View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Partnerships to Advance Cancer Health Equity (PACHE) Program Meeting – Participant Feedback (NCI)	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	1	PACHE 2021 feedback screenshots	PACHE 2021 Feedback Survey Screenshots_v2 (1).docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	300	0	300	0	0	0
Annual IC Time Burden (Hours)	50	0	50	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
email invite	2021 PACHE Evaluation Email.docx	09/22/2021
fast track survey for PACHE feedback	Customer Feedback Submission - PACHE 2021 Meetings.docx	09/22/2021

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