Information Collection Request

Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI's Contact Center, Cancer Information Service (CIS) Clients (NCI)

ICR 202201-0925-001 · OMB 0925-0208 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 7 Cancer Info Call Backs Form New Repair queued
Form 5 VA Calls Back Form Modified Repair queued
Form 6 E-mail Intake form Form Modified Repair queued
Form 2 LiveHelp Clients Form Modified Repair queued
Form 4 Smoking Call Backs Form Modified Repair queued
Form 8 Customer Satisfaction Questions Form Modified Repair queued
Form 3 Smoking Cessation "Intake" Questions Form and Instruction Modified Repair queued
Form 2 Telephone Clients Demographic & Customer Satisfaction Questions Form and Instruction Removed Repair queued
Form 1 Customer Service and Demographic Questions Form and Instruction Modified Repair queued
CIS 30-day notice.pdf Supplementary Document Uploaded 2022-01-11 Repair queued
SSA CIS 2021 1.3.2022.docx Supporting Statement A Uploaded 2022-01-04 Repair queued
Appendix 10 ECRF with Screen Shots_2021.docx Supplementary Document Uploaded 2022-01-04 Repair queued
Appendix 8 CC Annual Data Report 2020 (1).docx Supplementary Document Uploaded 2022-01-04 Repair queued
Appendix 7 Confidentiality of Communications Policy (1).docx Supplementary Document Uploaded 2022-01-04 Repair queued
Appendix 6 Office of Human Subject Research Not Applicable (2).docx Supplementary Document Uploaded 2022-01-04 Repair queued
Appendix 5 PA Memo - NCI CIS Application PA Officer signed.pdf Supplementary Document Uploaded 2022-01-04 Repair queued
PIA.pdf Supplementary Document Uploaded 2022-01-04 Repair queued
Appendix 3 Facebook.docx Supplementary Document Uploaded 2022-01-04 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
251014 Cancer Info Call Backs Form New
232457 VA Calls Back Form Modified
219416 E-mail Intake form Form Modified
219415 LiveHelp Clients Form Modified
219413 Smoking Call Backs Form Modified
219411 Customer Satisfaction Questions Form Modified
219410 Smoking Cessation "Intake" Questions Form and Instruction Modified
219409 Telephone Clients Demographic & Customer Satisfaction Questions Form and Instruction Removed
219408 Customer Service and Demographic Questions Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 02/28/2022
108,208 58,452
5,818 1,865
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 108,208 58,452 0 49,756 0 0
Annual Time Burden (Hours) 5,818 1,865 0 3,953 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No