Information Collection Request

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

ICR 201005-0925-004 · OMB 0925-0406 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Phase III CATI v. 2 Instrument for Agricultural Health Study Form and Instruction Modified Available
Form 12 BEEA Home Visit CAPI for Agricultural Health Study Form and Instruction New Available
Form 10 BEEA Schedule Home Visit Script for Agricultural Health Study Form and Instruction New Available
Form 9 BEEA Home Visit CAPI for Agricultural Health Study Form and Instruction New Available
Form 7 BEEA CATI Eligibility Screener for Agricultural Health Study Form and Instruction New Available
Form 5 Phase III Buccal Cell Reminder, Missing or Damaged Scripts for Agricultural Health Study Form and Instruction New Available
Form 2 Phase III Telephone Interview and Buccal Cell Scripts for Agricultural Health Study Form and Instruction Modified Available
Passback_Attachment_Biomarker Study Protocol 2010-02-25.doc Supplementary Document Uploaded 2010-05-21 Available
Supporting State B_4-2010_v 3_highlight.docx Supporting Statement B Uploaded 2010-04-28 Available
Attach 26_BEEA IRB Approvals.pdf Supplementary Document Uploaded 2010-05-20 Available
Attach 22_BEEA consent forms.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 14_Phase III Buccal Consent Forms.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 12 - Phase III IRB Approvals.pdf Supplementary Document Uploaded 2010-04-28 Available
Attach 11_STARS_AHS Confidentiality Agreement.pdf Supplementary Document Uploaded 2010-04-28 Available
Attach 9_Contractor Confidentialiy Agreement.dot Supplementary Document Uploaded 2010-04-28 Repair queued
Attach 8_ NIH Privacy Act Memo.pdf Supplementary Document Uploaded 2010-05-20 Available
Attach 7_Certificate of Confidentiality_NCI-02-028A.pdf Supplementary Document Uploaded 2010-04-28 Available
Attach 6_NAP Members_consultants (2).docx Supplementary Document Uploaded 2010-04-28 Available
Attach 5_International Ag Consort Consultants.doc Supplementary Document Uploaded 2010-04-28 Available
Attach 1_Bibliography.doc Supplementary Document Uploaded 2010-04-28 Available
Pre-Submission Cover Memo_Ag Health.docx Supplementary Document Uploaded 2010-04-28 Repair queued
Attach 27_Letter for CBC lymphocyte assay results_NCI_generic.doc Supplementary Document Uploaded 2010-04-29 Available
Attach 25A&B_BEEA Advance Letters for First Post-Diazinon Application Visit.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 24_BEEA pre-visit reminder letters and script.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 23_BEEA consent mailing letters and pre-visit prep.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 21_BEEA introductory letters and information sheets.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 17B_Buccal Remail Consent Form Cover Letter Iowa.rtf Supplementary Document Uploaded 2010-04-29 Available
Attach 18B_Buccal Remail Kit Cover Letter Iowa.doc Supplementary Document Uploaded 2010-04-29 Available
Attach 13_Phase III buccal contact scripts and letters.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 15_Phase III buccal kit cover letters and instructions.pdf Supplementary Document Uploaded 2010-04-29 Available
Attach 10_Phase III Introductory letters.pdf Supplementary Document Uploaded 2010-04-29 Available
Supporting State A_4-2010_v.3_highlight.docx Supporting Statement A Uploaded 2010-04-29 Available

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2013 36 Months From Approved 10/31/2011
1,780 0 6,861
550 0 4,140
0 0 0





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 1,780 6,861 0 -5,081 0 0
Annual Time Burden (Hours) 550 4,140 0 -3,590 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No