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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Application form Pilot Study for The Center for Cancer Research (CCR) Faculty Recruitment Application Website (NCI)	Form and Instruction
Form 2 Feedback survey Pilot Study for The Center for Cancer Research (CCR) Faculty Recruitment Application Website (NCI)	Form
Form 3 reference request 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.