Information Collection Request

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

ICR 200901-0925-003 · OMB 0925-0584 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Food Propensity Form and Instruction New Available
Form 11 Focus Groups Form and Instruction Modified Available
Form 1 Non Participant Components Form and Instruction Modified Available
Form 1 Participant Telephone Interviews Form and Instruction Modified Available
Form 9 Clinic Questionaires Form and Instruction Modified Available
Form 12 Clinic Exam Procedures Form and Instruction Modified Available
Form 1 Household Enumeration Form and Instruction Modified Available
Form 2 Recruitment Contact and Appoinment Confirmation Form and Instruction Modified Available
HCHS -Supporting Statement Dec.01.08.doc Supporting Statement B Uploaded 2008-12-03 Available
Summary of Changes 12 03 08.doc Supplementary Document Uploaded 2008-12-03 Available
OMB budget repspone brf(1).1-31-08.xls Supplementary Document Uploaded 2008-12-03 Available
Protocol[1].source.doc Supplementary Document Uploaded 2008-12-03 Available
Personal Information QxQ_1-29-08[1].doc Supplementary Document Uploaded 2008-12-03 Available
Personal Information_11-21-08_span.doc Supplementary Document Uploaded 2008-12-03 Available
Examples of QXQs[1].doc Supplementary Document Uploaded 2008-12-03 Available
CC[1]. HIPAA Form - Revised 1-25-08.doc Supplementary Document Uploaded 2008-12-03 Available
FPQ Spanish_11-04-08.doc Supplementary Document Uploaded 2008-12-03 Available
Exit Interview_10-24-08_span.doc Supplementary Document Uploaded 2008-12-03 Available
Claudication_3-05-08_span.doc Supplementary Document Uploaded 2008-12-03 Available
Informant interview_10-20-08_span_annotated (2).doc Supplementary Document Uploaded 2008-12-03 Available
Annual Followup_Y3_11-03-08_span_annotated.doc Supplementary Document Uploaded 2008-12-03 Available
Annual Followup_Y2_11-03-08_span_annotated.doc Supplementary Document Uploaded 2008-12-03 Available
Annual Followup_Y1_11-03-08_span_annotated.doc Supplementary Document Uploaded 2008-12-03 Available
IRBapproval.Bronx .PDF Supplementary Document Uploaded 2008-12-03 Available
San Diego.IRB.doc Supplementary Document Uploaded 2008-12-03 Available
Northwestern.IRB approval.pdf Supplementary Document Uploaded 2008-12-03 Available
HCHS Miami IRB approval.2.pdf Supplementary Document Uploaded 2008-12-03 Available
CSCC_letter signed IRB2007-08.pdf Supplementary Document Uploaded 2008-12-03 Available
OMB Burden_Notice_Nov08 (2).ppt Supplementary Document Uploaded 2008-12-03 Available
Xwalk_rev_11-12-08.doc Supplementary Document Uploaded 2008-12-03 Available
OSMB June 08 Minutes.doc Supplementary Document Uploaded 2008-12-03 Source copy available
Timeline - Hispanic Community Health Study.doc Supplementary Document Uploaded 2008-12-03 Source copy available
Well being_span.doc Supplementary Document Uploaded 2008-11-21 Available
Weight History_span.doc Supplementary Document Uploaded 2008-11-21 Available
Socio cultural_span.doc Supplementary Document Uploaded 2008-11-21 Available
Social Network Index_span.doc Supplementary Document Uploaded 2008-11-21 Available
Sleep_span.doc Supplementary Document Uploaded 2008-11-21 Available
SF12_span.doc Supplementary Document Uploaded 2008-11-21 Available
Screen and Roster_span.doc Supplementary Document Uploaded 2008-11-21 Available
Respiratory_span.doc Supplementary Document Uploaded 2008-11-21 Available
Resident Response_span.doc Supplementary Document Uploaded 2008-11-21 Available
Physical Activity_span.doc Supplementary Document Uploaded 2008-11-21 Available
Tobacco Use_span.doc Supplementary Document Uploaded 2008-11-21 Available
Personal Information_span.doc Supplementary Document Uploaded 2008-11-21 Available
Personal Identifiers_span.doc Supplementary Document Uploaded 2008-11-21 Available
Oral Health_span.doc Supplementary Document Uploaded 2008-11-21 Available
Phone_script_span.doc Supplementary Document Uploaded 2008-11-21 Source copy available
Occupation_span.doc Supplementary Document Uploaded 2008-11-21 Available
Neurocognitive Assessment_span.doc Supplementary Document Uploaded 2008-11-21 Available
Medication Use_span.doc Supplementary Document Uploaded 2008-11-21 Available
Medical History_span.doc Supplementary Document Uploaded 2008-11-21 Available
Introductory letter_span.doc Supplementary Document Uploaded 2008-11-21 Available
Informed Consent_span.doc Supplementary Document Uploaded 2008-11-21 Available
Informed Consent_span.doc Supplementary Document Uploaded 2008-11-21 Available
Hearing Exam_span.doc Supplementary Document Uploaded 2008-11-21 Available
Health Care Use_span.doc Supplementary Document Uploaded 2008-11-21 Available
Diet and Supplement Phone Script Recall_span.doc Supplementary Document Uploaded 2008-11-21 Available
Diet and Supplement In-Person Recall_span.doc Supplementary Document Uploaded 2008-11-21 Available
In-person script_span.doc Supplementary Document Uploaded 2008-11-21 Available
Appointment Reminder call_09-12-07_span.doc Supplementary Document Uploaded 2008-11-21 Available
Alcohol Use_span.doc Supplementary Document Uploaded 2008-11-21 Available
Epidemiologic Research in Hispanic Populations.doc Supplementary Document Uploaded 2008-11-21 Available
Brochure-Span.pdf Supplementary Document Uploaded 2008-11-21 Available
Privacy Policy.doc Supplementary Document Uploaded 2008-11-21 Available
Privacy Act.doc Supplementary Document Uploaded 2008-11-21 Available
Legislative Mandate.pdf Supplementary Document Uploaded 2008-11-21 Available
Economic_span.doc Supplementary Document Uploaded 2008-11-21 Available
Council Minutes.doc Supplementary Document Uploaded 2008-11-21 Available
introductory letter.doc Supplementary Document Uploaded 2007-09-13 Available
Brochure-Eng.pdf Supplementary Document Uploaded 2007-09-13 Available
Revised A Supporting Statement Dec 01 08.doc Supporting Statement A Uploaded 2008-12-03 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
187780 Food Propensity Form and Instruction New
183722 Focus Groups Form and Instruction Modified
182193 Non Participant Components Form and Instruction Modified
182192 Participant Telephone Interviews Form and Instruction Modified
182191 Clinic Questionaires Form and Instruction Modified
182190 Clinic Exam Procedures Form and Instruction Modified
182189 Household Enumeration Form and Instruction Modified
182188 Recruitment Contact and Appoinment Confirmation Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2012 36 Months From Approved 02/28/2011
66,640 0 61,307
48,114 0 44,168
0 0 0





