3 Informant

OMB#: 0925-XXXX

Exp. XX/XXXX

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address.

Script for the Informant Interview for Follow-up Event Ascertainment Collected by Phone:

“Hello! My name is (insert your first name) with the ( insert Institution name )and I am calling for the Hispanic Community Health Study/Study of Latinos to collect the information for that study. May I speak with (insert informaNt’s name)?

Wait until the informant is on the phone. Introduce yourself again and say you are calling for the HCHS/SOL then ask: “Is this a good time to talk?”

Hesitate and wait for a response. If the response is “no”, ask if you can call back later.

“Mr./Mrs. (DECEDENT) was part of HCHS/SOL, a national study of health in the Hispanic/Lantino community. I understand form our records that (SUPPLY NAME of DECEDENT) died in (SUPPLY MONTH), 20__. We are sorry to learn of His/her death. Information about the events surround his/her death may provide clues which will help in the fight against heart disease, stroke, diabetes, and respiratory disease.” (PAUSE)

“I’d like to ask you a few medical questions concerning (NAME)’s illness and death. This involves an interview taking 30 minutes or less over the phone. Your answers are confidential. Can you talk now, or would another time be better? (PAUSE)

PROCEED WITH INTERVIEW IF CONVENIENT TO INFORMANT.

IF TIMING IS INCONVENIENT, RESCHEDULE AND RECORD TIME TO CALL. INFORMATNS MAY REFUSE INTERVIEW AT THIS POINT. IF SO, PURSUE THIS INTERVIEW NO FURTHER. ASK WETHER INFORMANT CAN RECOMMEND SOMEONE ELSE WHO WOULD BE WILLING TO TALK.

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