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
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 Repair queued
Supporting State B_AHS_4-21-08.doc Supporting Statement B Uploaded 2008-06-19 Repair queued
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 Repair queued
Attach 13B_Buccal Cell Contact Letter with Kit Iowa Prostate.doc Supplementary Document Uploaded 2008-06-19 Repair queued
Attach 13A_Buccal Cell Pre-Contact Letter Iowa Prostate.doc Supplementary Document Uploaded 2008-06-19 Repair queued
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 Repair queued
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 Repair queued
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 Repair queued
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 Repair queued
Attach 14A_Buccal Consent Form Iowa.docx Supplementary Document Uploaded 2008-06-19 Repair queued
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 Repair queued
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 Repair queued
Attach 11_Collaborator_Confidentiality.doc Supplementary Document Uploaded 2008-06-19 Available
Attach 9_Contractor Confidentialiy Agreement.dot Supplementary Document Uploaded 2008-06-19 Repair queued
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 Repair queued
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 Repair queued
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
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
0925-0406 200807-0925-003
Historical Active 200506-0925-001
HHS/NIH
Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture (NCI)
Extension without change of a currently approved collection   No
Regular
Approved without change 10/24/2008
Retrieve Notice of Action (NOA) 07/30/2008
Clearance is provided to continue the data collection for Phase III of this project, consistent with the prior terms of clearance. NCI/NIH will sumbit a change package that describes the design and protocol for Phase IV of the study before beginning the data collection for that phase.
  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

The Agricultural Health Study (AHS) is a cohort study of 89,568 licensed pesticide applicators and their spouses in Iowa and North Carolina to be followed for 20 years or more. The focus of the phase III follow-up period (2005-2008) is to update exposure information and health histories by means of a computer assisted telephone interview, and to follow the cohort to determine disease incidence and mortality. This request is to complete the follow-up for phase III for 20,583 enrolled subjects who were not contacted previously due to a slow release of funding to the field centers resulting in an unexpected slow rate of data collection. The stimulus for this prospective investigation comes from the growing evidence that, despite a low mortality overall, farmers experience an excess of several cancers. A small sub-set of the cohort (N=993) will be asked to participate in the buccal cell collection to assess the effect of inherited polymorphisms and the interaction of environment and genomic predisposition.

US Code: 42 USC 285a-2 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  73 FR 23473 04/30/2008
73 FR 38227 07/03/2008
No

  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
No
No

$449,333
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Mikia Currie 3014350941

  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.
07/30/2008