Information Collection

BEEA CATI Eligibility Screener for Agricultural Health Study

IC 192869 under ICR 201005-0925-004 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7 BEEA CATI Eligibility Screener for Agricultural Health Study	Form and Instruction
7 Attach 20A BEEA CATI for RANDOM Select Group Attach 20A_CATI Eligibility Script_Random Select Group.docx	Form and Instruction
8 Attach 20B BEEA CATI Screen for RANDOM Group Attach 20B_CATI Eligibility Script_Recently Exposed.docx	Form and Instruction
Attach 21_BEEA introductory letters and information sheets.pdf Attach 21A-21F BEEA Intro Letters & Information	IC Document

IC Title:

BEEA CATI Eligibility Screener for Agricultural Health Study

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7	Attach 20A BEEA CATI for RANDOM Select Group	Attach 20A_CATI Eligibility Script_Random Select Group.docx		Yes	Yes	Fillable Printable
Form and Instruction	8	Attach 20B BEEA CATI Screen for RANDOM Group	Attach 20B_CATI Eligibility Script_Recently Exposed.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD

FR Citation: 67 FR 60776

Number of Respondents: 960

Number of Respondents for Small Entity: 960

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	960	960
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 21A-21F BEEA Intro Letters & Information	Attach 21_BEEA introductory letters and information sheets.pdf	04/29/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.