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
DocumentTypeStatusAvailability
Form 1 Food Propensity Form and Instruction New Available
Form 11 Focus Groups Form and Instruction Modified Repair queued
Form 1 Non Participant Components Form and Instruction Modified Repair queued
Form 1 Participant Telephone Interviews Form and Instruction Modified Available
Form 9 Clinic Questionaires Form and Instruction Modified Repair queued
Form 12 Clinic Exam Procedures Form and Instruction Modified Repair queued
Form 1 Household Enumeration Form and Instruction Modified Available
Form 2 Recruitment Contact and Appoinment Confirmation Form and Instruction Modified Repair queued
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 Repair queued
OMB budget repspone brf(1).1-31-08.xls Supplementary Document Uploaded 2008-12-03 Repair queued
Protocol[1].source.doc Supplementary Document Uploaded 2008-12-03 Repair queued
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 Repair queued
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 Repair queued
Exit Interview_10-24-08_span.doc Supplementary Document Uploaded 2008-12-03 Repair queued
Claudication_3-05-08_span.doc Supplementary Document Uploaded 2008-12-03 Repair queued
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 Repair queued
Annual Followup_Y2_11-03-08_span_annotated.doc Supplementary Document Uploaded 2008-12-03 Repair queued
Annual Followup_Y1_11-03-08_span_annotated.doc Supplementary Document Uploaded 2008-12-03 Repair queued
IRBapproval.Bronx .PDF Supplementary Document Uploaded 2008-12-03 Repair queued
San Diego.IRB.doc Supplementary Document Uploaded 2008-12-03 Available
Northwestern.IRB approval.pdf Supplementary Document Uploaded 2008-12-03 Repair queued
HCHS Miami IRB approval.2.pdf Supplementary Document Uploaded 2008-12-03 Repair queued
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 Repair queued
Xwalk_rev_11-12-08.doc Supplementary Document Uploaded 2008-12-03 Available
OSMB June 08 Minutes.doc Supplementary Document Uploaded 2008-12-03 Repair queued
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 Repair queued
Social Network Index_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Sleep_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
SF12_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Screen and Roster_span.doc Supplementary Document Uploaded 2008-11-21 Available
Respiratory_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Resident Response_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Physical Activity_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Tobacco Use_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Personal Information_span.doc Supplementary Document Uploaded 2008-11-21 Available
Personal Identifiers_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Oral Health_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Phone_script_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Occupation_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Neurocognitive Assessment_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Medication Use_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Medical History_span.doc Supplementary Document Uploaded 2008-11-21 Available
Introductory letter_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Informed Consent_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Informed Consent_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Hearing Exam_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Health Care Use_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Diet and Supplement Phone Script Recall_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Diet and Supplement In-Person Recall_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
In-person script_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Appointment Reminder call_09-12-07_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
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 Repair queued
Legislative Mandate.pdf Supplementary Document Uploaded 2008-11-21 Available
Economic_span.doc Supplementary Document Uploaded 2008-11-21 Repair queued
Council Minutes.doc Supplementary Document Uploaded 2008-11-21 Repair queued
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
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
0925-0584 200901-0925-003
Historical Active 200709-0925-003
HHS/NIH
The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)
Revision of a currently approved collection   No
Regular
Approved without change 03/16/2009
Retrieve Notice of Action (NOA) 01/12/2009
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
03/31/2012 36 Months From Approved 02/28/2011
66,640 0 61,307
48,114 0 44,168
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

  73 FR 57634 10/03/2008
73 FR 75725 12/12/2008
No

8
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

  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
Yes
Miscellaneous Actions
No
The changes to the estimated participant burden in this application come from the following sources: (1) the addition of a claudication questionnaire (Claudication_2-25-08.doc; Claudication_03-03-08_span.doc) at the baseline exam to meet the goal of documenting peripheral vascular disease and an optional exit interview form (Exit Interview_10-24-08.doc ; Exit Interview_10-24-08_span.doc) designed to help the study understand how to make the experience better for the participant, and (2) the addition of a food propensity questionnaire (FPQ_English_11-04-08.doc ; FPQ_Spanish_11-04-08.doc) to collect food frequency in order to adjust the nutrient recall information collected at baseline for the participants usual dietary intake. The FPQ will be conducted one-year after the baseline exam in a phone call separate from the Annual Follow-Up call. The overall burden for the Annual Follow-Up (AFU) has not changed since the previous submission, however the AFU component has been modified as follows. Participant burden has been minimized over the 3 years of projected annual follow-up by developing 3 variations of the AFU form. The version of the form for year 1 (Annual Followup_Y1_11-03-08.doc ) has reduced content. AFU forms for years 2 and 3 (Annual Followup_Y2_11-03-08.doc ; Annual Followup_Y3_11-03-08.doc ) each have slightly different content and may be longer to administer depending upon the general health of the participant since baseline. The neurocognitive AFU component is only performed on participants aged 45 and over. The average time across all three years for a participant with the AFU questionnaire remains at 30 minutes contact time per year. See Table A.15 below for a summary of AFU by contact year. The Informant Interview has been modified to include episodes of angina and shortness of breath. The Physician Interview form has been modified by expanding adding sections on asthma, COPD, transient ischemic attack, congestive heart failure and vascular related surgeries.

$10,561,179
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Marilyn Tuttleman 3015947949 [email protected]

  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.
12/17/2008