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Attachment 10: BEEA Schedule Home Visit Scripts 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: 192871
OMB.report
HHS/NIH
OMB 0925-0406
ICR 201604-0925-001
IC 192871
( )
Documents and Forms
Document Name
Document Type
Form 2
Attachment 10: BEEA Schedule Home Visit Scripts for AHS
Form and Instruction
1 BEEA Previsit Reminder Script
Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.docx
Form and Instruction
2 BEEA Iowa Schedule PostApp Visit Script
Attachment 10-2_BEEA_IO_Sched_PostApp_Visit_Script.docx
Form and Instruction
3 BEEA North Carolina Schedule PostApp Visit Script
Attachment 10-3_BEEA_NC_Sched_PostApp_Visit_Script.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attachment 10: BEEA Schedule Home Visit Scripts 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
2
BEEA Iowa Schedule PostApp Visit Script
Attachment 10-2_BEEA_IO_Sched_PostApp_Visit_Script.docx
No
No
Printable Only
Form and Instruction
3
BEEA North Carolina Schedule PostApp Visit Script
Attachment 10-3_BEEA_NC_Sched_PostApp_Visit_Script.docx
No
No
Printable Only
Form and Instruction
1
BEEA Previsit Reminder Script
Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.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:
20
Number of Respondents for Small Entity:
20
Affected Public:
Private Sector
Private Sector:
Farms
Percentage of Respondents Reporting Electronically:
0 %
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
-60
0
0
60
Annual IC Time Burden (Hours)
0
0
-5
0
0
5
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.