Information Collection Request

The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)

ICR 200709-0925-003 · OMB 0925-0584 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 20 Focus Groups Form and Instruction New Available
Form 1 Non Participant Components Form and Instruction New Available
Form 1 Participant Telephone Interviews Form and Instruction New Available
Form 4 Clinic Questionaires Form and Instruction New Available
Form 1 Clinic Exam Procedures Form and Instruction New Available
Form 1 Household Enumeration Form and Instruction New Available
Form 1 Recruitment Contact and Appoinment Confirmation Form and Instruction New Available
Xwalk_rev_12-20-07.doc Supplementary Document Uploaded 2008-02-11 Available
Timeline - Hispanic Community Health Study.doc Supplementary Document Uploaded 2008-02-11 Available
Protocol.source.doc Supplementary Document Uploaded 2008-02-11 Available
Personal Information QxQ_1-29-08.doc Supplementary Document Uploaded 2008-02-11 Available
OMB budget repspone brf.1-31-08.xls Supplementary Document Uploaded 2008-02-11 Available
Examples of QXQs.doc Supplementary Document Uploaded 2008-02-11 Available
Council-Oct.04.pdf Supplementary Document Uploaded 2008-02-11 Available
Combined Response.Hispanic Survey - Response to OMB Questions - OMB passback2.doc Supplementary Document Uploaded 2008-02-11 Available
CC. HIPAA Form - Revised 1-25-08.doc Supplementary Document Uploaded 2008-02-11 Available
Attachments-OMB Passback2.doc Supplementary Document Uploaded 2008-02-11 Available
Revised B Supporting Statement 2.8.08.doc Supporting Statement B Uploaded 2008-02-11 Available
Well being_span.doc Supplementary Document Uploaded 2007-09-13 Available
Weight History_span.doc Supplementary Document Uploaded 2007-09-13 Available
Socio cultural_span.doc Supplementary Document Uploaded 2007-09-13 Available
Social Network Index_span.doc Supplementary Document Uploaded 2007-09-13 Available
Sleep_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
SF12_span.doc Supplementary Document Uploaded 2007-09-13 Available
Screen and Roster_span.doc Supplementary Document Uploaded 2007-09-13 Available
Respiratory_span.doc Supplementary Document Uploaded 2007-09-13 Available
Resident Response_span.doc Supplementary Document Uploaded 2007-09-13 Available
Physical Activity_span.doc Supplementary Document Uploaded 2007-09-13 Available
Tobacco Use_span.doc Supplementary Document Uploaded 2007-09-13 Available
Personal Information_span.doc Supplementary Document Uploaded 2007-09-13 Available
Personal Identifiers_span.doc Supplementary Document Uploaded 2007-09-13 Available
Oral Health_span.doc Supplementary Document Uploaded 2007-09-13 Available
Phone_script_span.doc Supplementary Document Uploaded 2007-09-13 Available
Occupation_span.doc Supplementary Document Uploaded 2007-09-13 Available
Neurocognitive Assessment_span.doc Supplementary Document Uploaded 2007-09-13 Available
Medication Use_span.doc Supplementary Document Uploaded 2007-09-13 Available
Medical History_span.doc Supplementary Document Uploaded 2007-09-13 Available
Introductory letter_span.doc Supplementary Document Uploaded 2007-09-13 Available
Informed Consent_span.doc Supplementary Document Uploaded 2007-09-13 Available
Hearing History_span.doc Supplementary Document Uploaded 2007-09-13 Available
Hearing Exam_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Health Care Use_span.doc Supplementary Document Uploaded 2007-09-13 Available
Economic_span.doc Supplementary Document Uploaded 2007-09-13 Available
Diet and Supplement In-Person Recall_span.doc Supplementary Document Uploaded 2007-09-13 Available
Diet and Supplement Phone Script Recall_span.doc Supplementary Document Uploaded 2007-09-13 Available
In-person script_span.doc Supplementary Document Uploaded 2007-09-13 Available
Appointment Reminder call_09-12-07_span.doc Supplementary Document Uploaded 2007-09-13 Available
Alcohol Use_span.doc Supplementary Document Uploaded 2007-09-13 Available
Brochure-Span.pdf Supplementary Document Uploaded 2007-09-13 Available
San Diego.IRB..doc Supplementary Document Uploaded 2008-02-11 Available
UNC_HCHS_Coordinating Center_IRB 2007.pdf Supplementary Document Uploaded 2007-09-13 Available
Bronx_IRB. Sep_ 11. 2007 (2).pdf Supplementary Document Uploaded 2007-09-13 Available
MIAMI.IRB pending.doc Supplementary Document Uploaded 2007-09-13 Available
Northwestern_IRB_approval.pdf Supplementary Document Uploaded 2007-09-13 Available
Privacy Policy.doc Supplementary Document Uploaded 2007-09-13 Available
Privacy Act.doc Supplementary Document Uploaded 2007-09-13 Available
Responses to OMB comments 5-7-07.doc Supplementary Document Uploaded 2007-09-13 Available
OSMB Minutes.doc Supplementary Document Uploaded 2007-09-13 Available
Epidemiologic Research in Hispanic Populations.doc Supplementary Document Uploaded 2007-09-13 Available
Council Minutes.doc Supplementary Document Uploaded 2007-09-13 Available
Legislative Mandate.pdf Supplementary Document Uploaded 2007-09-13 Available
Revised A Supporting Statement.2.08.08.doc Supporting Statement A Uploaded 2008-02-11 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
183722 Focus Groups Form and Instruction New
182193 Non Participant Components Form and Instruction New
182192 Participant Telephone Interviews Form and Instruction New
182191 Clinic Questionaires Form and Instruction New
182190 Clinic Exam Procedures Form and Instruction New
182189 Household Enumeration Form and Instruction New
182188 Recruitment Contact and Appoinment Confirmation Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2011 36 Months From Approved
61,307 0 0
44,168 0 0
0 0 0





