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

ICR 201211-0925-011

OMB: 0925-0624

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form
Modified
Form
Modified
Form
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supplementary Document
2012-11-27
Supplementary Document
2012-11-27
Justification for No Material/Nonsubstantive Change
2012-11-27
IC Document Collections
IC ID
Document
Title
Status
199005 Modified
195188 Modified
195187 Modified
195186 Modified
195185 Modified
195184 Modified
195183 Modified
195182 Modified
195181 Modified
195180 Modified
195179 Modified
195178 Modified
195177 Modified
195176 Modified
195175 Modified
195174 Modified
195173 Modified
195172 Modified
195171 Modified
195170 Modified
195169 Modified
195168 Modified
195167 Modified
195166 Modified
195165 Modified
195164 Modified
195163 Modified
195162 Modified
195161 Modified
195160 Modified
195159 Modified
195158 Modified
195157 Modified
195156 Modified
195155 Modified
195154 Modified
195153 Modified
ICR Details
0925-0624 201211-0925-011
Historical Active 201206-0925-002
HHS/NIH
Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/29/2012
Retrieve Notice of Action (NOA) 11/27/2012
  Inventory as of this Action Requested Previously Approved
12/31/2013 12/31/2013 12/31/2013
289,918 0 289,918
34,827 0 34,827
0 0 0

The CTSU collects standardized forms to support regulatory processing, patient enrollments, and data collection. In addition, the CTSU performs routine customer satisfaction surveys to assess help desk, web site, and patient enrollment services. The Supporting Statements A and B gives details on form and survey collection and processing.

US Code: 42 USC 413(285a-2) Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

No

37
IC Title Form No. Form Name
Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form 26 Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form
Attach 1AA - CTSU Patient Enrollment Transmittal Form 27 Attach 1AA - CTSU Patient Enrollment Transmittal Form
Attach 1BB - CTSU P2C Enrollment Transmittal Form 28 Attach 1BB - CTSU P2C Enrollment Transmittal Form
Attach 1CC - CTSU Transfer Form 29 Attach 1CC - CTSU Transfer Form
Attach 1DD - CTSU System Account Request Form 30 Attach 1DD - CTSU System Account Request Form
Attach 1EE - CTSU Request for Clinical Brochure 31 Attach 1EE - CTSU Request for Clinical Brochure
Attach 1FF - CTSU Supply Request Form 32 Attach 1FF - CTSU Supply Request Form
Attach 2 - CTSU Web Site Customer Satisfaction Survey 34 Attach 2 - CTSU Web Site Customer Satisfaction Survey
Attach 3 - CTSU Helpdesk Customer Satisfaction Survey 35 Attach 3 - CTSU Helpdesk Customer Satisfaction Survey
Attach 4 - CTSU OPEN Survey 36 Attach 4 - CTSU OPEN Survey
Attach 1GG - CTSU Generic Data Transmittal Form 33 Attach 1GG - CTSU Generic Data Transmittal Form
Attach 1B - CTSU IRB Certification Form 2 Attach 1B - CTSU IRB Certification Form v. 2_July 2011
Attach 1A - CTSU IRB/Regulatory Approval Transmittal Form 1 Attach 1A - CTSU IRB/Regulatory Approval Transmittal Form
Attach 1C- CTSU Acknowledgement Form 3 Attach 1C- CTSU Acknowledgement Form
Attach 1D - Optional Form 1 - Withdrawal from Protocol Participation Form 4 Attach 1D - Optional Form 1 - Withdrawal from Protocol Participation Form
Attach 1E - CTSU Roster Update Form 5 Attach 1E - CTSU Roster Update Form Version 2
Attach 1F - CTSU Radiation Therapy Facilities Inventory Form 6 Attach 1F - CTSU Radiation Therapy Facilities Inventory Form
Attach 1G - CTSU IBCSG Drug Accountability Form 7 Attach 1G - CTSU IBCSG Drug Accountability Form
Attach 1H - CTSU IBCSG Transfer of Investigational Agent Form 8 Attach 1H - CTSU IBCSG Transfer of Investigational Agent Form
Attach 1I - Site Initiated Data Update Form (generic) 9 Attach 1I - Site Initiated Data Update Form (generic)
Attach 1J - N0147 CTSU Data Transmittal Form 10 Attach 1J - N0147 CTSU Data Transmittal Form
Attach 1K - Site Initiated Data Update Form (DUF), Protocol: NCCTG N0147 11 Attach 1K - Site Initiated Data Update Form (DUF), Protocol: NCCTG N0147
Attach 1L - TAILORX/PACCT 1 CTSU Data Transmittal Form 12 Attach 1L - TAILORX/PACCT 1 CTSU Data Transmittal Form
Attach 1M - Data Clarification Form 13 Attach 1M - Data Clarification Form
Attach 1N - Unsolicited Data Modification Form (UDM), Protocol:TAILORx/PACCT1 14 Attach 1N - Unsolicited Data Modification Form (UDM), Protocol:TAILORx/PACCT1
Attach 1O - Z4032 CTSU Data Transmittal Form 15 Attach 1O - Z4032 CTSU Data Transmittal Form
Attach 1P - Z1031 CTSU Data Transmittal Form 16 Attach 1P - Z1031 CTSU Data Transmittal Form
Attach 1Q - Z1041 CTSU Data Transmittal Form 17 Attach 1Q - Z1041 CTSU Data Transmittal Form
Attach 1R - Z6051 CTSU Data Transmittal Form 18 Attach 1R - Z6051 CTSU Data Transmittal Form
Attach 1S - RTOG 0834 CTSU Data Transmittal Form 19 Attach 1S - RTOG 0834 CTSU Data Transmittal Form
Attach 1T - CTSU 7868 Data Transmittal Form 20 Attach 1T - CTSU 7868 Data Transmittal Form
Attach 1U - Site Initiated Data Update Form, protocol 7868 21 Attach 1U - Site Initiated Data Update Form, protocol 7868
Attach 1V - MC0845(8233) CTSU Data Transmittal 22 Attach 1V - MC0845(8233) CTSU Data Transmittal
Attach 1W - 8121 CTSU Data Transmittal Form 23 Attach 1W - 8121 CTSU Data Transmittal Form
Attach 1X- Site Initiated Data Update Form, Protocol 8121 24 Attach 1X- Site Initiated Data Update Form, Protocol 8121
Attach 1Y - USMCI 8214/Z6091: CTSU Data Transmittal 25 Attach 1Y - USMCI 8214/Z6091: CTSU Data Transmittal
Attach 1Di_CTSU Site Addition Form 5 Attach 1Di_Site Addition Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 289,918 289,918 0 0 0 0
Annual Time Burden (Hours) 34,827 34,827 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,520,343
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Saleda Perryman

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/27/2012


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