Information Collection

Pilot Study for The Center for Cancer Research (CCR) Faculty Recruitment Application Website (NCI)

IC 236488 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Pilot Study for The Center for Cancer Research (CCR) Faculty Recruitment Application Website (NCI) Form and Instruction
1 Application form Attachment 1 - Application Form (1).docx Form and Instruction
2 Feedback survey Attachment 2 - Survey.docx Form
3 reference request Attachment 3 - Reference Request.docx Form and Instruction
Mini SSA CCR Application Database - 6.13.19.docx Mini SSA IC Document
Attachment 4 - Auto-Generated Email Responses (3 samples).docx Auto-Generated Email Responses (three samples) IC Document
Attachment 5 - Auto-Generated Email Request - Reference Letter (1).docx Auto-Generated Email Request for Reference Letter IC Document
Attachment 6 - PrivacyImpactAssessmentForm_FINAL_050819.pdf PIA IC Document
Attachment 6 - PrivacyImpactAssessmentForm_FINAL_050819.docx PIA IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pilot Study for The Center for Cancer Research (CCR) Faculty Recruitment Application Website (NCI)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Application form	Attachment 1 - Application Form (1).docx	Yes	Yes	Fillable Fileable
Form	2	Feedback survey	Attachment 2 - Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	reference request	Attachment 3 - Reference Request.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,075	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,075	2,075
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA	Mini SSA CCR Application Database - 6.13.19.docx	06/13/2019
Auto-Generated Email Responses (three samples)	Attachment 4 - Auto-Generated Email Responses (3 samples).docx	06/13/2019
Auto-Generated Email Request for Reference Letter	Attachment 5 - Auto-Generated Email Request - Reference Letter (1).docx	06/13/2019
PIA	Attachment 6 - PrivacyImpactAssessmentForm_FINAL_050819.pdf	06/13/2019
PIA	Attachment 6 - PrivacyImpactAssessmentForm_FINAL_050819.docx	06/24/2019

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