Clinic Exam Procedures

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

OMB: 0925-0584

IC ID: 182190

Information Collection (IC) Details

View Information Collection (IC)

Clinic Exam Procedures
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 12 Oral Health Oral Health_07-09-07.doc Yes Yes Paper Only
Form and Instruction 1 Alcohol Use Alcohol Use_06-07-07.doc Yes Yes Paper Only
Form and Instruction 2 Dietary Recall and Supplement Use Diet and Supplement Phone Script recall.doc Yes Yes Paper Only
Form and Instruction 3 Dietary Behavior Dietary Beh_6-25-07.doc Yes Yes Paper Only
Form and Instruction 4 Economic Economic_7-04-07.doc Yes Yes Paper Only
Form and Instruction 5 Health Care Use Health Care Use_7-06-07.doc Yes Yes Paper Only
Form and Instruction 6 Hearing Exam Hearing Exam Qx_07-04-07.doc Yes Yes Paper Only
Form and Instruction 7 Informed Consent Informed consent.doc Yes Yes Paper Only
Form and Instruction 8 Medical History Medical History_6-28-07.doc Yes Yes Paper Only
Form and Instruction 9 Medication Use Medication Survey_07-02-07.doc Yes Yes Paper Only
Form and Instruction 10 Neuro Neurocognitive Assessment_07-31-07.doc Yes Yes Paper Only
Form and Instruction 11 Occupation Occupation_7-04-07.doc Yes Yes Paper Only
Form and Instruction 13 Personal Information Personal Information_7-02-07.doc Yes Yes Paper Only
Form and Instruction 14 Physical Activity Physical Activity_7-24-07.doc Yes Yes Paper Only
Form and Instruction 15 Respiratory Respiratory_7-05-07.doc Yes Yes Paper Only
Form and Instruction 16 SF 12 SF12v2 Health Survey_4-30-07.doc Yes Yes Paper Only
Form and Instruction 17 Sleep Sleep_6-29-07.doc Yes Yes Paper Only
Form and Instruction 18 Social Cultural Sociocultural_07-04-07.doc Yes Yes Paper Only
Form and Instruction 19 Tobacco Use Tobacco Use_6-18-07.doc Yes Yes Paper Only
Form and Instruction 20 Weight History Weight History_7-03-07.doc Yes Yes Paper Only
Form and Instruction 21 Well Being Wellbeing_5-25-07.doc Yes Yes Paper Only

Health Health Care Services

 

5,333 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,333 0 0 0 0 5,333
Annual IC Time Burden (Hours) 19,572 0 0 0 0 19,572
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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