Biological Sample Collection Questionnaire (Randomly Selected)

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Biological Sample Collection Questionnaire (Randomly Selected) Form
1 Biological Sample Collection Questionnaire (Randomly Sel AHS Biomarker Study Questionnaire - 01-07-10.doc Form

Information Collection (IC) Details

IC Title:	Biological Sample Collection Questionnaire (Randomly Selected)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Biological Sample Collection Questionnaire (Randomly Selected)	AHS Biomarker Study Questionnaire - 01-07-10.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,550	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,550	1,550
Annual IC Time Burden (Hours)	2,325	2,325
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.