Attachment 01_List_Of_Attachments_2012

Attachment 01_List_Of_Attachments_2012.docx

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

Attachment 01_List_Of_Attachments_2012

OMB: 0925-0406

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List of Attachments – 2012

* Indicates a form/instrument/script

1: List of attachments

2: Bibliography

3: Members of the International Agriculture Consortium (AGRICOH)

4: Members of the Agricultural Health National Advisory Panel (NAP)

5: Certificate of Confidentiality

6: Memo from NIH Privacy Act Officer

7: Contractor Staff Confidentiality Agreement

8: Collaborators Confidentiality Agreement

*9: Phase IV Buccal Cell Interview Scripts

9.1). Script and Consent for Iowa and North Carolina Respondents Following Mailing of Buccal Cell Letter

9.2). Reminder Call Script for Iowa Buccal Cell Respondents

9.3). Reminder Call Script for North Carolina Buccal Cell Respondents

9.4). Missing Buccal Cell Consent Forms Call Script for Both Sites

9.5). Damaged or Missing Buccal Cell Sample Call Script for Both Sites


*10: BEEA Interview Scripts

10.1). BEEA Pre-Visit Confirmation Call Script for Both Sites

10.2). BEEA Script for Scheduling Pre-Application Visit (Recent Exposure Groups) for Iowa

10.3). BEEA Script for Scheduling First Post-Diazinon Application Visit (Recent Exposure Groups) for

Iowa

10.4). BEEA Script for Scheduling Pre-Application Visit (Recent Exposure Groups) for North Carolina

10.5). BEEA Script for Scheduling First Post-Diazinon Application Visit (Recent Exposure Groups) for

North Carolina


11: BEEA FAQs

11.1). BEEA Brochure/Fact Sheet Content for Iowa Recently Exposed Respondents

11.2). BEEA Brochure/Fact Sheet Content for North Carolina Recently Exposed Respondents

11.3). BEEA Brochure Content for Both Sites for Randomly Selected Respondents


12: Phase IV Buccal Cell IRB Approval Signature Pages

12.1). Phase IV IRB NCI

12.2). Phase IV IRB Westat

12.3). Phase IV IRB University of Iowa



13: BEEA IRB Approval Signature Pages

13.1). BEEA IRB NCI

13.2). BEEA IRB Westat

13.3). BEEA IRB University of Iowa

14: Phase IV Buccal Cell Pre-Contact Letters

14.1). Phase IV Buccal Cell Pre-Contact Letter for Iowa

14.2). Phase IV Buccal Cell Pre-Contact Letter for North Carolina

15: Phase IV Buccal Cell Consent Forms

15.1). Phase IV Iowa Buccal Cell Consent Form

15.2). Phase IV North Carolina Buccal Cell Consent Form

16: Phase IV Buccal Cell Collection Information (kit letter, collection directions/instructions, FAQs, etc.)

16.1). Phase IV Iowa Buccal Cell Kit Cover Letter

16.2). Phase IV Iowa Buccal Cell Directions

16.3). Phase IV Iowa Buccal Cell Kit Re-mail Cover Letter

16.4). Phase IV North Carolina Buccal Cell Kit Cover Letter

16.5). Phase IV North Carolina Buccal Cell Directions

16.6). Phase IV North Carolina Buccal Cell Kit Re-mail Cover Letter

16.7). Phase IV Buccal Cell FAQs for Both Sites

17: BEEA Letters (Intro, Cover, Reminder, Results, Show Cards)

17.1). BEEA Introductory Letter for Iowa Respondents

17.2). BEEA Introductory Letter for North Carolina Respondents

17.3). BEEA Consent Mailing Cover Letter for Iowa Respondents

17.4). BEEA Consent Mailing Cover Letter for North Carolina Respondents

17.5). BEEA Pre-Visit Preparation Show Card for Iowa Respondents

17.6). BEEA Pre-Visit Preparation Show Card for North Carolina Respondents

17.7). BEEA Directions for Urine Specimen Collection for Iowa Respondents

17.8). BEEA Directions for Urine Specimen Collection for North Carolina Respondents

17.9). BEEA Pre-Visit Reminder Letter for Iowa Respondents

17.10). BEEA Pre-Visit Reminder Letter for North Carolina Respondents

17.11). BEEA Letter for Scheduling First Post-Diazinon Application Visit for Iowa Respondents

17.12). BEEA Letter for Scheduling First Post-Diazinon Application Visit for North Carolina Respondents

17.13). BEEA NCI Letter for CBC Lymphocyte Assay Results

17.14). BEEA Letter to Contact Us for Iowa Respondents – Both Groups

17.15). BEEA Letter to Contact Us for North Carolina Respondents – Both Groups

18: BEEA Consent Forms

18.1). BEEA Consent form for Iowa Randomly Selected Respondents

18.2). BEEA Consent form for North Carolina Randomly Selected Respondents

18.3). BEEA Consent form for Iowa Recently Exposed Respondents

18.4). BEEA Consent form for North Carolina Recently Exposed Respondents


*19: BEEA Computer Assisted In-Person Interview (CAPI)


*20: BEEA Computer Assisted Telephone Interview (CATI) for Randomly Selected Respondents


*21: BEEA CATI for Recently Exposed Respondents


22: BEEA Objectives


23: Phase IV Health Follow-Up IRB Approval Signature Pages

23.1). AHS Health Follow-Up Office of Protocol Services Continuing Review Approval under the AHS AutoImmuneII Protocol

23.2). AHS Health Follow-Up Copernicus Group IRB Continuing Review Approval under the AHS AutoImmuneII Protocol

23.3). AHS Health Follow-Up Office of Protocol Services Amendment Approval under the AHS AutoImmuneII Protocol


24: Phase IV Health Follow-Up Letters

24.1). AHS Phase IV Health Follow-Up Participant Invitation Letter

24.2). AHS Phase IV Health Follow-Up Next of Kin Invitation Letter

24.3). AHS Phase IV Health Follow-UpWebsite Letter

*25: Phase IV Health Follow-Up Participant Interview Scripts

25.1). AHS Phase IV Health Follow-Up CAWI Participant Introductory Interview Script

25.2). AHS Phase IV Health Follow-Up CATI Participant Introductory Interview Script

25.3). AHS Phase IV Health Follow-Up CAWI/CATI Participant Survey

25.4). AHS Phase IV Health Follow-Up Paper & Pen Participant Survey


*26: Phase IV Health Follow-Up Proxy Interview Scripts

26.1). AHS Phase IV Health Follow-Up CAWI Proxy Introductory Interview Script

26.2). AHS Phase IV Health Follow-Up CATI Proxy Introductory Interview Script

26.3). AHS Phase IV Health Follow-Up CAWI/CATI Proxy Survey

26.4). AHS Phase IV Health Follow-Up Paper & Pen Proxy Survey


27: Phase IV Health Follow-Up FAQs for CAWI/CATI

28: Agricultural Health Study Privacy Impact Assessments Summary and Approvals


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