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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 27 Low Accrual Clinical Trial Survey	Form and Instruction	Unchanged	Available
Form 26 Prospective Clinical Trial Survey	Form and Instruction	Unchanged	Available
Form 25 Concept Clinical Trial Survey	Form and Instruction	Unchanged	Available
Form 24 Protocol and Information Office (PIO) External Customer Satisfaction	Form and Instruction	Unchanged	Available
Form 5 Site Addition Form	Form and Instruction	Unchanged	Available
Form 14 CTSU Generic Data Transmittal Form	Form and Instruction	Unchanged	Repair queued
Form 23 Oncology Patient Enrollment Network (OPEN) Survey	Form and Instruction	Unchanged	Available
Form 22 Help Desk Survey Customer Satisfaction Survey	Form and Instruction	Unchanged	Available
Form 23 OPEN-Website Survey	Form and Instruction	Unchanged	Available
Form 20 CTSU Supply Request Form	Form and Instruction	Unchanged	Available
Form 19 CTSU Request for Clinical Brochure	Form and Instruction	Unchanged	Available
Form 18 CTSU System Account Request Form	Form and Instruction	Unchanged	Available
Form 17 CTSU Transfer Form	Form and Instruction	Unchanged	Available
Form 16 CTSU P2C Enrollment Transmittal Form	Form and Instruction	Unchanged	Available
Form 15 CTSU Patient Enrollment Transmittal Form	Form and Instruction	Unchanged	Available
Form 13 MC0845 (8233) CTSU Data Transmittal Form	Form and Instruction	Unchanged	Available
Form 12 RTOG 0834 CTSU Data Transmittal Form	Form and Instruction	Unchanged	Available
Form 11 Data Clarification Form	Form and Instruction	Unchanged	Available
Form 10 Site Initiated Data Update Form	Form and Instruction	Unchanged	Available
Form 9 CTSU IBCSG Transfer of Investigational Agent Form	Form and Instruction	Unchanged	Available
Form 8 CTSU IBCSG Drug Accountability Form	Form and Instruction	Unchanged	Available
Form 7 CTSU Radiation Therapy Facilities Inventory Form	Form and Instruction	Unchanged	Available
Form 6 CTSU Roster Update Form	Form and Instruction	Unchanged	Available
Form 4 Optional Form 1 - Withdrawal from Protocol Participation	Form and Instruction	Unchanged	Available
Form 3 CTSU Acknowledgement Form	Form and Instruction	Unchanged	Available
Form 2 CTSU IRB Certification Form	Form and Instruction	Unchanged	Available
Form 1 CTSU IRB/Regulatory Approval Transmittal Form	Form and Instruction	Unchanged	Available
ChangeRequestMemo 3.2.2015.docx	Supplementary Document	Uploaded 2015-03-03	Available
Attach1u_TAILORx_CTSU_DTF.PDF	Supplementary Document	Uploaded 2015-01-23	Available
0925-0624 ChangeRequestMemo_DEC2014.docx	Supplementary Document	Uploaded 2015-01-23	Available
attach_1e_siteadd_highlights.pdf	Supplementary Document	Uploaded 2014-09-19	Available
attach_1d_wd_highlights.pdf	Supplementary Document	Uploaded 2014-09-19	Available
attach_1c_ctsuac_highlights.pdf	Supplementary Document	Uploaded 2014-09-19	Available
attach_1b_IRBCRT_highlights.pdf	Supplementary Document	Uploaded 2014-09-19	Available
Cover Memo 9.5.2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-09-19	Available
SSB_CTSU_10-25-2013.docx	Supporting Statement B	Uploaded 2013-10-30	Available
attachment_11_privacy act memo.pdf	Supplementary Document	Uploaded 2013-10-30	Available
attachment_10_irb and OHSR determination.pdf	Supplementary Document	Uploaded 2013-10-30	Available
attachment_9_PIA.pdf	Supplementary Document	Uploaded 2013-10-30	Available
Cover Memo_10-25-2013.doc	Supplementary Document	Uploaded 2013-10-30	Available
