Information Collection Request

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture (NCI)

ICR 201302-0925-004 · OMB 0925-0406 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 7 Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction Modified Available
Form 14 Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction New Available
Form 5 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 3 Form and Instruction Modified Available
Form 1 Attachment 10: BEEA Schedule Home Visit Scripts for AHS Form and Instruction Modified Available
Form 3 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS Form and Instruction Modified Available
Form 2 Attachment 20 or 21: BEEA CATI Screener for AHS Form and Instruction Modified Available
Form 1 Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction Modified Available
Form 12 Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction Modified Available
Supporting State B_1107012.docx Supporting Statement B Uploaded 2013-02-08 Available
Attachment 28_AHS_PrivacyImpactAssessments.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 27_PhaseIV_HFUP_FAQs_CAWI_CATI.docx Supplementary Document Uploaded 2013-02-05 Available
Attachment 24_Phase_IV_HFUP_Letters.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 23_Phase_IV_HFUP_IRB_Appr_Signature_Pages.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 22_BEEA_Objectives.doc Supplementary Document Uploaded 2013-02-05 Available
Attachment 18_BEEA_Consent_Forms.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 17_BEEA_Letters.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 16_Phase_IV_Buccal_Cell_Collection_Information.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 15_Phase_IV_Buccal_Consents.docx Supplementary Document Uploaded 2013-02-05 Available
Attachment 14_Phase_IV_Buccal_Cell_Pre-Contact_Letters.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 13_BEEA_IRB_Approval_Signature_Pages.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 12_Phase_IV_Buccal_Cell_IRB_Approval_Signature_Pages.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 11_BEEA_FAQs.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 08_STARS_AHS_Confidentiality_Agreement.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 07_Contractor_Confidentialiy_Agreement.dot Supplementary Document Uploaded 2013-02-05 Available
Attachment 06_ NIH_Privacy_Act_Memo.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 05_Certificate_Of_Confidentiality_NCI-02-028A.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 04_NAP_Members_Consultants.doc Supplementary Document Uploaded 2013-02-05 Available
Attachment 03_AGRICOH_Steering_Committee_Mbr_2011.pdf Supplementary Document Uploaded 2013-02-05 Available
Attachment 02_Bibliography.docx Supplementary Document Uploaded 2013-02-05 Available
Attachment 01_List_Of_Attachments_2012.docx Supplementary Document Uploaded 2013-02-05 Available
Cover Memo_Ag Health_12132012_FINAL.docx Supplementary Document Uploaded 2013-02-05 Available
Attachment 09-1_Phase_IV_Initial_Script_Consent_Buccal_Cell.docx Supplementary Document Uploaded 2013-02-06 Repair queued
Supporting State A_1102012.docx Supporting Statement A Uploaded 2013-02-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
7302 Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction Modified
205828 Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction New
192872 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 3 Form and Instruction Modified
192871 Attachment 10: BEEA Schedule Home Visit Scripts for AHS Form and Instruction Modified
192870 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS Form and Instruction Modified
192869 Attachment 20 or 21: BEEA CATI Screener for AHS Form and Instruction Modified
192868 Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction Modified
185933 Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2016 36 Months From Approved 05/31/2013
25,551 0 1,780
10,465 0 550
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 25,551 1,780 0 23,771 0 0
Annual Time Burden (Hours) 10,465 550 0 9,915 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No