Form 1 Submission Form

OMB #: 0925-XXXX

Expiry Date: XX/XX/20XX

Attachment 3: Submission Application

Using Public Data for Cancer Prevention and Control:

From Innovation to Impact (NCI)

Contestant’s Contact Information:

First Name:

Last Name:

Email:

Telephone Number:

Mailing Address:

Title of Application:

Description of the Application:

Link to the Application:

List of data sources and/or datasets used:

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address