View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Market Research to Inform Next Generation Physician's Data Query (PDQ) (NCI)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Patient Screener (screenshot) Attachment 1 - FINAL Patient Screener (Screenshots) (7).docx Yes Yes Fillable Fileable
Form and Instruction 2 Caregiver Screener (screenshot) Attachment 2 - FINAL Caregiver Screener (Screenshots) (3).docx Yes Yes Fillable Fileable
Form and Instruction 3 Medical Oncologist Screener (screenshot) Attachment 3 - FINAL Medical Oncologist Screener (Screenshots) (2).docx Yes Yes Fillable Fileable
Form and Instruction 4 PCP Screener (screenshot) Attachment 4 - FINAL PCP Screener (Screenshots) (2).docx Yes Yes Fillable Fileable
Form and Instruction 5 Oncology Nurse Screener (screenshot) Attachment 5 - FINAL Oncology Nurse Screener (Screenshots) (2).docx Yes Yes Fillable Fileable
Form and Instruction 6 Non-Oncologist Clinician Screener (screenshot) Attachment 6 - FINAL Non-Oncologist Clinician (Screenshots) (2).docx Yes Yes Fillable Fileable
Form and Instruction 7 Radiation Oncologist Screener (screenshot) Attachment 7 - FINAL Radiation Oncologist Screener (Screenshots) (6).docx Yes Yes Fillable Fileable
Form and Instruction 8 Medical Director Screener (screenshot) Attachment 8 - FINAL Medical Director Screener (Screenshots) (3).docx Yes Yes Fillable Fileable
Form and Instruction 9 Navigator Screener (screenshot) Attachment 9 - FINAL Navigator Screener (Screenshots) (5).docx Yes Yes Fillable Fileable
Form and Instruction 10 Patient Interview Attachment 15 ___ FINAL Patient Discussion Guide.docx No   Paper Only
Form and Instruction 11 Caregiver Interview Attachment 16 ___ FINAL Caregiver Discussion Guide (1).docx No   Paper Only
Form and Instruction 12 Oncologist Interview Attachment 17 ___ FINAL Oncologist Discussion Guide.docx No   Paper Only
Form and Instruction 13 PCP Interview Attachment 18 ___ FINAL PCP Discussion Guide.docx No   Paper Only
Form and Instruction 14 Oncology Nurse Interview Attachment 19 ___ FINAL Oncology Nurse Discussion Guide (1).docx No   Paper Only
Form and Instruction 15 Non-Oncologist Clinician Interview Attachment 20 ___ FINAL Non-Oncologist Clinician Discussion Guide.docx No   Fillable Fileable
Form and Instruction 16 Radiation Oncologist Interview Attachment 21 ___ FINAL Radiation Oncologist Discussion Guide (1).docx No   Paper Only
Form and Instruction 17 Medical Director Interview Attachment 22 ___ FINAL Medical Director Discussion Guide.docx (2).docx No   Paper Only
Form and Instruction 18 Navigator Interview Attachment 23 ___ FINAL Navigator Discussion Guide (1).docx No   Paper Only

Health Health Care Services

 

1,149 0
   
Individuals or Households
 
   50 %

  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 1,149 0 1,149 0 0 0
Annual IC Time Burden (Hours) 144 0 144 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Medical Directors Invitation Attachment 10 - Medical Directors Invitation.pdf 04/08/2019
Nurse and Non-Onc Clinical Invitation Attachment 11 - Nurse and Non-Onc Clinical Invitation.pdf 04/08/2019
patient and Caregiver Invitation Attachment 12 - Patient and Caregiver Invitation.pdf 04/08/2019
PCP, ONC, Rad Onc and Gastro Invitation Attachment 13 - PCP, Onc, Rad Onc and Gastro Invitation.pdf 04/08/2019
Email Reminder Template with website screenshot Attachment 14 - Email Reminder Template with Website Screenshot.pdf 04/08/2019
Mini SSA PDQ Mini SSA PDQ 4.8.19 FINAL.docx 04/08/2019
Mini SSB PDQ Mini SSB PDQ 4.3.19 FINAL (002).docx 04/08/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.