Form 1 2018 NCORP Annual Meeting Planning Survey

2018 NCORP Annual Meeting planning survey

OMB #0925-0642 | Expiration Date 05-31-2020

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of study participants are protected by The
Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate
will not affect your benefits in any way. The information collected in this study will be kept private to the extent provided by law. Names and other identifiers
will not appear in any report of the study. Information provided will be combined for all study participants and reported as summaries. You are being contacted
by email to complete this instrument in inform the NCORP Annual Meeting planning.

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this
address.

1. What is your role in NCORP?
PI
Administrator
CCDR Lead
Clinical Manager/ Research Staff
Other (please specify)

2. Did you attend the 2017 NCORP Annual Meeting?
No, did not attend
Yes, did attend

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3. Are you planning or considering attending the 2018 NCORP Annual Meeting
(September 20-21, 2018)?
Yes
No
Unsure

4. What are the top 3 topic areas you would like to see covered during the 2018
NCORP Annual Meeting?
Topic 1
Topic 2
Topic 3

5. Additional comments/feedback

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