Reginfo record details
7
table that charts list of burden
IC Title Form No. Form Name
Non Participant Components 1, 2 Letter ,   Qx
Focus Groups 20, 21, 13, 14, 19, 9, 8, 1, 3, 4, 5, 17, 18, 15, 16, 11, 10, 12, 2, 6, 7 Weight History ,   Well Being ,   Personal Information ,   Medication Use ,   Alcohol Use ,   Medical History ,   Dietary Behavior ,   Economic ,   Physical Activity ,   Tobacco Use ,   Health Care Use ,   Sleep ,   Social Cultural ,   Respiratory ,   SF 12 ,   Occupation ,   Neuro ,   Oral Health ,   Dietary Recall and Supplement Use ,   Hearing Exam ,   Informed Consent
Clinic Questionaires 1, 2, 3, 4, 5, 6, 14, 15, 16, 17, 18, 19, 20, 21, 7, 8, 9, 10, 11, 12, 13 Economic ,   Health Care Use ,   Hearing Exam ,   Informed Consent ,   Medical History ,   Medication Use ,   Neuro ,   Occupation ,   Oral Health ,   Personal Information ,   Physical Activity ,   Respiratory ,   SF 12 ,   Sleep ,   Social Cultural ,   Tobacco Use ,   Dietary Recall and Supplement Use ,   Dietary Behavior ,   Alcohol Use ,   Weight History ,   Well Being
Household Enumeration 1, 2 Personal Identifiers ,   Screen and Roster
Clinic Exam Procedures 15, 1, 2, 3, 4, 5, 16, 17, 18, 19, 20, 21, 6, 7, 8, 9, 10, 11, 12, 13, 14 Alcohol Use ,   Dietary Recall and Supplement Use ,   Dietary Behavior ,   Economic ,   Health Care Use ,   Hearing Exam ,   Informed Consent ,   Medical History ,   Medication Use ,   Neuro ,   Occupation ,   Oral Health ,   Personal Information ,   Physical Activity ,   Respiratory ,   SF 12 ,   Sleep ,   Social Cultural ,   Tobacco Use ,   Weight History ,   Well Being
Recruitment Contact and Appoinment Confirmation 2, 3, 1, 5, 4 In Person Script ,   Residential Response ,   App. Reminder Call ,   Phone Script ,   Safety Screen
Participant Telephone Interviews 1, 2, 3, 4 Recall ,   Annual Follow-up ,   Informant ,   Interview

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 61,307 0 0 61,307 0 0
Annual Time Burden (Hours) 44,168 0 0 44,168 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No