Attachment 1 List of Attachments

List of Attachments – 2016
* Indicates a form/instrument/script. Yellow indicates a change. NEW indicates an added attachment.
1: List of attachments
2: Bibliography
3: Members of the International Agriculture Consortium (AGRICOH)
4: Members of the Agricultural Health National Advisory Panel (NAP)
5: Certificate of Confidentiality
6: Memo from NIH Privacy Act Officer
7: Contractor Staff Confidentiality Agreement
8: Collaborators Confidentiality Agreement
*9: Phase IV Buccal Cell Interview Scripts
9.1). Script and Consent for Iowa and North Carolina Respondents Following Mailing of Buccal Cell
Letter
9.2). Reminder Call Script for Iowa Buccal Cell Respondents
9.3). Reminder Call Script for North Carolina Buccal Cell Respondents
9.4). Missing Buccal Cell Consent Forms Call Script for Both Sites
9.5). Damaged or Missing Buccal Cell Sample Call Script for Both Sites
*10: BEEA Pre-Visit Scripts
10.1). BEEA Pre-Visit Confirmation Call Script for Both Sites
10.2). BEEA Script for Scheduling First Post-Exposure Application Visit for Iowa (Recent Exposure
Group)
10.3). BEEA Script for Scheduling First Post-Exposure Application for North Carolina (Recent Exposure
Group)
NEW - 10.4). BEEA Script for Pre-Visit Confirmation Call Script for Both Sites - Air Monitoring Visit
11: BEEA Brochures
11.1). BEEA Brochure Content for the Randomly Selected and Recently Exposed Groups
11.2). BEEA Brochure Content for the Recently Exposed Group Air Monitoring Visit
NEW - 11.3). BEEA Brochure Content the Control Group
12: Phase IV Buccal Cell IRB Approval Signature Pages
12.1). Phase IV IRB NCI
12.2). Phase IV IRB Westat
12.3). Phase IV IRB University of Iowa
1

13: BEEA IRB Approval Signature Pages
13.1). BEEA IRB NCI
13.2). BEEA IRB Westat
13.3). BEEA IRB University of Iowa
14: Phase IV Buccal Cell Pre-Contact Letters
14.1). Phase IV Buccal Cell Pre-Contact Letter for Iowa
14.2). Phase IV Buccal Cell Pre-Contact Letter for North Carolina
*15: Phase IV Buccal Cell Consent Forms
15.1). Phase IV Iowa Buccal Cell Consent Form
15.2). Phase IV North Carolina Buccal Cell Consent Form
16: Phase IV Buccal Cell Collection Information (kit letter, collection directions/instructions, FAQs, etc.)
16.1). Phase IV Iowa Buccal Cell Kit Cover Letter
16.2). Phase IV Iowa Buccal Cell Directions
16.3). Phase IV Iowa Buccal Cell Kit Re-mail Cover Letter
16.4). Phase IV North Carolina Buccal Cell Kit Cover Letter
16.5). Phase IV North Carolina Buccal Cell Directions
16.6). Phase IV North Carolina Buccal Cell Kit Re-mail Cover Letter
16.7). Phase IV Buccal Cell FAQs for Both Sites
17: BEEA Letters (Intro, Cover, Reminder, Results, Show Cards)
17.1). BEEA Introductory Letter for Iowa Respondents (Randomly Selected, Recently Exposed, and Air
Monitoring Groups)
17.2). BEEA Introductory Letter for North Carolina Respondents (Randomly Selected Recently Exposed,
and Air Monitoring Groups)
17.3). BEEA Consent Mailing Cover Letter for Iowa Respondents (Randomly Selected, Recently Exposed,
and Control Groups)
17.4). BEEA Consent Mailing Cover Letter for North Carolina Respondents (Randomly Selected,
Recently Exposed, and Control Groups)
17.5). BEEA Consent Mailing Cover Letter for Iowa Air Monitoring Visit Respondents
17.6). BEEA Consent Mailing Cover Letter for North Carolina Air Monitoring Visit Respondents
*17.7). BEEA Pre-Visit Preparation Show Card for Iowa Respondents (Randomly Selected, Recently
Exposed and Air Monitoring Groups)
*17.8). BEEA Pre-Visit Preparation Show Card for North Carolina Respondents (Randomly Selected,
Recently Exposed and Air Monitoring Groups)
17.9). BEEA Directions for Urine Specimen Collection for Iowa Respondents (All Groups)
17.10). BEEA Directions for Urine Specimen Collection for North Carolina Respondents (All Groups)
17.11). BEEA Letters for CBC Lymphocyte Assay Results (Recently Exposed and Control Groups)
17.12). BEEA “Contact Us” Letter for Iowa Respondents (Randomly Selected, Recently Exposed, and Air
Monitoring Groups)
2

