Form 2 NCI CareerTrac Data Collection Form

FIC CareerTrac

NCI CareerTrac Data Collection Form

Trainees

OMB: 0925-0568

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0925-0568 can be found here:

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CareerTrac Data Collection Form

US Dept of Health and Human Services / National Cancer Institute / National Institutes of Health

Hello!

The National Institutes of Health (NIH) is delighted to introduce you to CareerTrac, an information system developed to document and improve long term training program outcomes. CareerTrac collects, tracks, and reports information about NIH-supported trainees, such as trainee name, contact information, biographical information, training information, and subsequent career information. The system also supports tracking of trainees' accomplishments, such as fellowships, awards, employment, education, product or policy development, publications, funding received, presentations at conferences, and students mentored.

NIH uses this information to evaluate the long-term outcomes of training program investments and make recommendations for improvement. The information may be aggregated and disclosed with science officers, evaluators and administrators at NIH, and with other organizations such as DHHS, Congress and other organizations interested in NIH training investments and outcomes. Your training grant Principal Investigator (PI) and their administrator(s) also have access to this information; they are responsible for entering the data.

Collection of this information is authorized under 42 U.S.C. 241. The primary use of this information is to identify candidates for clinical and research fellow, clinical elective, and other training positions as well as to maintain a permanent record of those individuals who have received research training at the National Institutes of Health. NIH will take every reasonable precaution to protect your information. CareerTrac is securely hosted behind the NIH firewall; we maintain appropriate physical, electronic and procedural safeguards to ensure the security, integrity and privacy of your personal information.

As a trainee, providing information to CareerTrac is voluntary. NIH requires PIs to track trainees and provide trainee data for 10 years after a trainees’ appointment to a training grant. If you choose not to participate, your PI is still expected to enter information on your training experience and outcomes. If you have questions or concerns, please feel free to contact your PI directly or the CareerTrac Administrators [email protected].

Thank you,

The CareerTrac Development Team

Respondent Burden Statement

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, 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 0925-0568

Do not return the completed form to this address.

This questionnaire includes the following sections:

Trainee Personal Information (“Personal Info Page”)…………………………………………...……………....

This section contains questions regarding your personal information, including name, email address, and gender.

Current Address (“Contact Info Page”)………………………………………………………..…………………….….

This section contains questions regarding the best way to contact you.

Biographical Information (“Pre-Training Info Page”)………………………………………..…………….……...

This section contains questions regarding your professional and educational history before your NCI funding / training

In-Training Education & Mentor (“In-Training Experience Page”)…………………………………………..

This section contains questions regarding your NCI-funded training experience. It also contains questions regarding the degree or certificate earned through your NCI-funded training, the start and end date of your funding period, and mentor data etc…

Accomplishments (“Accomplishments Page”)………………………………………….…………………..………..

This section contains questions regarding your personal achievements that can be attributed to your NCI-funded training.

Trainee Personal Information (Personal Info Page)

1. First Name (required; please click on text field to enter data):

2. Middle Name:

3. Last Name (required):

4. Suffix (i.e. Jr., Sr., I.,):

5. Primary e-mail address (required):

6. Secondary e-mail address:

7. Gender (required; click on the “SELECT ONE” to display DROP DOWN list):

8. Country of Origin (required):

9. U.S. Citizens or U.S. Residents only (required for U.S. Citizens and Permanent Residents; please select ethnicity status; definitions provided below):

Hispanic or Latino Not Hispanic or Latino Choose not to specify

Ethnicity Definitions as defined by the Office of Management and Budget (OMB)

Hispanic or Latino	A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term "Spanish origin" can also be used in addition to "Hispanic or Latino."
Not Hispanic or Latino	All other ethnicities
Choose not to specify	Not specified

10. U.S. Citizens or U.S. Residents only (required for U.S. Citizens and Permanent Residents; please select all that apply; definitions provided below):

American Indian or Alaskan

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

Choose not to specify

m. NIH Field of Training (choose ONE from the list below; NOTE: sections broken into clinical and non-clinical):

Predominantly Clinical Research Training (can include any degree)

n. Scientific Field method of training (required: select up to six technical fields):

o. Advanced in-country mentor research support (indicate if you received funds for re-entry when you returned to home country): YES NO

p. Please indicate if your training contributed to support any of the following:

To enable NCI to coordinate with other international activities, it is important to know if trainee's AIDS work contributed to any of these programs:

N/A (Not Applicable) CIPRA (Comprehensive International Programs for Research on AIDS)

CDC - PEPFAR CPOL (Community Popular Opinion Leaders)

GPA Research HPTN (HIV Prevention Trials Network) HVTN (HIV Vaccine Trials Network)

q. Associated Research or Training Sponsor (list the sponsor of any research funding other than NCI under which you conducted research.

OMB NO.: 0925-0568

Expires 9/30/2012

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Trainee personal information
Author	cordtsab
File Modified	0000-00-00
File Created	2021-01-30

American Indian or Alaskan	A person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliations or community attachment
Asian	A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. (NOTE: Individuals from the Philippine Islands have been recorded as Pacific Islanders in previous data collection strategies).
Black or African American	A person having origins in any of the black racial groups of Africa. Terms such as "Haitian"; or "Negro"; can be used in addition to "Black or African American";
Native Hawaiian or Pacific Isl.	A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
White	A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Choose not to specify	Not specified

Degree or Nature of Training (required)	Country of the institution that granted the degree	Institution that granted the degree (NO acronyms)	Year the degree(s) was awarded (YYYY):
Bachelor’s
Master’s
Other non-degree training (>=3 months)
Postdoctoral position (>= 3 months)
Professional Doctorate (i.e. MD, JD)
Research Doctorate (i.e. PhD)
Short Term Training (<3 months)

Training status when research was conducted:
Article Title (required):
Journal name (required):
Volume and pages:
Journal publication date (MM/YYYY):
First author (required):
Last author (enter the name of article’s last author in Last name, first name format):
Other authors (enter the name of article’s other authors (separated by a semi-colon) in Last name; first name format):
PMID number
PMCID number
Has this article been Peer Reviewed?	YES NO	YES NO	YES NO	YES NO
Training Status when Research Conducted:	Pre-training In-training Post-training	Pre-training In-training Post-training	Pre-training In-training Post-training	Pre-training In-training Post-training
Journal Readership/ distribution:	Local International	Local International	Local International	Local International
Research country (country(ies) in which research described in the article took place):
Is research reported in this publication supported by a Fogarty Training grant? (required):	YES NO	YES NO	YES NO	YES NO
Please indicate whether Fogarty support is acknowledged in the article (required):	YES NO	YES NO	YES NO	YES NO