Information Collection

Sub-study #2_Assessing Cancer Information Service (CIS) Clients Actions After Receiving Clinical Trial Information

IC 206587 under ICR 201304-0925-003 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Sub-study #2_Assessing Cancer Information Service (CIS) Clients Actions After Receiving Clinical Trial Information	Form and Instruction
1 CIS Survey CIS_#2_Attach B_Screenshot Survey.pdf	Form and Instruction
CIS_#2_Justif Memo_3-22-2013.docx CIS_#2_Justif Memo_3-22-2013	IC Document
CIS_#2_Attach A Verbal Consent-Sampling Script_32113.doc CIS_#2_Attach A Verbal Consent-Sampling Script_32113	IC Document
CIS_#2_Attach C_OHSRP_Review_11860_CY2013.pdf CIS_#2_Attach C_OHSRP_Review_11860_CY2013	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #2_Assessing Cancer Information Service (CIS) Clients Actions After Receiving Clinical Trial Information

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	CIS Survey	CIS_#2_Attach B_Screenshot Survey.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0156, "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: 344

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	344	0	0	0	0	0
Annual IC Time Burden (Hours)	57	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CIS_#2_Justif Memo_3-22-2013	CIS_#2_Justif Memo_3-22-2013.docx	03/28/2013
CIS_#2_Attach A Verbal Consent-Sampling Script_32113	CIS_#2_Attach A Verbal Consent-Sampling Script_32113.doc	03/28/2013
CIS_#2_Attach C_OHSRP_Review_11860_CY2013	CIS_#2_Attach C_OHSRP_Review_11860_CY2013.pdf	03/28/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.