Information Collection

NCI Cancer Information Service on Demographic and Smoking/Tobacco Use

IC 43626 under ICR 200706-0925-002 · OMB 0925-0208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0208 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NCI Cancer Information Service on Demographic and Smoking/Tobacco Use	Form and Instruction
1 Survey OMB Appendix 2 ECRF data collection instrument.doc	Form and Instruction
JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06.doc JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06	IC Document

IC Title:

NCI Cancer Information Service on Demographic and Smoking/Tobacco Use

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey	OMB Appendix 2 ECRF data collection instrument.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 49,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 4 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	49,400	0	49,400
Annual IC Time Burden (Hours)	1,976	153	1,823
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06	JUSTIFICATION FOR REQUESTED CHANGES TO OMB 0925 revised 11-9-06.doc	11/17/2006

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