Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS

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

⚠️ Notice: This information collection may be referencing outdated material.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 7 Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
7 CATI Attachment 25-2_CATI_Ppt_Intro.doc Form and Instruction
9 Paper and Pencil Attachment 25-4_Ppt_PaperPenSurvey.docx Form and Instruction
6 Paper/pen, CAWI or CATI Attachment 25-1_CAWI_Ppt_Intro.docx Form and Instruction
8 CAWI-CATI Attachment 25-3_CAWI_CATI_Ppt_Survey_Partial.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators 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	7	CATI	Attachment 25-2_CATI_Ppt_Intro.doc	No	No	Printable Only
Form and Instruction	9	Paper and Pencil	Attachment 25-4_Ppt_PaperPenSurvey.docx	No	No	Printable Only
Form and Instruction	6	Paper/pen, CAWI or CATI	Attachment 25-1_CAWI_Ppt_Intro.docx	Yes	Yes	Fillable Printable
Form and Instruction	8	CAWI-CATI	Attachment 25-3_CAWI_CATI_Ppt_Survey_Partial.pdf	Yes	No	Fillable Fileable

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: 13,855	Number of Respondents for Small Entity: 13,855

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Previously Approved
Annual Number of Responses for this IC	13,855	13,855
Annual IC Time Burden (Hours)	5,773	5,773
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.