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
Recruitment Contact and Appoinment Confirmation 2, 1, 3, 4, 5 Residential Response ,   In Person Script ,   App. Reminder Call ,   Phone Script ,   Safety Screen
Clinic Exam Procedures 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 Oral Health ,   Alcohol Use ,   Dietary Recall and Supplement Use ,   Dietary Behavior ,   Economic ,   Health Care Use ,   Hearing Exam ,   Informed Consent ,   Medical History ,   Medication Use ,   Neuro ,   Occupation ,   Personal Information ,   Physical Activity ,   Respiratory ,   SF 12 ,   Sleep ,   Social Cultural ,   Tobacco Use ,   Weight History ,   Well Being
Clinic Questionaires 15, 16, 17, 18, 19, 20, 21, 22, 23, 8, 9, 1, 2, 3, 4, 5, 6, 7, 10, 11, 12, 14 Medication Use ,   Respiratory ,   SF 12 ,   Sleep ,   Social Cultural ,   Tobacco Use ,   Weight History ,   Well Being ,   survey ,   survey ,   Physical Activity ,   Alcohol Use ,   Dietary Recall and Supplement Use ,   Dietary Behavior ,   Economic ,   Health Care Use ,   Hearing Exam ,   Informed Consent ,   Medical History ,   Neuro ,   Occupation ,   Oral Health
Household Enumeration 1, 2 Personal Identifiers ,   Screen and Roster
Non Participant Components 1, 2 Letter ,   survey
Food Propensity 1 survey
Focus Groups 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 Occupation ,   Oral Health ,   Personal Information ,   Physical Activity ,   Respiratory ,   SF12 ,   Sleep ,   Social Cultural ,   Tobacco Use ,   Weight History ,   Well Being
Participant Telephone Interviews 1, 3, 2, 5, 6, 4, 7 Recall ,   Informant ,   survey ,   survey ,   survey ,   survey ,   survey

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 66,640 61,307 0 5,333 0 0
Annual Time Burden (Hours) 48,114 44,168 0 3,573 373 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No