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

Latest forms, documents, and information collections
DocumentType
Form 8 CAWI-CATIForm and Instruction
Form 6 Paper/pen, CAWI or CATIForm and Instruction
Form 9 Paper and PencilForm and Instruction
Form 7 CATIForm and Instruction
Form 12 Attachment 10-1 BEEA Previsit Reminder Call ScriptForm and Instruction
Form 28 Attachment 26-3 AHS Phase IV Health Follow-up Paper & Pen Proxy SurveyForm and Instruction
Form 27 Attachment 26-2 AHS Phase IV Health Follow-up CATI Proxy Survey ScriptForm and Instruction
Form 26 Attachment 26-1 AHS Phase IV Health Follow-up CAWI Proxy SurveyForm and Instruction
Form 25 Attachment 25-3 AHS Phase IV Health Follow-up Paper & Pen Participant SurveyForm and Instruction
Form 24 Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy Survey ScriptForm and Instruction
Form 23 Attachment 25-1 AHS Phase IV Health Follow-up CAWI Participant SurveyForm and Instruction
Form 25 Attachment 25-3 AHS Phase IV Health Follow-up Paper & Pen Participant SurveyForm and Instruction
Form 24 Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy Survey ScriptForm and Instruction
Form 23 Attachment 25-1 AHS Phase IV Health Follow-up CAWI Participant SurveyForm and Instruction
Form 22 Attachment 22-2 BEEA Smartphone App Screenshots and User WorkflowForm and Instruction
Form 21 Attachment 22-3 and 22-4 BEEA IA NC Smartphone App ConsentForm and Instruction
Form 20 Attachment 19-2 BEEA CAPI Questionnaire ControlsForm and Instruction
Form 12 Attachment 10-1 BEEA Previsit Reminder Call ScriptForm and Instruction
Form 11 Attachment 21 Dust QuestionnaireForm and Instruction
Form 19 Attachment 17-16 and 17-17 BEEA IA NC Pre-Visit Prep Showcards ControlsForm and Instruction
Form 18 Attachment 18-9 thru 18-11 BEEA IA NC Informed Consent Control Group RSG and REGForm and Instruction
Form 17 Attachment 20-4 BEEA CATI Script Control GroupForm and Instruction
Form 16 Attachment 10-4 BEEA Pre-Visit Reminder Call Script Air MonitoringForm and Instruction
Form 15 Attachment 18-7 and 18-8 BEEA IA/NC Informed Consent Air Monitoring Farm VisitForm and Instruction
Form 13 Attachment 19-1 BEEA CAPI QuestionnaireForm and Instruction
Form 12 Attachment 10-1 BEEA Previsit Reminder Call ScriptForm and Instruction
Form 11 Attachment 21 Dust QuestionnaireForm and Instruction
Form 10 Attachment 17-7 and 17-8 BEEA IA/NC Pre-Visit Prep ShowcardsForm and Instruction
Form 14 Attachment 10-2 and 10-3 IA-NC BEEA REG Post Exposure Scheduling ScriptForm and Instruction
Form 13 Attachment 19-1 BEEA CAPI QuestionnaireForm and Instruction
Form 11 Attachment 21 Dust QuestionnaireForm and Instruction
Form 10 Attachment 17-7 and 17-8 BEEA IA/NC Pre-Visit Prep ShowcardsForm and Instruction
Form 13 Attachment 19-1 BEEA CAPI QuestionnaireForm and Instruction
Form 12 Attachment 10-1 BEEA Previsit Reminder Call ScriptForm and Instruction
Form 11 Attachment 21 Dust QuestionnaireForm and Instruction
Form 10 Attachment 17-7 and 17-8 BEEA IA/NC Pre-Visit Prep ShowcardsForm and Instruction
Form 9 Attachment 18-5 and 18-6 BEEA IA/NC Informed Consent Air Monitoring Home VisitForm and Instruction
Form 8 Attachment 18-3 and 18-4 BEEA IA/NC Informed Consent Recent Exposure GroupForm and Instruction
Form 7 Attachment 18-1 and 18-2 BEEA IA/NC Informed Consent Random Select GroupForm and Instruction
Form 6 Attachment 20-3 BEEA CATI Script Recently Exposed +Air Monitoring GroupForm and Instruction
Form 5 Attachment 20-2 BEEA CATI Script Recent Exposed GroupForm and Instruction
Form 4 Attachment 20-1 BEEA CATI Script Random Select GroupForm and Instruction
Form 3 Attachment 9.2 thru 9.5 Phase IV Buccal kit Follow up ScriptsForm and Instruction
Form 2 Attachment 15.1 and 15.2 Phase IV Buccal IA_NC Consent FormForm and Instruction
Form 1 Attachment 9.1 Phase IV Buccal IA_NC Verbal Consent ScriptForm and Instruction
Form 3 BEEA Dust Specimen QuestionnaireForm and Instruction
Form 2 BEEA Consent Form - DustForm and Instruction
Form 1 BEEA Show CardsForm and Instruction
Form 16 CAWI-CATI ProxyForm and Instruction
Form 14 CAWI ProxyForm and Instruction
Form 17 Paper-Pen ProxyForm and Instruction
Form 15 CATI ProxyForm and Instruction
Form 5 BEEA Home Visit CAPI, Blood, & Urine x 3Form and Instruction
Form 3 BEEA North Carolina Schedule PostApp Visit ScriptForm and Instruction
Form 2 BEEA Iowa Schedule PostApp Visit ScriptForm and Instruction
Form 1 BEEA Previsit Reminder ScriptForm and Instruction
Form 3 BEEA Home Visit CAPI, Blood, & Urine x 1Form and Instruction
Form 1 Attachment 20: BEEA CATI ScriptForm and Instruction
Form 3 CATI Eligibility Script_Recently Exposed RespondentsForm and Instruction
Form 4 Damaged or Missing Buccal Cell Sample Call ScriptForm and Instruction
Form 2 Reminder Call Script for North Carolina Buccal Cell RespondentsForm and Instruction
Form 3 Missing Buccal Cell Consent Forms Call ScriptForm and Instruction
Form 1 Reminder Call Script for Iowa Buccal Cell RespondentsForm and Instruction
Form 13 Paper/PenForm and Instruction
Form 11 CATIForm and Instruction
Form 10 CAWIForm and Instruction
Form 12 CAWI-CATIForm 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.docSupporting 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.docSupporting Statement B
Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
Attachment 25: Paper/pen, CAWI or CATI Instruments for Private Applicators for AHS Form and Instruction
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
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
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 IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit 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
BEEA CATI Screening Script for RSG Eligibility, REG Eligibility or AMG Eligibility 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
Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire 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 26: Paper/pen, CAWI, and CATI for Proxy for AHS Form and Instruction
Attachment 26: Paper/pen, CAWI, and CATI for Proxy for AHS 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 10: BEEA Schedule Home Visit Scripts for AHS 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 20 or 21: BEEA CATI Screener for AHS Form and Instruction
Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction
Attachment 9: Reminder, Missing or Damaged Scripts for AHS Form and Instruction
Attachment 9: Reminder, Missing or Damaged Scripts 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
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS Form and Instruction

All Historical Document Collections

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