Form 16 Attachment 10-4 BEEA Pre-Visit Reminder Call Script Air

Attachment 10.4: BEEA PRE-VISIT REMINDER CALL SCRIPT
(RECENT EXPOSURE GROUP AIR MONITORING VISIT)
OMB NO.: 0925-0406
EXPIRATION DATE: 09/30/2016
Collection of this information is authorized by The Public Health Service Act (42 USC 285l). 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 contacted to complete this health follow-up survey because, as a member of the Agricultural Health
Study, your continued involvement can help us learn more about how agricultural and environmental factors may affect the health of farmers
and their families.
Public reporting burden for this telephone contact is estimated to average two minutes per response, including the time for reviewing
instructions, and answering questions. 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 (0925-0406). Do not return the completed form to this address.

Hello, Mr. ______________, my name is ____________. I will be coming to your home to
shadow you as you do your normal farming activities, and to collect dust samples on the farm
as a part of the Study of Biomarkers of Exposures and Effects in Agriculture.
I just wanted to remind you that the visit is scheduled for (tomorrow/DATE) at (TIME) (AM).
I also wanted to remind you that my colleague is scheduled to visit you on DATE at TIME. She
will be conducting an interview with you and collect your blood, saliva, urine and household
dust samples.
IF FIRST/OFF-SEASON VISIT:
Have you had a chance to review the consent form for the farm visit? Do you have any
questions at this time? We will review these materials during the visit (tomorrow).
Did you receive the other materials about the home visit, and have a chance to review them?
You should have received a urine collection kit and instructions. Do you have any questions at
this time? Please be sure to collect this sample on the morning of your home visit and store it
in your refrigerator until my colleague comes to pick it up. In addition, did you have a chance
to review the dust collection questionnaire form? Do you have any questions? My colleague
will collect the form at the visit when she collects the household dust from your vacuum.
For the home visit, there will need to be a quiet area with a table such as a kitchen or dining
room, in which to complete the interview and sample collections. Do you have space that can
be used for these activities?
Do you have any questions or concerns at this time?

CONFIRM ADDRESS AND ASK FOR DIRECTIONS IF NECESSARY.