The Framingham Study (NHLBI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form A6b Informant Contact Form	Form and Instruction	Modified	Available
Form A2b Home Visit form-Original	Form and Instruction	Modified	Available
Form A6a Records Request Form	Form and Instruction	Modified	Available
Form A2a Clinical Exam Form -Original	Form and Instruction	Modified	Available
Form A7b Exam Scheduling Form	Form and Instruction	Modified	Available
Form A4 Medical Status Update Form	Form and Instruction	Modified	Available
Form A7a Telephone Call to Set up Meeting	Form and Instruction	Modified	Available
Form 6b Informant Contact Form	Form and Instruction	New	Available
Form 6a Records Request Form	Form and Instruction	New	Available
Form A4 Health Status Update Form	Form and Instruction	New	Available
Form A4 Health Status Update Form	Form and Instruction	Modified	Available
Form A14 Consent Forms	Form and Instruction	Modified	Available
Form 1b Home Visit/Nursing Home Visit Form	Form and Instruction	Modified	Available
Form 1a Clinical Exam Form	Form and Instruction	Modified	Available
Form A3 Food Frequency Form	Form and Instruction	Modified	Available
Form 7a Initial Telephone Contact Form	Form and Instruction	Modified	Available
Form 6b Informant Contact Form	Form and Instruction	Modified	Available
Form 6a Records Request Form	Form and Instruction	Modified	Available
0925-0216 SSB FINAL 09 16 13.doc	Supporting Statement B	Uploaded 2013-09-17	Available
Attachment 13 - Consent Forms, Offspring & Omni Grp 1.pdf	Supplementary Document	Uploaded 2013-09-25	Available
Attachment 8- OSMB Minutes.pdf	Supplementary Document	Uploaded 2013-09-25	Available
Attachment 15- Description of Tables A.12-1.1-A.12-1.3.doc	Supplementary Document	Uploaded 2013-09-25	Available
Attachment 5- Publications 2011-2012.pdf	Supplementary Document	Uploaded 2013-09-17	Available
Attachment 14- Annual Newsletter.pdf	Supplementary Document	Uploaded 2013-09-17	Available
Attachment 11- IRB Approval Omni Grp 2.pdf	Supplementary Document	Uploaded 2013-09-17	Available
Attachment 10- IRB Approval Omni Grp 1.pdf	Supplementary Document	Uploaded 2013-09-17	Available
Attachment 9- FHS IRB Approval.pdf	Supplementary Document	Uploaded 2013-09-17	Available
Attachment 12- Privacy Act Memo.pdf	Supplementary Document	Uploaded 2013-09-17	Available
0925-0216 SSA FINAL 09 16 13.doc	Supporting Statement A	Uploaded 2013-09-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7259	Original Cohort Forms	Form and Instruction	Modified	Informant Contact Form
7259	Original Cohort Forms	Form and Instruction	Modified	Home Visit form-Original
7259	Original Cohort Forms	Form and Instruction	Modified	Records Request Form
7259	Original Cohort Forms	Form and Instruction	Modified	Clinical Exam Form -Original
7259	Original Cohort Forms	Form and Instruction	Modified	Exam Scheduling Form
7259	Original Cohort Forms	Form and Instruction	Modified	Medical Status Update Form
7259	Original Cohort Forms	Form and Instruction	Modified	Telephone Call to Set up Meeting
208860	Generation 3 and Omni Group 2 Cohorts	Form and Instruction	New	Informant Contact Form
208860	Generation 3 and Omni Group 2 Cohorts	Form and Instruction	New	Records Request Form
208860	Generation 3 and Omni Group 2 Cohorts	Form and Instruction	New	Health Status Update Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Health Status Update Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Consent Forms
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Home Visit/Nursing Home Visit Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Clinical Exam Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Food Frequency Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Initial Telephone Contact Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Informant Contact Form
183649	Offspring and Omni Group 1 Cohorts	Form and Instruction	Modified	Records Request Form

ICR Details

OMB Control No: 0925-0216	ICR Reference No: 201309-0925-008
Status: Historical Active	Previous ICR Reference No: 201011-0925-006
Agency/Subagency: HHS/NIH	Agency Tracking No: 20523
Title: The Framingham Study (NHLBI)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/31/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2016	36 Months From Approved	11/30/2013
Responses	9,380	0	6,921
Time Burden (Hours)	4,264	0	6,091
Cost Burden (Dollars)	0	0	0

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Abstract: The Framingham Study will continue to conduct examinations and morbidity and mortality follow-up in original, offspring and third generation participants to study the determinants of cardiovascular disease.

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Authorizing Statute(s): US Code: 42 USC 285b-3 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 26639	05/07/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 58318	09/23/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Generation 3 and Omni Group 2 Cohorts	A4, 6a, 6b	Health Status Update Form ,   Records Request Form ,   Informant Contact Form
Offspring and Omni Group 1 Cohorts	6a, 6b, 7a, A3, 1a, 1b, A14, A4	Records Request Form ,   Informant Contact Form ,   Initial Telephone Contact Form ,   Food Frequency Form ,   Clinical Exam Form ,   Home Visit/Nursing Home Visit Form ,   Consent Forms ,   Health Status Update Form
Original Cohort Forms	A7a, A4, A7b, A2a, A6a, A2b, A6b	Telephone Call to Set up Meeting ,   Medical Status Update Form ,   Exam Scheduling Form ,   Clinical Exam Form -Original ,   Records Request Form ,   Home Visit form-Original ,   Informant Contact Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,380	6,921	0	2,459	0	0
Annual Time Burden (Hours)	4,264	6,091	0	-1,827	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: A revision to the previous OMB submission is requested because the numbers of Offspring and Omni Group 1 participants to be examined for the 2014-2016 time period are much smaller than those during the last OMB approval period. This is because a great majority of these two cohorts will have completed their examinations by the end of the 2013. The small number of participants remaining to be examined is reflected in the decrease in the estimated annualized burden hours for these two cohorts as well as for the entire study, compared to the last OMB approval period.

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Annual Cost to Federal Government: $8,306,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/30/2013

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