Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
IIE-Informant Interview Deaths - Eng New 154 77 0 Form and Instruction 1 IIE Informant Interview Deaths
PQE Hospitalization records/physician interview New 1591 796 0 Form and Instruction 1 PQE-Physician Interview
Anthropometry New 13878 1619 0 Form and Instruction 1 ANT-Anthropometry
Determination of fasting & blood draw New 13878 2544 0 Form and Instruction 1 BIO-Biospecimen Collection
Determination of blood glucose, OGTT New 13878 1388 0 Form and Instruction 1 BIO-Biospecimen Collection
Seated BP New 13878 2082 0 Form and Instruction 1 SBP-Sitting Blood Pressure
Echocardiography New 8000 4000 0 Form and Instruction 1 Echocardiography Manual
Health Care Access and Utilization New 13878 3470 0 Form and Instruction 1 HCE-HealthCare-Eng
Chronic Stress New 13878 925 0 Form and Instruction 1 STE-Chronic Stress-Eng
Social Support New 13878 694 0 Form and Instruction 1 Social Support
Acculturation New 13878 694 0 Form and Instruction 1 Acculturation Questionnaire
AFU Year 3 New 3146 787 0 Form and Instruction 1 AFU Year 3
AFU Year 4 New 9033 2258 0 Form and Instruction 1 AFU Year 4 English
AFU Year 10 New 16222 4056 0 Form and Instruction 1 AFU-Years 7-11 Annual Followup English
Reception, informed consent, medical releases New 13878 4626 0 Form and Instruction 1 SOL IC English
Participants Follow-up Year 2 Removed 0 0 0 Form and Instruction 2 Interview
Form 1 Food Propensity
Non Participant Components Removed 0 0 0 Form and Instruction 1 Questionaire
Form and Instruction 2 Informant Interview
Participants Follow-up Year 3 to 6 Removed 0 0 0 Form and Instruction 3 Interview
Form and Instruction 4 Interview
Form and Instruction 5 Interview
Form and Instruction 6 Interview
Pre-visit scheduling and safety screening Modified 13878 463 0 Form and Instruction 1 ELE-Participant eligibility - billingual
Tobacco Use New 13878 925 0 Form and Instruction 1 Tobacco
Personal Medical History New 13878 2313 0 Form and Instruction 1 MHE-Personal Medical History-Eng
Well Being New 13878 925 0 Form and Instruction 1 Well Being
Abbreviated Medication Use New 13878 925 0 Form and Instruction 1 MSE-Medication Use Survey -Eng
Alcohol Use New 13878 694 0 Form and Instruction 1 Alcohol Use
Participant Feedback New 13878 2776 0 Form and Instruction 1 Participant Feedback
AFU Year 5 New 14259 3565 0 Form and Instruction 1 AFU-Year 5 Annual Followup English
AFU Year 6 New 16222 4056 0 Form and Instruction 1 AFU year 6 Annual followup English
AFU Year 7 New 16222 4056 0 Form and Instruction 1 AFU-Years7-11 Annual Followup English
AFU Year 8 New 16222 4056 0 Form and Instruction 1 AFU-Years 7-11 Annual followup English
AFU Year 9 New 16222 4056 0 Form and Instruction 1 AFU- Years 7-11 Annual Followup English
AFU Year 11 New 16222 4056 0 Form and Instruction 1 AFU-Years7-11 Annual Followup English
Change clothes, urine specimen New 13878 2313 0 Form and Instruction 1 BIO-Biospecimen Collection
Updated personal information New 13878 1157 0 Form and Instruction 1 IDE-Personal Identifiers-Eng
2-hour blood draw, snack New 13878 2776 0 Form and Instruction 1 BIO-Biospecimen Collection
Participant disability screening New 13878 694 0 Form and Instruction 1 PDE-Participant Disability Screen Eng
Participant safety screeing update and routing New 13878 463 0 Form and Instruction 1 PSE-Participant Safety Screen
Reproductive Medical History New 9000 1350 0 Form and Instruction 1 RME-Repro and Medical History-Eng
Pregnancy Complications History New 9000 900 0 Form and Instruction 1 PCE-Pregnancy Complications Hx - Eng
Socio-economic Status - Occupation New 13878 694 0 Form and Instruction 1 SEE-Socio Econonic Status-Occup-Eng
Family Cohesion New 13878 1157 0 Form and Instruction 1 FCE-Family Cohesion-Eng
Total burden requested under this ICR: 470709 74386 0  
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