2 Unknown Informant Letter

OMB# 0925-0491

Expiration Date XX/XXXX

DATE

INFORMANT

ADDRESS

ADDRESS

Dear INFORMANT:

We would like to express our sincerest sympathies for your loss. We are writing on behalf of the National Heart, Lung and Blood Institute’s Jackson Heart Study to ask for your help. The Jackson Heart Study was designed to measure the rates of heart disease in the Hinds, Rankin and Madison counties. Your name is listed as an informant on the death certificate of PARTICIPANT who passed away on DATE and was a participant in the Jackson Heart Study. We would like to explain more about the project and ask a few medical questions about the decedent but have been unable to find your telephone number. Please help us in carrying on (Name?)’s Legacy of Health for African Americans by providing us with the following valuable information for the Jackson Heart Study.

Could you take a few minutes to fill out and return the enclosed form to us? The information needed will be used for statistical purposes only and will remain strictly confidential. It will contribute to our efforts of understanding heart disease and to prevent its occurrence in the future. Your assistance in our research is entirely voluntary.

If you have any questions or would like to give us this information over the telephone, please call (601)979-8767. Thank you for your cooperation in this study.

Sincerely,

Herman A. Taylor Jr., MD, MPH

Professor

Director and Principal Investigator, Jackson Heart Study

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My area code and telephone number is ______ - ______ - ____________.

The best time to reach me is ___________________________.

An alternate number is ________ - ________ - _____________.

The best time to reach me is _____________________________.

OR

________I do not have a telephone number or do not want you to contact me, but I agree to be interviewed in person and will call your staff to set up an interview.

OR

_______Please do not contact me.

Version:2/23/2006