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Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS
Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture
OMB: 0925-0406
IC ID: 185933
OMB.report
HHS/NIH
OMB 0925-0406
ICR 201604-0925-001
IC 185933
( )
Documents and Forms
Document Name
Document Type
Form 12
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS
Form and Instruction
12 CAWI-CATI
Attachment 25-3_CAWI_CATI_Ppt_Survey_Placeholder.docx
Form and Instruction
10 CAWI
Attachment 25-1_CAWI_Ppt_Intro.docx
Form and Instruction
11 CATI
Attachment 25-2_CATI_Ppt_Intro.doc
Form and Instruction
13 Paper/Pen
Attachment 25-4_Ppt_PaperPenSurvey.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attachment 25: Paper/pen, CAWI or CATI for Spouses for AHS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
12
CAWI-CATI
Attachment 25-3_CAWI_CATI_Ppt_Survey_Placeholder.docx
Yes
Yes
Fillable Fileable
Form and Instruction
10
CAWI
Attachment 25-1_CAWI_Ppt_Intro.docx
Yes
Yes
Fillable Fileable
Form and Instruction
11
CATI
Attachment 25-2_CATI_Ppt_Intro.doc
No
No
Printable Only
Form and Instruction
13
Paper/Pen
Attachment 25-4_Ppt_PaperPenSurvey.docx
No
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
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:
10,201
Number of Respondents for Small Entity:
10,201
Affected Public:
Private Sector
Private Sector:
Farms
Percentage of Respondents Reporting Electronically:
33 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
-10,201
0
0
10,201
Annual IC Time Burden (Hours)
0
0
-4,250
0
0
4,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.