Attachment 9: Reminder, Missing or Damaged Scripts for AHS

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction
1 Reminder Call Script for Iowa Buccal Cell Respondents Attachment 09-2_Phase_IV_Remind_Call_IO_Buccal_Cell_Script.docx Form and Instruction
3 Missing Buccal Cell Consent Forms Call Script Attachment 09-4_Phase_IV_Missing_Consent_Buccal_Cell_Script.docx Form and Instruction
2 Reminder Call Script for North Carolina Buccal Cell Resp Attachment 09-3_Phase_IV_Remind_Call_NC_Buccal_Cell_Script.docx Form and Instruction
4 Damaged or Missing Buccal Cell Sample Call Script Attachment 09-5_Phase_IV_Missing_Damaged_Buccal_Cell_Sample_Script.docx Form and Instruction
Attachment 09-1_Phase_IV_Initial_Script_Consent_Buccal_Cell.docx Attachment 09-1_Phase_IV_Initial_Script_Consent_Buccal_Cell IC Document

Information Collection (IC) Details

IC Title:	Attachment 9: Reminder, Missing or Damaged Scripts for AHS	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	Reminder Call Script for Iowa Buccal Cell Respondents	Attachment 09-2_Phase_IV_Remind_Call_IO_Buccal_Cell_Script.docx	No	No	Printable Only
Form and Instruction	3	Missing Buccal Cell Consent Forms Call Script	Attachment 09-4_Phase_IV_Missing_Consent_Buccal_Cell_Script.docx	No	No	Printable Only
Form and Instruction	2	Reminder Call Script for North Carolina Buccal Cell Respondents	Attachment 09-3_Phase_IV_Remind_Call_NC_Buccal_Cell_Script.docx	No	No	Printable Only
Form and Instruction	4	Damaged or Missing Buccal Cell Sample Call Script	Attachment 09-5_Phase_IV_Missing_Damaged_Buccal_Cell_Sample_Script.docx	No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

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: 100	Number of Respondents for Small Entity: 100

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-50	150
Annual IC Time Burden (Hours)	8	-5	13
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 09-1_Phase_IV_Initial_Script_Consent_Buccal_Cell	Attachment 09-1_Phase_IV_Initial_Script_Consent_Buccal_Cell.docx	02/06/2013

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