View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Bundled Sub-studies #14, #15, #16 (#14 WYNTK, #15 Accrual CT, #16 CIRB Pilot)	Agency IC Tracking Number:

IC Status: New

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	14	Attach 14A and 14B (Interview Guide and Screener)	#14_Attach 14A & 14B Interview Guide & Screener _WYNTK.docx		Yes	No	Paper Only
Form and Instruction	15	Attach 15A and 15B Oncology Survey & Staff Survey	#15_Attach A B_Oncologist Staff Survey_Accrual CT.docx		Yes	Yes	Fillable Fileable
Form and Instruction	16	#16_Attach 16B 16C 16D 16E 16F Survey and Forms	#16_Attach 16B 16C 16D 16E 16F.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0156 "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD."	FR Citation: 67 FR 60743

Number of Respondents: 3,322	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

	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	3,322	0	0	0	0	0
Annual IC Time Burden (Hours)	644	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo to OMB_Key To Bundle #14 15 16	Memo to OMB_Key To Bundle #14 15 16.docx	05/12/2011
Bundle Gen IC Form_14-15-16-WYNTK_Accrual_CIRB Pilot	Bundle Gen IC Form_14-15-16-WYNTK_Accrual_CIRB Pilot.docx	05/12/2011
#14_Justif Memo & Attach 14C 14D_WYNTK	#14_Justif Memo & Attach 14C 14D_WYNTK.doc	05/12/2011
#15_Justif Memo_Accrual CT_CTEP	#15_Justif Memo_Accrual CT_CTEP.docx	05/12/2011
#16_Justif Memo Attach 16A Consent_CIRB	#16_Justif Memo Attach 16A Consent_CIRB.docx	05/12/2011
NCI response to questions	NCI Response for 0925-0046.docx	06/15/2011

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