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
DocumentTypeStatusAvailability
Form 20 Focus Groups Form and Instruction New Repair queued
Form 1 Non Participant Components Form and Instruction New Repair queued
Form 1 Participant Telephone Interviews Form and Instruction New Available
Form 4 Clinic Questionaires Form and Instruction New Repair queued
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 Repair queued
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 Repair queued
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 Repair queued
Combined Response.Hispanic Survey - Response to OMB Questions - OMB passback2.doc Supplementary Document Uploaded 2008-02-11 Repair queued
CC. HIPAA Form - Revised 1-25-08.doc Supplementary Document Uploaded 2008-02-11 Repair queued
Attachments-OMB Passback2.doc Supplementary Document Uploaded 2008-02-11 Repair queued
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 Repair queued
Social Network Index_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Sleep_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
SF12_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Screen and Roster_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Respiratory_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Resident Response_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
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 Repair queued
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 Repair queued
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 Repair queued
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 Repair queued
Economic_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Diet and Supplement In-Person Recall_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
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 Repair queued
Appointment Reminder call_09-12-07_span.doc Supplementary Document Uploaded 2007-09-13 Repair queued
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 Repair queued
Bronx_IRB. Sep_ 11. 2007 (2).pdf Supplementary Document Uploaded 2007-09-13 Available
MIAMI.IRB pending.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Northwestern_IRB_approval.pdf Supplementary Document Uploaded 2007-09-13 Repair queued
Privacy Policy.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Privacy Act.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Responses to OMB comments 5-7-07.doc Supplementary Document Uploaded 2007-09-13 Available
OSMB Minutes.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Epidemiologic Research in Hispanic Populations.doc Supplementary Document Uploaded 2007-09-13 Available
Council Minutes.doc Supplementary Document Uploaded 2007-09-13 Repair queued
Legislative Mandate.pdf Supplementary Document Uploaded 2007-09-13 Repair queued
Revised A Supporting Statement.2.08.08.doc Supporting Statement A Uploaded 2008-02-11 Available
IC Document Collections
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
0925-0584 200709-0925-003
Historical Active
HHS/NIH
The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 02/11/2008
Retrieve Notice of Action (NOA) 09/30/2007
This ICR is approved consistent with revised supporting statements (parts A and B) and with the understanding that funding is available to continue the longitudinal component of this study beyond the three years requested for approval (although it is only the first 3 years of the study that is being approved here). NIH shall exercise caution in reporting study results and will disclose all study limitations when such results are publicly disclosed, particularly concerning the cross-sectional components of this study (e.g. the inability of this study to rigorously assess differences by country of origin within the 4 study sites due to geographical clustering by country of origin, etc.).
  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

This project seeks to determine the prevalence of risk factors for cardiovascular disease among Hispanics living in the U.S. and their realtionship to cardiovascular morbidity and mortality.

US Code: 42 USC 285b-3 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  72 FR 37789 07/11/2007
72 FR 52153 09/12/2007
No

7
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

  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
Yes
Miscellaneous Actions
No
This is a new information collection.

$12,565,175
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/30/2007