Attach 1AA - CTSU Patient Enrollment Transmittal Form

Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0624 can be found here:

Documents and Forms

Document Name Document Type
Form 27 Attach 1AA - CTSU Patient Enrollment Transmittal Form Form and Instruction
27 Attach 1AA - CTSU Patient Enrollment Transmittal Form attach_1aa_ptenef.zip Form and Instruction

Information Collection (IC) Details

IC Title:	Attach 1AA - CTSU Patient Enrollment Transmittal Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	27	Attach 1AA - CTSU Patient Enrollment Transmittal Form	attach_1aa_ptenef.zip		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD	FR Citation: 67 FR 60776

Number of Respondents: 600	Number of Respondents for Small Entity: 180

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,200	7,200
Annual IC Time Burden (Hours)	1,200	1,200
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.