R-52973 HH_Sample Forms Specs.pdf
PDF 370 KB Posted
- Attached to
- DFS-DNA Indexing Kits-SLB
- Solicitation number
- 20-493ISP-FOREN-B-13088
- Issued by
- St. Clair County, Illinois
About this file
This document is a sample DNA indexing database buccal swab collection kit for the Illinois State Police Division of Forensic Services DNA Indexing Laboratory. The kit contains instructions for completing the information portion of the kit, buccal swab collection instructions, and a DNA indexing database sample receipt form. The kit is used to collect DNA samples from individuals for inclusion in the Illinois DNA indexing database. The document provides details on the collection procedure, required identification numbers, qualifying reasons for DNA collection, and agency information. It also includes a consent form for voluntary DNA samples. The document does not contain any information about a state or local contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment - Notice of Electronic Submission Only~1.pdf | ||
| Forms A Section V.18.1~4.doc | DOC document | |
| Forms B Section V.20.1~8.docx | DOCX document | |
| Signed NOA B-13088.pdf | ||
| IFB V.20.1-DNA Indexing Kits.docx | DOCX document | |
| Standard Certifications and Taxpayer Identification number form~2.doc | DOC document |
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Text version
Folding Diagram
Envelope attached, overhanging edge
Conviction Information
For Laboratory Use Only
DNA Indexing Database Sample Receipt
ATTACHMENT HH: SAMPLE FORMS
Printing Diagram:
Side 1
DNA INDEXING DATABASE
SAMPLE RECEIPT
Side 2
Voluntary Consent
(3) Collection Date
Instructions for Completing Information Portion of Kit
(8) Conviction Information
Buccal Swab Collection Instructions
Attach Envelope
DNA Indexing Database Buccal Swab Collection Kit
Perforate Here
Score Here
Score Here
Vendor Name Vendor Return Address Reorder information
Peal off seal
Backside of Mailing envelope
Barcode of Kit#
Desiccant pack to be inside the swab envelope
Ink strips, labeled Peel Here
Do-over stickers for covering bad thumb prints
Kit shipping seal
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Vo lu nt ar y Sa m pl e:
I, vo lu nt ar ily c on se nt t o pr ov id e a bu cc al s w ab sp ec im en to th e I lli no is S ta te
P ol ic e.
I un de rs ta nd sc ie nt ifi c i nf or m at io n ob ta in ed fr om th e s w ab
(s m ay b e u se d fo r c rim in al in ve st ig at io ns an d m ay be re ta in ed in a re co rd k ee pi ng sy st em fo r f ut ur e re fe re nc e.
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Pr in te d N am e of C ol le ct io n O ffi ci al /W itn es s
Si gn at ur e of C ol le ct io n O ffi ci al /W itn es s
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Pr in te d N am e of P ar en t o r L eg al
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P rin t d at e of b irt h an d ch ec k ra ce ge er
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T hi s is e sp ec ia lly i m po rta nt f or d on or s w ith s uf fi x es hy ph en at ed n am es
2) C ol le ct io n C er tifi c at io n:
R ea d an d si gn st at in g th at y ou ha v er ifi ed th e id en tit y of th e do no r.
3) C ol le ct io n D at e:
D at e th e sa m pl e w as c ol le ct ed
4)
I de nt ifi ca tio n N um be rs : E nt er a pp ro pr ia id en tifi c at io n nu m be rs fo r t he d on or
5)
Q ua lif yi ng R ea so n:
S el ec t th e re as on w hy t he d on or is e lig ib le /re qu ire d to d on at e a sa m pl e.
E nc lo se a c op y of th e si gn ed c ou rt or de r f or c ou rt or de re d sa m pl es
If do no r is tr an sf er rin g to I lli no is f ro m a no th er s ta te re co rd th e ot he r s ta te in th e sp ac e pr ov id ed
6)
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R es po ns ib le
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P le as e lis t th e co m pl et e ad dr es s, in cl ud in g zi p co de of ag cy c ol le ct in g th e sa m pl e.
In cl ud e a co nt ac t’s n am e an d te le ph on e n um be r.
T he u se o f p rin te d ad dr es s l ab el s is e nc ou ra ge d.
7)
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En te r d at e of th e ad ju di ca tio n, c on vi ct io n, co ur t o rd er o r s ex o ffe nd er re gi str at io n.
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If th e rig ht um b ca nn ot b e pr in te d, th e le ft th um b or a no th er d ig it m ay b e us ed
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R ol l th e in ke d th um b on th e t hu m bp rin t b lo ck in th e s am e m an ne r.
Th e pr in t s ho ul d ex te nd f ro m s id e to s id e an d fro m th e tip o f th e fi n ge r to j us t be lo w t he fi rs t jo in t.
Th e pr in t sh ou ld c on sis t o f c le ar , d ist in ct ri dg es
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4)
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O pe n on e of t he s te ri le s w ab p ac ka ge s co nt ai ni ng tw o sw ab s.
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R em ov e sw ab s fr om t he d on or
’s m ou th co m pl et el y ai r dr y an d re pl ac e in th e op st er ile sw ab p ac ka ge
O pe n th e se co nd s te ri le s w ab p ac ka ge nt ai ni ng tw o sw ab s an d vi go ro us ly s in sid e of th e do no r’s o th er c he ek a t l ea st tim es . R em ov e s w ab s f ro m th e d on or
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R em ov e th e ba ck in g fr om t he fl a p an d pr es s to s ea l th e en ve lo pe
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R es po ns ib le Il lin oi s A ge nc y
C ol le ct io n A ge nc y N am e
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R ig ht T hu m bp ri nt
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Envelope - Maximum 3.25"
Envelope - maximum 8"
Label or printed
Envelope should overhang off edge of receipt form
Perforated edge
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