Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 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⚠️ Notice: This information collection may be referencing outdated material.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 3 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS Form and Instruction
3 BEEA Home Visit CAPI, Blood, & Urine x 1 Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	BEEA Home Visit CAPI, Blood, & Urine x 1	Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc		Yes	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: 160	Number of Respondents for Small Entity: 160

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	160	-150	310
Annual IC Time Burden (Hours)	80	-23	103
Annual IC Cost Burden (Dollars)	0	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.