OMB control number

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

OMB 0925-0406 · HHS/NIH.

OMB 0925-0406

Latest Forms, Documents, and Supporting Material

Document Name
Form 7 Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
Form 12 BEEA Pre-Home Visit Script Form and Instruction
Form 26 Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
Form 23 Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
Form 23 Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
Form 22 BEEA 'Life in a Day" Smartphone Application Form and Instruction
Form 21 BEEA "Life in a Day" Smartphone App Consent and Setup Form and Instruction
Form 20 Control Home Visit CAPI, Blood,Buccal cell, Urine & Dust Form and Instruction
Form 12 BEEA Pre-Home Visit Script Form and Instruction
Form 11 BEEA Paper/Pen Duct Questionnaire Form and Instruction
Form 19 IA/NC Pre-Visit Show Card Form and Instruction
Form 18 IA/NC Control Home Visit Consent Form and Instruction
Form 17 Control CATI Eligibility Script Form and Instruction
Form 16 Pre-Farm Visit Script Form and Instruction
Form 15 IA/NC Consent for AMG Farm Visit Form and Instruction
Form 13 BEEA AMG Home Visit CAPI, Blood, Urine, Buccal cell & Dust Form and Instruction
Form 12 BEEA Pre-Home Visit Script Form and Instruction
Form 11 BEEA Paper/Pen Duct Questionnaire Form and Instruction
Form 10 BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
Form 14 BEEA REG IA/NC Post-Exposure Scheduling Script Form and Instruction
Form 13 BEEA REG Home Visit CAPI, Blood, Buccal cell, Urine & Dust Form and Instruction
Form 11 BEEA Paper/Pen Duct Questionnaire Form and Instruction
Form 10 BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
Form 13 BEEA RSG Home Visit CAPI, Blood, Buccal cell, Urine & Dust Form and Instruction
Form 12 BEEA Pre-Homme Visit Script Form and Instruction
Form 11 BEEA Paper/Pen Duct Questionnaire Form and Instruction
Form 10 BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
Form 8 BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit Form and Instruction
Form 4 BEEA CATI Screening Script for RSG Eligibility, REG Eligibility or AMG Eligibility Form and Instruction
Form 3 Phase IV Buccal Kit Follow up Scripts Form and Instruction
Form 2 Phase IV Buccal IA/NC Written Consent for Buccal Kit Form and Instruction
Form 1 Phase IV Buccal IA/NC Scripts for Verbal Consent for Buccal Kit Form and Instruction
Form 1 Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire Form and Instruction
Form 15 Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction
Form 5 Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 3 Form and Instruction
Form 2 Attachment 10: BEEA Schedule Home Visit Scripts for AHS Form and Instruction
Form 3 Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 1 for AHS Form and Instruction
Form 3 Attachment 20 or 21: BEEA CATI Screener for AHS Form and Instruction
Form 1 Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction
Form 12 Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction
30 day NIEHS AHS2016-09296.pdf Supplementary Document
0925–0406 30-Day Notice PUblished.pdf Supplementary Document
AHS OMB Supporting Statement_A_04-2016.doc Supporting Statement A
Attachment 28_AHS_PrivacyImpactAssessments.pdf Supplementary Document
Attachment 27_PhaseIV_HFUP_FAQs_CAWI_CATI.pdf Supplementary Document
Attachment 24_Phase_IV_HFUP_Letters.pdf Supplementary Document
Attachment 23 Phase IV_HFUP_IRB Appr Signature Pages.pdf Supplementary Document
Attachment 22-1_BEEA_Objectives and Revisions.pdf Supplementary Document
Attachment 17-1 thru 17-19_BEEA_Supplementary_Letters_Directions_Results.pdf Supplementary Document
Attachment 16_Phase_IV_Buccal_Cell_Collection_Information.pdf Supplementary Document
Attachment 14_Phase_IV_Buccal_Cell_Pre-Contact_Letters.pdf Supplementary Document
Attachment 13_BEEA IRB Approvals.pdf Supplementary Document
Attachment 12_AHS Phase IV IRB.pdf Supplementary Document
Attachment 11_BEEA Brochures.pdf Supplementary Document
Attachment 08_STARS_AHS_Confidentiality_Agreement.pdf Supplementary Document
Attachment 07_Contractor_Confidentialiy_Agreement.pdf Supplementary Document
