Form 1 IDEAL telephone screener Part 1

Attachment 5a— IDEAL Telephone Screening Interview Part 1
When the responsibility for administrating the IDEAL telephone screening interview transitioned from
Westat to the NIA, the protocol was also changed. Instead of administering the IDEAL screening
interview in one contact, as Westat did, the NIA conducts the screening interview in two parts, using the
same recruitment and screening instruments administered to all potential BLSA participants. Part 1 is
administered by a BLSA recruiter when a potential IDEAL participant calls in; this contact takes up to 10
minutes and preliminarily establishes the caller’s potential eligibility. Anyone not excluded from
eligibility at this initial contact is called back by a BLSA nurse practitioner to complete Part 2 of the
screening interview. Part 2 revisits the eligibility questions from Part 1, and asks additional questions
pertaining to eligibility. This contact likewise takes up to 10 minutes.
Together, the IDEAL Screening Interview instruments administered by the NIA cover the same questions
previously administered using the Westat instrument with the exception of several new questions.
The following questions from the NIA Screening Interview Part 1 are new:
10. Do you experience Peripheral Neuropathy or nerve damage in your hands and feet?
15. Do you have any type of birth defect, genetic or inherited?
16. Do you have peptic ulcer disease?

IDEAL – Telephone Screening Interview Part 1

OMB No.: 0925-0631
Expiration Date: xx/xx/20xx
Collection of this information is authorized by Public Law 93-296. Rights of study participants are protected by The Privacy Act of
1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to
participate will not affect your benefits in any way. The information collected in this study will be kept private to the extent provided
by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all study
participants and reported as summaries. You are being interviewed by telephone to complete this instrument so that we can
determine your eligibility for IDEAL.
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0631). Do not return the completed form to this
address.