


  1. For which of the following proximates has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Ash

Calories

Carbohydrates

Fat

Total Fat (sum of fatty acids)

Total Fat (extracted)

Moisture

Solids


Dietary Fiber

Insoluble

Insoluble + High Molecular Weight Soluble

Low Molecular Weight Soluble

High Molecular Weight Soluble

High Molecular Weight Total

Soluble

Total


  1. For which of the following fatty acids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Butryic Acid (C4:0)

Caproic Acid (C6:0)

Caprylic Acid (C8:0)

Capric Acid (C10:0)

Undecanoic Acid (C11:0)

Lauric Acid (C12:0)

Tridecanoic Acid (C13:0)

Myristic Acid (C14:0)

Myristoleic Acid (C14:1 n-5)

Pentadecanoic Acid (C15:0)

Palmitic Acid (C16:0)

Palmitoleic Acid (C16:1 n-7)

trans-Palmitelaidic Acid (C16:1-9t)

Hexadecadienoic Acid (C16:2)

Margaric Acid (C17:0)

Margaroleic Acid (C17:1 n-6)

Stearic Acid (C18:0)

Vaccenic Acid (C18:1 n-7)

Oleic Acid (C18:1 n-9)

trans-Vaccenic Acid (C18:1-11t)

Elaidic Acid (C18:1-9t)

Linoelaidic Acid (C18:2)

9,12-Octadecadienoic Acid (C18:2-9t)

9,12-Octadecadienoic Acid (C18:2-12t)

Linoleic Acid (C18:2 n-6)

α-Linolenic Acid (C18:3 n-3)

γ-Linolenic Acid (C18:3 n-6)

Stearidonic Acid (C18:4)

Arachidic Acid (C20:0)

Gadoleic Acid (C20:1 n-7)

Gondoic Acid (C20:1 n-9)

Eicosadienoic Acid (C20:2 n-6)

Dihomo-γ-linolenic Acid (C20:3 n-6)

11,14,17-Eicosatrienoic Acid (C20:3 n-3)

EPA (C20:4 n-3)

Arachidonic Acid (C20:4 n-6)

Heneicosanoic Acid (C21:0)

Behenic Acid (C22:0)

Erucic Acid (C22:1 n-9)

13,16-Docosadienoic Acid (C22:2)

DPA (C22:5 n-3)

DHA (C22:6 n-3)

Lignoceric Acid (C24:0)

Nervonic Acid (C24:1 n-9)

cis-Monounsaturated Fat

cis-Polyunsaturated Fat

Saturated Fat

Total cis-C18:1

Total cis-C18:2

Total cis-C20:1

Total cis-C22:4

Total cis-C22:5

Total trans Fat

Total trans-C18:1

Total trans-C18:2

Total trans-C18:2 Conjugated

Total ω-3 Fatty Acids

Total ω-6 Fatty Acids



  1. For which of the following amino acids has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Alanine

Arginine

Aspartic Acid

Cystine

Glutamic Acid

Glycine

Histidine

Hydroxyproline

Isoleucine

L-theanine

Leucine

Lysine

Methionine

Phenylalanine

Proline

Serine

Taurine

Threonine

Tryptophan

Tyrosine

Valine


  1. For which of the following sugars has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Fructose

Glucose

Lactose

Maltose

Sucrose

Total Sugars


  1. For which of the following other analytes has your laboratory used <SRM 1849a Infant/Adult Nutritional Formula>? This is an all-inclusive list. Some may be removed if there are no assigned values in the SRM being queried.

Anions

Phosphate

Sulfate

Catechins

Catechin

Catechin Monomers

Epicatechin

Epicatechin Gallate

Epigallocatechin

Epigallocatechin Gallate

Gallocatechin Gallate

Gallic Acid

Gallocatechin

Epigallocatechin Methylgallate

Cholesterol

Isoflavones

Daidzein

Daidzin

Genistein

Genistin

Glycitein

Glycitin

Flavonoid Aglycones

Quercetin

Kaempferol

Isorhamnetin

Total

Naphthodianthrones

Hypericin

Pseudohypericin

Organic Acids

Ascorbic Acid

Citric Acid

Galacturonic Acid

Glycolic Acid

Isocitric Acid

Malic Acid

Oxalic Acid

Quinic Acid

Shikimic Acid

Tartaric Acid


Phytosterols

Campesterol

β-Sitosterol

Stigmasterol

Cycloartenol

Brassicasterol

Lupeol

Xanthines

Caffeine

Theobromine

Theophylline

L-theanine

Terpene Lactones

Ginkgolide A

Ginkgolide B

Ginkgolide C

Ginkgolide J

Bilobalide

Total Antioxidant Capacity

Total Polyphenols

Total Procyanidins



  1. Please list any other analytes or analyte groups that would be beneficial to have assigned in <SRM 1849a Infant/Adult Nutritional Formula>. Click here to enter text.


  1. Please describe other ways that <SRM 1849a Infant/Adult Nutritional Formula> could better suit your needs. Click here to enter text.


  1. Please describe other ways that <SRM 1849a Infant/Adult Nutritional Formula> could better suit your needs. Click here to enter text.




The coordinators of the NIST Food and Nutrition Reference Materials Program thank you for your participation in this questionnaire.



This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 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. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Melissa Phillips, NIST, 100 Bureau Drive, Gaithersburg, MD 20899-8392; Email: melissa.phillips@nist.gov.


OMB Control No. 0693-0033


Expiration Date: 06/30/2019

Page 12 of 21

OMB Control #0693-0033

Expiration Date 06/30/2019

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPhillips, Melissa M.
File Modified0000-00-00
File Created2021-01-16

© 2024 OMB.report | Privacy Policy