BEEA REG Home Visit CAPI, Blood, Buccal cell, Urine & Dust

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 13 BEEA REG Home Visit CAPI, Blood, Buccal cell, Urine & Dust Form and Instruction
13 Attachment 19-1 BEEA CAPI Questionnaire Attachment 19-1_BEEA CAPI Questionnaire_v2.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	BEEA REG Home Visit CAPI, Blood, Buccal cell, Urine & Dust	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13	Attachment 19-1 BEEA CAPI Questionnaire	Attachment 19-1_BEEA CAPI Questionnaire_v2.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: 20	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	60	60
Annual IC Time Burden (Hours)	90	90
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.