Form 1 Informed Consent

OMB No.: 0925-0046

Expiration Date: 05/31/2016

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, 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 (0925-0046). Do not return the completed form to this address.

National Institute of Health/National Cancer Institute/Division of Cancer Control and Population Sciences/Epidemiology and Genomics Research Program (EGRP)

Survey of Training Landscape for Cancer Epidemiology

Consent to Participate in a Program Evaluation Interview

The Epidemiology and Genomics Research Program (EGRP), part of the NCI’s Division of Cancer Control and Population Sciences, and the Division of Cancer Epidemiology and Genetics (DCEG) seek to gather information about how cancer epidemiology training programs around the United States are currently preparing their trainees. We have developed a set of survey questions intended to obtain a snapshot of the current curricula in epidemiology, with a specific focus on cancer epidemiology, across several leading academic institutions. A week before the scheduled interview, participants will be sent an electronic copy of the survey questions via email. The questions will ask for the participants’ assessment in identified competencies within their training curricula and opinions about possible topics that may drive the future of cancer epidemiology. Unless permission is obtained, no personal identifying information will be collected during the interview.

Individual interviews will be conducted by at least one of the project leads. The interviewer will take handwritten notes of your responses. The individual interview may last no more than one hour. About three weeks after the interview, you will receive a written summary of the interview and you may correct, modify, or add information to that summary.

There is no direct benefit to you from participating in the interview, but the information you provide could help our understanding of the training landscape for cancer epidemiologists and may inform recommendations for future training development and directions. A written evaluation report will be prepared that will contain information from the interviews and from other sources. Unless permission is obtained, the individual comments will not be identified in the report.

Taking part in this interview is voluntary. You may choose either to participate or not participate in the interview. NO matter what decision you make, there will be no penalty to you. Your relationship with the NCI and EGRP will be affected by your decision. If you have any questions about the interview or the evaluation, you may contact Tram Kim Lam, PhD, Epidemiologist at 240-276-6967 or [email protected]

Participant: I have read this consent form. I understand the information and have had my questions answered. I understand that I will be provided with a signed copy of this form. By signing this consent form, I agree to take part in this interview.

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