View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	NCI Community Engagement Initiative	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	Interview Guide	Interview Topic Guide.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1	Intake Form	Community Engagement Intake Form.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: Records of Participants in Programs and Respondents in Surveys to Evaluate Programs of the Public Health Service	FR Citation: 67 FR 60742

Number of Respondents: 4,448	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	4,448	0	4,448	0	0	0
Annual IC Time Burden (Hours)	508	0	508	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Template	Fast Track Sub-Study - NCI Community Engagement Initiative FINAL.docx	06/23/2023
Privacy Act Memo	Privacy Act Memo - NCI Community Engagement Initiative 2023 signed.pdf	06/23/2023
PIA	NCI Community Engagement PIA.pdf	06/23/2023
Email Invitation	Email Invitation NCI Community Engagement.docx	06/23/2023

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