Families

The Jackson Heart Study: Annual Follow-up with Third Party Respondents (NHLBI)

Documents and Forms

Document Name Document Type
Form 1 Families Form and Instruction
1 Known Informant Letter Attachment 8 -Known number_Death certificate contact notification.doc Form and Instruction
2 Unknown Informant Letter Attachment 9 -Unknown number Letter.doc Form and Instruction
3 Informant Interview Form (IFI) Attachment 10 -Informant Interview (IFI) Form.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Families	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Known Informant Letter	Attachment 8 -Known number_Death certificate contact notification.doc	No	No	Printable Only
Form and Instruction	2	Unknown Informant Letter	Attachment 9 -Unknown number Letter.doc	No	No	Printable Only
Form and Instruction	3	Informant Interview Form (IFI)	Attachment 10 -Informant Interview (IFI) Form.doc	No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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