Information Collection

BEEA Schedule Home Visit Script for Agricultural Health Study

IC 192871 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⚠️ Notice: This information collection may be referencing outdated material.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 10 BEEA Schedule Home Visit Script for Agricultural Health Study	Form and Instruction
10 Attach 25C and 25D Scripts for Scheduling Post-Applicati Attach 25C&D_Scripts for Scheduling First Post-App Visit_Iowa & NC_Recent Exposure Group_v2.pdf	Form and Instruction
Attach 24_BEEA pre-visit reminder letters and script.pdf Attach 24A-24C BEEA Pre-visit Letters & Script	IC Document

IC Title:

BEEA Schedule Home Visit Script 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	10	Attach 25C and 25D Scripts for Scheduling Post-Application Visit	Attach 25C&D_Scripts for Scheduling First Post-App Visit_Iowa & NC_Recent Exposure Group_v2.pdf		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: 10

Number of Respondents for Small Entity: 10

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	30	30
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 24A-24C BEEA Pre-visit Letters & Script	Attach 24_BEEA pre-visit reminder letters and script.pdf	04/29/2010

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