Information Collection

Bundled Sub-studies #14, #15, #16 (#14 WYNTK, #15 Accrual CT, #16 CIRB Pilot)

IC 197863 under ICR 201008-0925-004 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 14 Bundled Sub-studies #14, #15, #16 (#14 WYNTK, #15 Accrual CT, #16 CIRB Pilot)	Form and Instruction
14 Attach 14A and 14B (Interview Guide and Screener) #14_Attach 14A & 14B Interview Guide & Screener _WYNTK.docx	Form and Instruction
15 Attach 15A and 15B Oncology Survey & Staff Survey #15_Attach A B_Oncologist Staff Survey_Accrual CT.docx	Form and Instruction
16 #16_Attach 16B 16C 16D 16E 16F Survey and Forms #16_Attach 16B 16C 16D 16E 16F.docx	Form and Instruction
Memo to OMB_Key To Bundle #14 15 16.docx Memo to OMB_Key To Bundle #14 15 16	IC Document
Bundle Gen IC Form_14-15-16-WYNTK_Accrual_CIRB Pilot.docx Bundle Gen IC Form_14-15-16-WYNTK_Accrual_CIRB Pilot	IC Document
#14_Justif Memo & Attach 14C 14D_WYNTK.doc #14_Justif Memo & Attach 14C 14D_WYNTK	IC Document
#15_Justif Memo_Accrual CT_CTEP.docx #15_Justif Memo_Accrual CT_CTEP	IC Document
#16_Justif Memo Attach 16A Consent_CIRB.docx #16_Justif Memo Attach 16A Consent_CIRB	IC Document
NCI Response for 0925-0046.docx NCI response to questions	IC Document

Information Collection (IC) Details

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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 %

table that charts list of burden
	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

table that charts IC Documents
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.