Information Collection

Application for Inclusion in NCI Cancer Genetics Services Directory (PDQ)(R)

IC 198117 under ICR 201106-0925-003 · OMB 0925-0639.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0639 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Application for Inclusion in NCI Cancer Genetics Services Directory (PDQ)(R) Form
1 Application for Inclusion in NCI Cancer Genetics Service Attach 1_Application_CGDirectory.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Inclusion in NCI Cancer Genetics Services Directory (PDQ)(R)	Agency IC Tracking Number:

Is this a Common Form? No		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	Application for Inclusion in NCI Cancer Genetics Services Directory (PDQ?)	Attach 1_Application_CGDirectory.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: SORN 09-25-0156 "Records of Participants in Programs and Respondents in Survey Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIHOD"	FR Citation: 67 FR 60743

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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