Information Collection

BEEA Home Visit CAPI for Agricultural Health Study

IC 192870 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⚠️ Notice: This information collection may be referencing outdated material.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 9 BEEA Home Visit CAPI for Agricultural Health Study	Form and Instruction
9 Attach 19 BEEA CAPI Attach 19_CAPI Questionnaire_Both Groups - 03-22-10 rev.doc	Form and Instruction
Attach 23_BEEA consent mailing letters and pre-visit prep.pdf Attach 23A-23F BEEA Consent Mail Letters & Pre-visit Prep	IC Document

IC Title:

BEEA Home Visit CAPI 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	9	Attach 19 BEEA CAPI	Attach 19_CAPI Questionnaire_Both Groups - 03-22-10 rev.doc		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: 310

Number of Respondents for Small Entity: 310

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	310	310
Annual IC Time Burden (Hours)	103	103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 23A-23F BEEA Consent Mail Letters & Pre-visit Prep	Attach 23_BEEA consent mailing letters and pre-visit prep.pdf	04/29/2010

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