Information Collection

The Jackson Heart Study: Annual Follow-up with Third Party Respondents

IC 7410 under ICR 200705-0925-006 · OMB 0925-0491.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0491 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9 The Jackson Heart Study: Annual Follow-up with Third Party Respondents	Form and Instruction
2 JHS Cohort Event Eligibility.PDF	Form and Instruction
3 JHS Confidential Data.PDF	Form and Instruction
1 JHS Cohort Stroke Abstraction.PDF	Form and Instruction
4 JHS Death Certificate.PDF	Form and Instruction
5 JHS Hospital Abstraction.PDF	Form and Instruction
6 JHS Informant Interview.PDF	Form and Instruction
7 JHS Physician Questionnaire.PDF	Form and Instruction
9 JHS Surveillance Event Inventory Linkage.PDF	Form and Instruction
JHS OSMB May 2004.pdf JHS OSMB May 2004	IC Document
Sample Letters to Informants.PDF Sample Letters to Informants	IC Document
JHSAB.doc JHSAB	IC Document
JHSFDAP.doc JHSFDAP	IC Document
May05JHSOSMB1.doc May05JHSOSMB1	IC Document
April 06 Minutes JHS OSMB.doc April 06 Minutes JHS OSMB	IC Document
april 07 OSMB minutes.doc april 07 OSMB minutes	IC Document
Council.doc Council	IC Document

IC Title:

The Jackson Heart Study: Annual Follow-up with Third Party Respondents

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	9	JHS	Surveillance Event Inventory Linkage.PDF	Yes	Yes	Paper Only
Form and Instruction	7	JHS	Physician Questionnaire.PDF	Yes	Yes	Paper Only
Form and Instruction	2	JHS	Cohort Event Eligibility.PDF	Yes	Yes	Paper Only
Form and Instruction	3	JHS	Confidential Data.PDF	Yes	Yes	Paper Only
Form and Instruction	1	JHS	Cohort Stroke Abstraction.PDF	Yes	Yes	Paper Only
Form and Instruction	4	JHS	Death Certificate.PDF	Yes	Yes	Paper Only
Form and Instruction	5	JHS	Hospital Abstraction.PDF	Yes	Yes	Paper Only
Form and Instruction	6	JHS	Informant Interview.PDF	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
JHS OSMB May 2004	JHS OSMB May 2004.pdf	05/16/2007
Sample Letters to Informants	Sample Letters to Informants.PDF	05/16/2007
JHSAB	JHSAB.doc	05/16/2007
JHSFDAP	JHSFDAP.doc	05/16/2007
May05JHSOSMB1	May05JHSOSMB1.doc	05/16/2007
April 06 Minutes JHS OSMB	April 06 Minutes JHS OSMB.doc	05/16/2007
april 07 OSMB minutes	april 07 OSMB minutes.doc	05/16/2007
Council	Council.doc	05/16/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.