BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture

Documents and Forms

Document Name Document Type
Form 8 BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit Form and Instruction
7 Attachment 18-1 and 18-2 BEEA IA/NC Informed Consent Ran Attachment 18-1 and 18-2_BEEA_IA_NC_Informed Consent_Random Select Group.pdf Form and Instruction
8 Attachment 18-3 and 18-4 BEEA IA/NC Informed Consent Rec Attachment 18-3 and 18-4_BEEA_IA_NC_Informed Consent_Recent Exposure Group.pdf Form and Instruction
9 Attachment 18-5 and 18-6 BEEA IA/NC Informed Consent Air Attachment 18-5 and 18-6_BEEA_IA_NC_Informed Consent_Air Monitoring Home Visit.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	8	Attachment 18-3 and 18-4 BEEA IA/NC Informed Consent Recent Exposure Group	Attachment 18-3 and 18-4_BEEA_IA_NC_Informed Consent_Recent Exposure Group.pdf	No	Paper Only
Form and Instruction	9	Attachment 18-5 and 18-6 BEEA IA/NC Informed Consent Air Monitoring Home Visit	Attachment 18-5 and 18-6_BEEA_IA_NC_Informed Consent_Air Monitoring Home Visit.pdf	No	Paper Only
Form and Instruction	7	Attachment 18-1 and 18-2 BEEA IA/NC Informed Consent Random Select Group	Attachment 18-1 and 18-2_BEEA_IA_NC_Informed Consent_Random Select Group.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200 Clinical, Basic and Population-based Research Studies	FR Citation: 67 FR 60776

Number of Respondents: 196	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	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.