Form 6 Email Intake
Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients
Appendix 2 Email Intake Form
CIS Email Intake Form (Appendix 2_REV)
OMB: 0925-0208
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0925-0208 can be found here:
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APPENDIX 2
DATA COLLECTION INSTRUMENTS
Email Intake Form
(customer service and demographics questions)
Email Intake Form- (upper half of page) http://www.cancer.gov/global/contact/email-us
Email Intake Form- (lower half of page)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | ilene Holly Burstyn |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |
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