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 26 Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
26 Attachment 26-1 AHS Phase IV Health Follow-up CAWI Proxy Attachment 26-1. AHS Phase IV Health Follow-Up CAWI Proxy Survey.pdf Form and Instruction
27 Attachment 26-2 AHS Phase IV Health Follow-up CATI Proxy 26-2. AHS Phase IV Health Follow-Up CATI Proxy Survey Script.pdf Form and Instruction
28 Attachment 26-3 AHS Phase IV Health Follow-up Paper & Pe Attachment 26-3 AHS Phase IV Health Follow-Up Paper & Pen Proxy 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	26	Attachment 26-1 AHS Phase IV Health Follow-up CAWI Proxy Survey	Attachment 26-1. AHS Phase IV Health Follow-Up CAWI Proxy Survey.pdf	Yes	No	Fillable Fileable
Form and Instruction	27	Attachment 26-2 AHS Phase IV Health Follow-up CATI Proxy Survey Script	26-2. AHS Phase IV Health Follow-Up CATI Proxy Survey Script.pdf	Yes	No	Fillable Fileable
Form and Instruction	28	Attachment 26-3 AHS Phase IV Health Follow-up Paper & Pen Proxy Survey	Attachment 26-3 AHS Phase IV Health Follow-Up Paper & Pen Proxy 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: 635	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	635	635
Annual IC Time Burden (Hours)	159	159
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.