Information Collection

Offspring and Omni Group 1 Cohorts

IC 183649 under ICR 201604-0925-002 · OMB 0925-0216.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A4 Offspring and Omni Group 1 Cohorts	Form and Instruction
6a Records Request Form Attachment 6a- Records Request.pdf	Form and Instruction
6b Informant Contact Form Attachment 6b- Informant Contact.pdf	Form and Instruction
7a Initial Telephone Contact Form Attachment 7a- Telephone Contact.pdf	Form and Instruction
A3 Food Frequency Form Attachment 3- FFQ, Offspring and Omni Grp 1.pdf	Form and Instruction
1a Clinical Exam Form Attachment 1a - Clinic Exam, Offspring & Omni Grp 1.pdf	Form and Instruction
1b Home Visit/Nursing Home Visit Form Attachment 1b- Home Visit, Offspring & Omni Grp 1.pdf	Form and Instruction
A14 Consent Forms Attachment 14- Annual Newsletter.pdf	Form and Instruction
A4 Health Status Update Form Attachment 4 - Medical Hx Update Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	A4	Health Status Update Form	Attachment 4 - Medical Hx Update Form.pdf	Yes	Yes	Paper Only
Form and Instruction	6a	Records Request Form	Attachment 6a- Records Request.pdf	Yes	Yes	Paper Only
Form and Instruction	6b	Informant Contact Form	Attachment 6b- Informant Contact.pdf	Yes	Yes	Paper Only
Form and Instruction	7a	Initial Telephone Contact Form	Attachment 7a- Telephone Contact.pdf	Yes	Yes	Paper Only
Form and Instruction	A3	Food Frequency Form	Attachment 3- FFQ, Offspring and Omni Grp 1.pdf	Yes	Yes	Paper Only
Form and Instruction	1a	Clinical Exam Form	Attachment 1a - Clinic Exam, Offspring & Omni Grp 1.pdf	No	No	Paper Only
Form and Instruction	1b	Home Visit/Nursing Home Visit Form	Attachment 1b- Home Visit, Offspring & Omni Grp 1.pdf	No	No	Paper Only
Form and Instruction	A14	Consent Forms	Attachment 14- Annual Newsletter.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,813

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4,813	4,813
Annual IC Time Burden (Hours)	-2,235	2,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.