Phase III Telephone Interview and Buccal Cell Scripts for Agricultural Health Study

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Phase III Telephone Interview and Buccal Cell Scripts for Agricultural Health Study Form and Instruction
2 Phase III Interview Script and Consent Attach 3_Phase III Interview Script and Verbal Consent .pdf Form and Instruction
3 Phase III Buccal Script and Consent Attach 4_Phase III Buccal Script and Verbal Consent .pdf Form and Instruction
Attach 15_Phase III buccal kit cover letters and instructions.pdf Attach 15A-15G Phase III Buccal Kit Letters, FAQs, etc. IC Document
Attach 13_Phase III buccal contact scripts and letters.pdf Attach 13A-13D Phase III Buccal Pre-Contact Letters IC Document

Information Collection (IC) Details

IC Title:	Phase III Telephone Interview and Buccal Cell Scripts for Agricultural Health Study	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Phase III Interview Script and Consent	Attach 3_Phase III Interview Script and Verbal Consent .pdf		Yes	Yes	Fillable Printable
Form and Instruction	3	Phase III Buccal Script and Consent	Attach 4_Phase III Buccal Script and Verbal Consent .pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD	FR Citation: 67 FR 60776

Number of Respondents: 150	Number of Respondents for Small Entity: 150

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	-181	331
Annual IC Time Burden (Hours)	13	-318	331
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 15A-15G Phase III Buccal Kit Letters, FAQs, etc.	Attach 15_Phase III buccal kit cover letters and instructions.pdf	04/29/2010
Attach 13A-13D Phase III Buccal Pre-Contact Letters	Attach 13_Phase III buccal contact scripts and letters.pdf	04/29/2010

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