Information Collection Request

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture (NCI)

ICR 200807-0925-003 · OMB 0925-0406 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Phase III CATI v. 2 Instrument for Agricultural Health Study Form Modified Available
Form 15F Buccal Cell Collection for Agricultural Health Study Form and Instruction New Available
Supporting State B_AHS_4-21-08.doc Supporting Statement B Uploaded 2008-06-19 Available
Attach 13D_Buccal Contact Letter with kit Iowa NHL.mar08.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 13C_Buccal Pre-contact Letter Iowa NHL.mar08.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 13B_Buccal Cell Contact Letter with Kit Iowa Prostate.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 13A_Buccal Cell Pre-Contact Letter Iowa Prostate.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 10C_Intro-Consent Letter Spouse.rtf Supplementary Document Uploaded 2008-06-19 Available
Attach 10B_Intro Letter North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 10A_ Intro Letter-Consent Iowa.rtf Supplementary Document Uploaded 2008-06-19 Available
Attach 4C_ Buccal Script Iowa NHL.mar08.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 4B_Buccal Script Iowa Prostate.doc Supplementary Document Uploaded 2008-06-19 Repair queued
Cover Memo_Ag Health.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 18B_Buccal Remail Kit Cover Letter Iowa.doc Supplementary Document Uploaded 2008-06-19 Repair queued
Attach 18A_Buccal Recontact Script for Damaged or Missing Buccal Sample Iowa.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 17B_Buccal Remail Consent Form Cover Letter Iowa.rtf Supplementary Document Uploaded 2008-06-19 Available
Attach 17A_Buccal Cell Missing Consent Form Script Iowa.doc Supplementary Document Uploaded 2008-06-19 Repair queued
Attach 16B_Buccal Cell Remind Script North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 15G_Buccal FAQs North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 4A_Buccal Script North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 16A_Buccal Cell Remind Script Iowa.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 15E_Buccal Cell Kit Cover Letter North Carolina.doc Supplementary Document Uploaded 2008-06-19 Repair queued
Attach 15D_Answers_to_questions Iowa NHL.mar08.DOC Supplementary Document Uploaded 2008-06-19 Available
Attach 15C_Answers_to_questions Iowa Prostate.DOC Supplementary Document Uploaded 2008-06-19 Repair queued
Attach 3B_Interview Script and Consent North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 15A_Buccal Kit Cover Letter Iowa.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 14A_Buccal Consent Form Iowa.docx Supplementary Document Uploaded 2008-06-19 Available
Attach 12D_IRB NC Knott.pdf Supplementary Document Uploaded 2008-06-19 Available
Attach 14B_Buccal Cell Consent Form North Carolina.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 12C_IRB_Iowa 2007 Main.pdf Supplementary Document Uploaded 2008-06-19 Available
Attach 12B_Westat 2007 IRB_7874-Annual.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 12A_IRB NCI.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 11_Collaborator_Confidentiality.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 9_Contractor Confidentialiy Agreement.dot Supplementary Document Uploaded 2008-06-19 Available
Attach 8_Privacy Act Memo.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 7_Confidentiality Certificate.pdf Supplementary Document Uploaded 2008-06-19 Available
Attach 6_NAP Members_consultants.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 5_International Ag Consort Consultants.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 1_Bibliography.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 3A_Interview Script and Consent Iowa.rtf Supplementary Document Uploaded 2008-06-19 Available
Attach 15B_Buccal Directions Iowa.doc Supplementary Document Uploaded 2008-06-19 Available
Supporting State A_ver4_7-30-08.doc Supporting Statement A Uploaded 2008-07-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
7302 Phase III CATI v. 2 Instrument for Agricultural Health Study Form Modified
185933 Buccal Cell Collection for Agricultural Health Study Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2011 36 Months From Approved 10/31/2008
6,861 0 24,733
4,140 0 44,270
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Phase III CATI v. 2 Instrument for Agricultural Health Study 1 Phase III CATI v. 2 for AHS
Buccal Cell Collection for Agricultural Health Study 15F, 2 Swab ,   CATI v. 2

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 6,861 24,733 0 0 -17,872 0
Annual Time Burden (Hours) 4,140 44,270 0 0 -40,130 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No