Information Collection

Market Research to Inform Next Generation Physician's Data Query (PDQ) (NCI)

IC 235617 under ICR 201605-0925-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Market Research to Inform Next Generation Physician's Data Query (PDQ) (NCI)	Form and Instruction
1 Patient Screener (screenshot) Attachment 1 - FINAL Patient Screener (Screenshots) (7).docx	Form and Instruction
2 Caregiver Screener (screenshot) Attachment 2 - FINAL Caregiver Screener (Screenshots) (3).docx	Form and Instruction
3 Medical Oncologist Screener (screenshot) Attachment 3 - FINAL Medical Oncologist Screener (Screenshots) (2).docx	Form and Instruction
4 PCP Screener (screenshot) Attachment 4 - FINAL PCP Screener (Screenshots) (2).docx	Form and Instruction
5 Oncology Nurse Screener (screenshot) Attachment 5 - FINAL Oncology Nurse Screener (Screenshots) (2).docx	Form and Instruction
6 Non-Oncologist Clinician Screener (screenshot) Attachment 6 - FINAL Non-Oncologist Clinician (Screenshots) (2).docx	Form and Instruction
7 Radiation Oncologist Screener (screenshot) Attachment 7 - FINAL Radiation Oncologist Screener (Screenshots) (6).docx	Form and Instruction
8 Medical Director Screener (screenshot) Attachment 8 - FINAL Medical Director Screener (Screenshots) (3).docx	Form and Instruction
9 Navigator Screener (screenshot) Attachment 9 - FINAL Navigator Screener (Screenshots) (5).docx	Form and Instruction
10 Patient Interview Attachment 15 ___ FINAL Patient Discussion Guide.docx	Form and Instruction
11 Caregiver Interview Attachment 16 ___ FINAL Caregiver Discussion Guide (1).docx	Form and Instruction
12 Oncologist Interview Attachment 17 ___ FINAL Oncologist Discussion Guide.docx	Form and Instruction
13 PCP Interview Attachment 18 ___ FINAL PCP Discussion Guide.docx	Form and Instruction
14 Oncology Nurse Interview Attachment 19 ___ FINAL Oncology Nurse Discussion Guide (1).docx	Form and Instruction
15 Non-Oncologist Clinician Interview Attachment 20 ___ FINAL Non-Oncologist Clinician Discussion Guide.docx	Form and Instruction
16 Radiation Oncologist Interview Attachment 21 ___ FINAL Radiation Oncologist Discussion Guide (1).docx	Form and Instruction
17 Medical Director Interview Attachment 22 ___ FINAL Medical Director Discussion Guide.docx (2).docx	Form and Instruction
18 Navigator Interview Attachment 23 ___ FINAL Navigator Discussion Guide (1).docx	Form and Instruction
Attachment 10 - Medical Directors Invitation.pdf Medical Directors Invitation	IC Document
Attachment 11 - Nurse and Non-Onc Clinical Invitation.pdf Nurse and Non-Onc Clinical Invitation	IC Document
Attachment 12 - Patient and Caregiver Invitation.pdf patient and Caregiver Invitation	IC Document
Attachment 13 - PCP, Onc, Rad Onc and Gastro Invitation.pdf PCP, ONC, Rad Onc and Gastro Invitation	IC Document
Attachment 14 - Email Reminder Template with Website Screenshot.pdf Email Reminder Template with website screenshot	IC Document
Mini SSA PDQ 4.8.19 FINAL.docx Mini SSA PDQ	IC Document
Mini SSB PDQ 4.3.19 FINAL (002).docx Mini SSB PDQ	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Market Research to Inform Next Generation Physician's Data Query (PDQ) (NCI)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Patient Screener (screenshot)	Attachment 1 - FINAL Patient Screener (Screenshots) (7).docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Caregiver Screener (screenshot)	Attachment 2 - FINAL Caregiver Screener (Screenshots) (3).docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Medical Oncologist Screener (screenshot)	Attachment 3 - FINAL Medical Oncologist Screener (Screenshots) (2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	PCP Screener (screenshot)	Attachment 4 - FINAL PCP Screener (Screenshots) (2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	5	Oncology Nurse Screener (screenshot)	Attachment 5 - FINAL Oncology Nurse Screener (Screenshots) (2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	6	Non-Oncologist Clinician Screener (screenshot)	Attachment 6 - FINAL Non-Oncologist Clinician (Screenshots) (2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	7	Radiation Oncologist Screener (screenshot)	Attachment 7 - FINAL Radiation Oncologist Screener (Screenshots) (6).docx	Yes	Yes	Fillable Fileable
Form and Instruction	8	Medical Director Screener (screenshot)	Attachment 8 - FINAL Medical Director Screener (Screenshots) (3).docx	Yes	Yes	Fillable Fileable
Form and Instruction	9	Navigator Screener (screenshot)	Attachment 9 - FINAL Navigator Screener (Screenshots) (5).docx	Yes	Yes	Fillable Fileable
Form and Instruction	10	Patient Interview	Attachment 15 ___ FINAL Patient Discussion Guide.docx	No		Paper Only
Form and Instruction	11	Caregiver Interview	Attachment 16 ___ FINAL Caregiver Discussion Guide (1).docx	No		Paper Only
Form and Instruction	12	Oncologist Interview	Attachment 17 ___ FINAL Oncologist Discussion Guide.docx	No		Paper Only
Form and Instruction	13	PCP Interview	Attachment 18 ___ FINAL PCP Discussion Guide.docx	No		Paper Only
Form and Instruction	14	Oncology Nurse Interview	Attachment 19 ___ FINAL Oncology Nurse Discussion Guide (1).docx	No		Paper Only
Form and Instruction	15	Non-Oncologist Clinician Interview	Attachment 20 ___ FINAL Non-Oncologist Clinician Discussion Guide.docx	No		Fillable Fileable
Form and Instruction	16	Radiation Oncologist Interview	Attachment 21 ___ FINAL Radiation Oncologist Discussion Guide (1).docx	No		Paper Only
Form and Instruction	17	Medical Director Interview	Attachment 22 ___ FINAL Medical Director Discussion Guide.docx (2).docx	No		Paper Only
Form and Instruction	18	Navigator Interview	Attachment 23 ___ FINAL Navigator Discussion Guide (1).docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,149

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,149	1,149
Annual IC Time Burden (Hours)	144	144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Medical Directors Invitation	Attachment 10 - Medical Directors Invitation.pdf	04/08/2019
Nurse and Non-Onc Clinical Invitation	Attachment 11 - Nurse and Non-Onc Clinical Invitation.pdf	04/08/2019
patient and Caregiver Invitation	Attachment 12 - Patient and Caregiver Invitation.pdf	04/08/2019
PCP, ONC, Rad Onc and Gastro Invitation	Attachment 13 - PCP, Onc, Rad Onc and Gastro Invitation.pdf	04/08/2019
Email Reminder Template with website screenshot	Attachment 14 - Email Reminder Template with Website Screenshot.pdf	04/08/2019
Mini SSA PDQ	Mini SSA PDQ 4.8.19 FINAL.docx	04/08/2019
Mini SSB PDQ	Mini SSB PDQ 4.3.19 FINAL (002).docx	04/08/2019

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