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Recruitment Contact and Appoinment Confirmation
The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)
OMB: 0925-0584
IC ID: 182188
OMB.report
HHS/NIH
OMB 0925-0584
ICR 200709-0925-003
IC 182188
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:
2014-07-17 - Revision of a currently approved collection
2011-10-24 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Recruitment Contact and Appoinment Confirmation
Form and Instruction
1 In Person Script
In-person Script.doc
Form and Instruction
2 Residential Response
Resident Response.doc
Form and Instruction
3 App. Reminder Call
Appt Reminder call_09-12-07.doc
Form and Instruction
4 Phone Script
Phone Script.doc
Form and Instruction
5 Safety Screen
Visit prep and safety screen_OMB.doc
Form and Instruction
Brochure-Eng.pdf
Brochure-Eng
IC Document
introductory letter.doc
introductory letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Recruitment Contact and Appoinment Confirmation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
In Person Script
In-person Script.doc
Yes
Yes
Paper Only
Form and Instruction
2
Residential Response
Resident Response.doc
Yes
Yes
Paper Only
Form and Instruction
3
App. Reminder Call
Appt Reminder call_09-12-07.doc
Yes
Yes
Paper Only
Form and Instruction
4
Phone Script
Phone Script.doc
Yes
Yes
Paper Only
Form and Instruction
5
Safety Screen
Visit prep and safety screen_OMB.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
35,703
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
35,703
0
35,703
0
0
0
Annual IC Time Burden (Hours)
2,856
0
2,856
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Brochure-Eng
Brochure-Eng.pdf
09/13/2007
introductory letter
introductory letter.doc
09/13/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.