17.13). BEEA “Contact Us” Letter for North Carolina Respondents (Randomly Selected, Recently
Exposed, and Air Monitoring Groups)
NEW - 17.14). BEEA Introductory Letter for Iowa Respondents (Control Group)
NEW - 17.15). BEEA Introductory Letter for North Carolina Respondents (Control Group)
*NEW - 17.16). BEEA Pre-Visit Preparation Show Card for Iowa Respondents (Control Group)
*NEW - 17.17). BEEA Pre-Visit Preparation Show Card for North Carolina Respondents (Control Group)
NEW - 17.18). BEEA “Contact Us” Letter for Iowa Respondents (Control Group)
NEW - 17.19). BEEA “Contact Us” Letter for North Carolina Respondents (Control Group)
*18: BEEA Consent Forms
18.1). BEEA Consent form for Iowa Randomly Selected Respondents
18.2). BEEA Consent form for North Carolina Randomly Selected Respondents
18.3). BEEA Consent form for Iowa Recently Exposed Respondents
18.4). BEEA Consent form for North Carolina Recently Exposed Respondents
18.5). BEEA Consent form for Iowa Recently Exposed Respondent Air Monitoring Home Visit
18.6). BEEA Consent form for North Carolina Recently Exposed Respondent Air Monitoring Home Visit
NEW - 18.7). BEEA Consent form for Iowa Recently Exposed Respondent Air Monitoring Farm Visit
NEW - 18.8). BEEA Consent form for North Carolina Recently Exposed Respondent Air Monitoring Farm
Visit
NEW - 18.9). BEEA Consent form for Iowa Control Group Respondents (RSG Blood Protocol)
NEW - 18.10). BEEA Consent form for Iowa Control Group Respondents (REG Blood Protocol)
NEW - 18.11). BEEA Consent form for North Carolina Control Group Respondents
*19: BEEA Computer Assisted In-Person Interview (CAPI)
19.1). BEEA CAPI for Randomly Selected, Recently Exposed, and Air Monitoring Group Respondents
NEW - 19.2). BEEA CAPI for Control Group Respondents
*20: BEEA Computer Assisted Telephone Interview (CATI)
20.1). BEEA CATI for Randomly Selected Group Respondents
20.2). BEEA CATI for Recently Exposed Groups Respondents
20.3). BEEA CATI for Recently Exposed Groups Respondents – Air Monitoring Visit
NEW - 20.4). BEEA CATI for Control Group Respondents
*21: BEEA Dust Specimen Questionnaire
22: BEEA Objectives Including New Control Group and Smartphone App Components
22.1). BEEA Objectives and Background, including the Control and Smartphone App Components
*NEW - 22.2). BEEA Smartphone Application Screenshots and User Workflows
*NEW - 22.3). BEEA Smartphone Application Consent Form for Iowa Respondents
*NEW - 22.4). BEEA Smartphone Application Consent Form for North Carolina Respondents
NEW - 22.5). BEEA Smartphone Application Quick Guide
23: Phase IV Health Follow-Up IRB Approval Signature Pages
23.1). AHS Health Follow-Up Office of Protocol Services Continuing Review Approval
23.2). AHS Health Follow-Up Copernicus Group IRB Closure Report
3

24: Phase IV Health Follow-Up Letters
24.1). AHS Phase IV Health Follow-Up Participant Invitation Letter
24.2). AHS Phase IV Health Follow-Up Next of Kin Invitation Letter
24.3). AHS Phase IV Health Follow-Up Website Letter
*25: Phase IV Health Follow-Up Participant Interview Scripts
25.1). AHS Phase IV Health Follow-Up CAWI Participant Survey
25.2). AHS Phase IV Health Follow-Up CATI Participant Script
25.3). AHS Phase IV Health Follow-Up Paper & Pen Participant Survey
*26: Phase IV Health Follow-Up Proxy Interview Scripts
26.1). AHS Phase IV Health Follow-Up CAWI Proxy Survey
26.2). AHS Phase IV Health Follow-Up CATI Proxy Script
26.3). AHS Phase IV Health Follow-Up Paper & Pen Proxy Survey
27: Phase IV Health Follow-Up FAQs for CAWI/CATI
28: Agricultural Health Study Privacy Impact Assessments Summary and Approvals

4