Information Collection

Survivorship Survey for Post-Transplant Interdisciplinary Providers (NCI)

IC 245206 under ICR 202109-0925-004 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survivorship Survey for Post-Transplant Interdisciplinary Providers (NCI)	Form and Instruction
Form 1 Survivorship Survey for Post-Transplant Interdisciplinary Providers (NCI)	Form and Instruction
1 Survey Survivorship Transplant Survey Survivorship Transplant.pdf	Form and Instruction
1 Survey Survivorship Transplant Survey Survivorship Transplant.pdf	Form and Instruction
Request-Survivor Transplant Consortium-NCI.docx Survivorship Transplant sub-study	IC Document
Request-Survivor Transplant Consortium-NCI.docx Survivorship Transplant sub-study	IC Document
Email to members of the Transplant Consortium.pdf email to members of Transplant consortium	IC Document
Email to members of the Transplant Consortium.pdf email to members of Transplant consortium	IC Document

IC Title:

Survivorship Survey for Post-Transplant Interdisciplinary Providers (NCI)

Agency IC Tracking Number:

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	1	Survey Survivorship Transplant	Survey Survivorship Transplant.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 159

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	159	159
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survivorship Transplant sub-study	Request-Survivor Transplant Consortium-NCI.docx	01/05/2021
email to members of Transplant consortium	Email to members of the Transplant Consortium.pdf	01/05/2021

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