SSA_CTSU_11-19-2013.docx	Supporting Statement A	Uploaded 2013-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215510	CTSU Data Transmittal Form for TailorX/PACCT-1 (Attachment 1u)		New
209614	Attach 8 - Low Accruing Clinical Trial Survey	Form and Instruction	Unchanged	Low Accrual Clinical Trial Survey
209613	Attach 7 - Prospective Clinical Trial Survey	Form and Instruction	Unchanged	Prospective Clinical Trial Survey
209612	Attach 6 - Concept Clinical Trial Survey	Form and Instruction	Unchanged	Concept Clinical Trial Survey
209611	Attach 5 - Protocol and Information Office (PIO) External Customer Satisfaction	Form and Instruction	Unchanged	Protocol and Information Office (PIO) External Customer Satisfaction
199005	Attach 1E_CTSU Site Addition Form	Form and Instruction	Unchanged	Site Addition Form
195188	Attach 1N - CTSU Generic Data Transmittal Form	Form and Instruction	Unchanged	CTSU Generic Data Transmittal Form
195187	Attach 4 - CTSU Oncology Patient Enrollment Network (OPEN) Survey	Form and Instruction	Unchanged	Oncology Patient Enrollment Network (OPEN) Survey
195186	Attach 3 - CTSU Helpdesk Customer Satisfaction Survey	Form and Instruction	Unchanged	Help Desk Survey Customer Satisfaction Survey
195185	Attach 2 - CTSU Web Site Customer Satisfaction Survey	Form and Instruction	Unchanged	OPEN-Website Survey
195184	Attach 1T - CTSU Supply Request Form	Form and Instruction	Unchanged	CTSU Supply Request Form
195183	Attach 1S - CTSU Request for Clinical Brochure	Form and Instruction	Unchanged	CTSU Request for Clinical Brochure
195182	Attach 1R - CTSU System Account Request Form	Form and Instruction	Unchanged	CTSU System Account Request Form
195181	Attach 1Q - CTSU Transfer Form	Form and Instruction	Unchanged	CTSU Transfer Form
195180	Attach 1P - CTSU P2C Enrollment Transmittal Form	Form and Instruction	Unchanged	CTSU P2C Enrollment Transmittal Form
195179	Attach 1o - CTSU Patient Enrollment Transmittal Form	Form and Instruction	Unchanged	CTSU Patient Enrollment Transmittal Form
195174	Attach 1M - MC0845(8233) CTSU Data Transmittal	Form and Instruction	Unchanged	MC0845 (8233) CTSU Data Transmittal Form
195171	Attach 1L - RTOG 0834 CTSU Data Transmittal Form	Form and Instruction	Unchanged	RTOG 0834 CTSU Data Transmittal Form
195165	Attach 1K - Data Clarification Form	Form and Instruction	Unchanged	Data Clarification Form
195161	Attach 1J - Site Initiated Data Update Form (generic)	Form and Instruction	Unchanged	Site Initiated Data Update Form
195160	Attach 1I - CTSU IBCSG Transfer of Investigational Agent Form	Form and Instruction	Unchanged	CTSU IBCSG Transfer of Investigational Agent Form
195159	Attach 1H - CTSU IBCSG Drug Accountability Form	Form and Instruction	Unchanged	CTSU IBCSG Drug Accountability Form
195158	Attach 1G - CTSU Radiation Therapy Facilities Inventory Form	Form and Instruction	Unchanged	CTSU Radiation Therapy Facilities Inventory Form
195157	Attach 1F - CTSU Roster Update Form	Form and Instruction	Unchanged	CTSU Roster Update Form
195156	Attach 1D - Optional Form 1 - Withdrawal from Protocol Participation Form	Form and Instruction	Unchanged	Optional Form 1 - Withdrawal from Protocol Participation
195155	Attach 1C- CTSU Acknowledgement Form	Form and Instruction	Unchanged	CTSU Acknowledgement Form
195154	Attach 1B - CTSU IRB Certification Form	Form and Instruction	Unchanged	CTSU IRB Certification Form
195153	Attach 1A - CTSU IRB/Regulatory Approval Transmittal Form	Form and Instruction	Unchanged	CTSU IRB/Regulatory Approval Transmittal Form

