Attachment 26: Paper/pen, CAWI, and CATI for Proxy 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⚠️ Notice: This information collection may be referencing outdated material.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 14 Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction
15 CATI Proxy Attachment 26-2_Proxy_CATI_Intro.doc Form and Instruction
16 CAWI-CATI Proxy Attachment 26-3_CAWI_Proxy_Survey.docx Form and Instruction
17 Paper-Pen Proxy Attachment 26-4_Proxy_PaperPenSurvey.docx Form and Instruction
14 CAWI Proxy Attachment 26-1_Proxy_CAWI_Intro_Interview_Script.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	14	CAWI Proxy	Attachment 26-1_Proxy_CAWI_Intro_Interview_Script.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	15	CATI Proxy	Attachment 26-2_Proxy_CATI_Intro.doc	No	No	Printable Only
Form and Instruction	16	CAWI-CATI Proxy	Attachment 26-3_CAWI_Proxy_Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	17	Paper-Pen Proxy	Attachment 26-4_Proxy_PaperPenSurvey.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: 635	Number of Respondents for Small Entity: 635

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	635	635
Annual IC Time Burden (Hours)	159	159
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.