Information Collection

Precision Medicine Survey Pilot Study

IC 220184 under ICR 201602-0925-012 · OMB 0925-0739.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0739 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Precision Medicine Survey Pilot Study	Form and Instruction
2 Attachment J NCI Precision Medicine Screenshots Attachment J-NCI Precision Medicine Screenshots.pdf	Form and Instruction
Attach A Precision Medicine Survey.pdf Attachment A Precision Medicine Survey	IC Document

IC Title:

Precision Medicine Survey Pilot Study

Agency IC Tracking Number:

Is this a Common Form? No

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	2	Attachment J NCI Precision Medicine Screenshots	Attachment J-NCI Precision Medicine Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A Precision Medicine Survey	Attach A Precision Medicine Survey.pdf	02/19/2016

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