Attachment 06_ NIH_Privacy_Act_SORN_Memo.pdf Supplementary Document
Attachment 05_Certificate_Of_Confidentiality_NCI-02-028A.pdf Supplementary Document
Attachment 04_NAP Members2015.pdf Supplementary Document
Attachment 03_AGRICOH_Steering_Committee_Mbr_2011.pdf Supplementary Document
Attachment 02_Bibliography.pdf Supplementary Document
Attachment 01_List Of Attachments_2016.pdf Supplementary Document
AHS OMB Supporting Statement_B_03-2016.doc Supporting Statement B
Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
BEEA Pre-Home Visit Script Form and Instruction
Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen Form and Instruction
BEEA 'Life in a Day" Smartphone Application Form and Instruction
BEEA "Life in a Day" Smartphone App Consent and Setup Form and Instruction
Control Home Visit CAPI, Blood,Buccal cell, Urine & Dust Form and Instruction
BEEA Pre-Home Visit Script Form and Instruction
BEEA Paper/Pen Duct Questionnaire Form and Instruction
IA/NC Pre-Visit Show Card Form and Instruction
IA/NC Control Home Visit Consent Form and Instruction
Control CATI Eligibility Script Form and Instruction
Pre-Farm Visit Script Form and Instruction
IA/NC Consent for AMG Farm Visit Form and Instruction
BEEA AMG Home Visit CAPI, Blood, Urine, Buccal cell & Dust Form and Instruction
BEEA Pre-Home Visit Script Form and Instruction
BEEA Paper/Pen Duct Questionnaire Form and Instruction
BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
BEEA REG IA/NC Post-Exposure Scheduling Script Form and Instruction
BEEA REG Home Visit CAPI, Blood, Buccal cell, Urine & Dust Form and Instruction
BEEA Paper/Pen Duct Questionnaire Form and Instruction
BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
BEEA RSG Home Visit CAPI, Blood, Buccal cell, Urine & Dust Form and Instruction
BEEA Pre-Homme Visit Script Form and Instruction
BEEA Paper/Pen Duct Questionnaire Form and Instruction
BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card Form and Instruction
BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit Form and Instruction
BEEA CATI Screening Script for RSG Eligibility, REG Eligibility or AMG Eligibility Form and Instruction
Phase IV Buccal Kit Follow up Scripts Form and Instruction
Phase IV Buccal IA/NC Written Consent for Buccal Kit Form and Instruction
Phase IV Buccal IA/NC Scripts for Verbal Consent for Buccal Kit Form and Instruction
Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire Form and Instruction
Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction
Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 3 Form and Instruction
Attachment 10: BEEA Schedule Home Visit Scripts for AHS Form and Instruction
Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 1 for AHS Form and Instruction
Attachment 20 or 21: BEEA CATI Screener for AHS Form and Instruction
Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction

All Historical Document Collections

201604-0925-001 Approved without change	Revision of a currently approved collection	2016-04-26
201308-0925-001 Approved without change	Revision of a currently approved collection	2013-08-15
201302-0925-004 Approved without change	Revision of a currently approved collection	2013-02-15
201005-0925-004 Approved with change	Revision of a currently approved collection	2010-05-12
201002-0925-001 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2010-02-03
200807-0925-003 Approved without change	Extension without change of a currently approved collection	2008-07-30
200506-0925-001 Approved with change	Revision of a currently approved collection	2005-06-06
200309-0925-001 Approved without change	Revision of a currently approved collection	2003-09-26
200203-0925-002 Approved with change	Revision of a currently approved collection	2002-03-14
200109-0925-001 Approved without change	Revision of a currently approved collection	2001-09-17
199808-0925-001 Approved without change	Reinstatement with change of a previously approved collection	1998-08-28
199610-0925-002 Approved without change	Revision of a currently approved collection	1996-10-07
199306-0925-001 Approved without change	New collection (Request for a new OMB Control Number)	1993-06-01