The Multi-Ethnic Study of Atherosclerosis (MESA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0493 can be found here:

Documents and Forms

Document Name Document Type
Form 1 The Multi-Ethnic Study of Atherosclerosis (MESA) Form and Instruction
1 Informant Informant Interview (English 11-09-2004).pdf Form and Instruction
2 Cardiac Cardiac-PVD Death Physician Questionnaire (English 11-09-2004).pdf Form and Instruction
3 Cardiac Cardiac-PVD Physician Questionnaire (English 11-09-2004).pdf Form and Instruction
4 Stroke Stroke-TIA Physician Questionnaire (English 11-09-2004).pdf Form and Instruction
Sample letters for MESA events.doc Sample letters for MESA events IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Multi-Ethnic Study of Atherosclerosis (MESA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Informant	Informant Interview (English 11-09-2004).pdf	Yes	Yes	Paper Only
Form and Instruction	2	Cardiac	Cardiac-PVD Death Physician Questionnaire (English 11-09-2004).pdf	Yes	Yes	Paper Only
Form and Instruction	3	Cardiac	Cardiac-PVD Physician Questionnaire (English 11-09-2004).pdf	Yes	Yes	Paper Only
Form and Instruction	4	Stroke	Stroke-TIA Physician Questionnaire (English 11-09-2004).pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 183	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	Previously Approved
Annual Number of Responses for this IC	183	-372	555
Annual IC Time Burden (Hours)	37	-5	42
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Sample letters for MESA events	Sample letters for MESA events.doc	10/12/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.