ICR Details

OMB Control No: 0925-0624	ICR Reference No: 201501-0925-005
Status: Historical Active	Previous ICR Reference No: 201409-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No: 20796
Title: Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/03/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/26/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	01/31/2017	01/31/2017
Responses	246,632	0	237,560
Time Burden (Hours)	26,716	0	25,204
Cost Burden (Dollars)	0	0	0

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Abstract: The Cancer Therapy Evaluation Program (CTEP) establishes and supports programs to facilitate the participation of qualified investigators on CTEP-supported studies, and to institute programs that minimize redundancy among grant and contract holders, thereby reducing overall cost of maintaining a robust treatment trials program. Currently guided by the efforts of the Clinical Trials Working Group (CTWG) and the Institute of Medicine (IOM) recommendations to revitalize the Cooperative Group program, CTEP has funded the Cancer Trials Support Unit (CTSU). The CTSU collects standardized forms to process site regulatory information, changes to membership, patient enrollment data, and routing information for case report forms. In addition, CTSU collects seven surveys used for customer satisfaction or related to clinical trials. The customer satisfaction surveys assess different areas of service delivery at CTSU including: the CTSU Help Desk, the CTSU web site, the Protocol and Information Office (PIO), and the Oncology Patient Enrollment Network (OPEN). User satisfaction surveys are compiled as part of the project quality assurance activities and are used to direct improvements to processes and technology. Additionally, there are three surveys collect information about health professional's interests in clinical trial, potential issues with opening and accruing to a clinical trial and reasons for low accrual.

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Authorizing Statute(s): US Code: 42 USC 413(285a-2) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 53763	08/30/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 69428	11/19/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 28

table that charts list of burden

IC Title	Form No.	Form Name
Attach 1A - CTSU IRB/Regulatory Approval Transmittal Form	1	CTSU IRB/Regulatory Approval Transmittal Form
Attach 1B - CTSU IRB Certification Form	2	CTSU IRB Certification Form
Attach 1C- CTSU Acknowledgement Form	3	CTSU Acknowledgement Form
Attach 1D - Optional Form 1 - Withdrawal from Protocol Participation Form	4	Optional Form 1 - Withdrawal from Protocol Participation
Attach 1E_CTSU Site Addition Form	5	Site Addition Form
Attach 1F - CTSU Roster Update Form	6	CTSU Roster Update Form
Attach 1G - CTSU Radiation Therapy Facilities Inventory Form	7	CTSU Radiation Therapy Facilities Inventory Form
Attach 1H - CTSU IBCSG Drug Accountability Form	8	CTSU IBCSG Drug Accountability Form
Attach 1I - CTSU IBCSG Transfer of Investigational Agent Form	9	CTSU IBCSG Transfer of Investigational Agent Form
Attach 1J - Site Initiated Data Update Form (generic)	10	Site Initiated Data Update Form
Attach 1K - Data Clarification Form	11	Data Clarification Form
Attach 1L - RTOG 0834 CTSU Data Transmittal Form	12	RTOG 0834 CTSU Data Transmittal Form
Attach 1M - MC0845(8233) CTSU Data Transmittal	13	MC0845 (8233) CTSU Data Transmittal Form
Attach 1N - CTSU Generic Data Transmittal Form	14	CTSU Generic Data Transmittal Form
Attach 1P - CTSU P2C Enrollment Transmittal Form	16	CTSU P2C Enrollment Transmittal Form
Attach 1Q - CTSU Transfer Form	17	CTSU Transfer Form
Attach 1R - CTSU System Account Request Form	18	CTSU System Account Request Form
Attach 1S - CTSU Request for Clinical Brochure	19	CTSU Request for Clinical Brochure
Attach 1T - CTSU Supply Request Form	20	CTSU Supply Request Form
Attach 1o - CTSU Patient Enrollment Transmittal Form	15	CTSU Patient Enrollment Transmittal Form
Attach 2 - CTSU Web Site Customer Satisfaction Survey	23	OPEN-Website Survey
Attach 3 - CTSU Helpdesk Customer Satisfaction Survey	22	Help Desk Survey Customer Satisfaction Survey
Attach 4 - CTSU Oncology Patient Enrollment Network (OPEN) Survey	23	Oncology Patient Enrollment Network (OPEN) Survey
Attach 5 - Protocol and Information Office (PIO) External Customer Satisfaction	24	Protocol and Information Office (PIO) External Customer Satisfaction
Attach 6 - Concept Clinical Trial Survey	25	Concept Clinical Trial Survey
Attach 7 - Prospective Clinical Trial Survey	26	Prospective Clinical Trial Survey
Attach 8 - Low Accruing Clinical Trial Survey	27	Low Accrual Clinical Trial Survey
CTSU Data Transmittal Form for TailorX/PACCT-1 (Attachment 1u)

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ICR Summary of Burden

table that charts list of burden

	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	246,632	237,560	0	9,072	0	0
Annual Time Burden (Hours)	26,716	25,204	0	1,512	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,953,405

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/26/2015

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