NCI Patient Education Publications Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NCI Patient Education Publications Survey Form and Instruction
1 NCI Patient Education Publications Survey AttachB Survey Screenshots 8-20-13_REV.pdf Form and Instruction
Fast Track Request Patient_Ed_Pubs 8-19-13.doc Fast Track Request Patient_Ed_Pubs 8-19-13 IC Document
AttachA_EmailInvite 8-8-13.doc AttachA_EmailInvite 8-8-13 IC Document

Information Collection (IC) Details

IC Title:	NCI Patient Education Publications Survey	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 and Instruction	1	NCI Patient Education Publications Survey	AttachB Survey Screenshots 8-20-13_REV.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	200	0	0	0	0	0
Annual IC Time Burden (Hours)	33	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Request Patient_Ed_Pubs 8-19-13	Fast Track Request Patient_Ed_Pubs 8-19-13.doc	08/20/2013
AttachA_EmailInvite 8-8-13	AttachA_EmailInvite 8-8-13.doc	08/20/2013

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