BEEA CATI Eligibility Screener for Agricultural Health Study

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.