Cancer Info Call Backs

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

Documents and Forms

Document Name Document Type
Form 7 Cancer Info Call Backs Form
7 Cancer Information CT Callbacks Appendix 1F Cancer Information CT Callbacks.docx Form
7 Cancer Information CT Callbacks Appendix 1F Cancer Information CT Callbacks.docx Form

Information Collection (IC) Details

IC Title:	Cancer Info Call Backs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	7	Cancer Information CT Callbacks	Appendix 1F Cancer Information CT Callbacks.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0156, “Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service	FR Citation: 67 FR 60742

Number of Respondents: 2,242	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,242	2,242
Annual IC Time Burden (Hours)	149	149
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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