Information Collection

Offspring and Omni Group 1 Cohorts

IC 183649 under ICR 201309-0925-008 · OMB 0925-0216.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0216 can be found here:

Documents and Forms

Document Name Document Type
Form 6a Offspring and Omni Group 1 Cohorts Form and Instruction
6a Records Request Form Attachment 6a- Records Request.pdf Form and Instruction
6b Informant Contact Form Attachment 6b- Informant Contact.pdf Form and Instruction
7a Initial Telephone Contact Form Attachment 7a- Telephone Contact.pdf Form and Instruction
A3 Food Frequency Form Attachment 3- FFQ, Offspring and Omni Grp 1.pdf Form and Instruction
1a Clinical Exam Form Attachment 1a - Clinic Exam, Offspring & Omni Grp 1.pdf Form and Instruction
1b Home Visit/Nursing Home Visit Form Attachment 1b- Home Visit, Offspring & Omni Grp 1.pdf Form and Instruction
A14 Consent Forms Attachment 14- Annual Newsletter.pdf Form and Instruction
A4 Health Status Update Form Attachment 4 - Medical Hx Update Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Offspring and Omni Group 1 Cohorts	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	6a	Records Request Form	Attachment 6a- Records Request.pdf	Yes	Yes	Paper Only
Form and Instruction	6b	Informant Contact Form	Attachment 6b- Informant Contact.pdf	Yes	Yes	Paper Only
Form and Instruction	7a	Initial Telephone Contact Form	Attachment 7a- Telephone Contact.pdf	Yes	Yes	Paper Only
Form and Instruction	A3	Food Frequency Form	Attachment 3- FFQ, Offspring and Omni Grp 1.pdf	Yes	Yes	Paper Only
Form and Instruction	1a	Clinical Exam Form	Attachment 1a - Clinic Exam, Offspring & Omni Grp 1.pdf	No	No	Paper Only
Form and Instruction	1b	Home Visit/Nursing Home Visit Form	Attachment 1b- Home Visit, Offspring & Omni Grp 1.pdf	No	No	Paper Only
Form and Instruction	A14	Consent Forms	Attachment 14- Annual Newsletter.pdf	Yes	Yes	Paper Only
Form and Instruction	A4	Health Status Update Form	Attachment 4 - Medical Hx Update Form.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,813	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,813	2,353	2,460
Annual IC Time Burden (Hours)	2,235	586	1,649
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.