OMB
.report
Search
CIS LiveHelp Questionnaire (Appendix 1B)
Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients (NCI)
OMB: 0925-0208
IC ID: 189803
OMB.report
HHS/NIH
OMB 0925-0208
ICR 201208-0925-003
IC 189803
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0208 can be found here:
2022-01-11 - Revision of a currently approved collection
2018-08-14 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 3
CIS LiveHelp Questionnaire (Appendix 1B)
Form and Instruction
3 CIS LiveHelp Form
Appendix 1B LiveHelp Questions.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CIS LiveHelp Questionnaire (Appendix 1B)
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
3
CIS LiveHelp Form
Appendix 1B LiveHelp Questions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
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:
7,800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
7,800
0
0
786
0
7,014
Annual IC Time Burden (Hours)
260
0
0
26
0
234
Annual IC Cost Burden (Dollars)
0
0
0
0
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.