Information Collection

Precision Medicine Survey Pilot Study

IC 220184 under ICR 201605-0925-011 · OMB 0925-0739.

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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Previously Approved
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.