Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen

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 23 Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
23 Attachment 25-1 AHS Phase IV Health Follow-up CAWI Parti Attachment 25-1. AHS Phase IV Health Follow-Up CAWI Participant Survey.pdf Form and Instruction
24 Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy Attachment 25-2. AHS Phase IV Health Follow-Up CATI Participant Survey Script.pdf Form and Instruction
25 Attachment 25-3 AHS Phase IV Health Follow-up Paper & Pe Attachment 25-3 AHS Phase IV Health Follow-Up Paper & Pen Participant Survey.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen	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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	23	Attachment 25-1 AHS Phase IV Health Follow-up CAWI Participant Survey	Attachment 25-1. AHS Phase IV Health Follow-Up CAWI Participant Survey.pdf	Yes	No	Fillable Fileable
Form and Instruction	24	Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy Survey Script	Attachment 25-2. AHS Phase IV Health Follow-Up CATI Participant Survey Script.pdf	Yes	No	Fillable Fileable
Form and Instruction	25	Attachment 25-3 AHS Phase IV Health Follow-up Paper & Pen Participant Survey	Attachment 25-3 AHS Phase IV Health Follow-Up Paper & Pen Participant Survey.pdf	Yes	No	Fillable Fileable

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: 10,201	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,201	10,201
Annual IC Time Burden (Hours)	4,250	4,250
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.