Information Collection

2021 NCI-CONNECT Survivorship Workshop Registration (NCI)

IC 245713 under ICR 202201-0925-002 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2021 NCI-CONNECT Survivorship Workshop Registration (NCI)	Form
1 2021 NCI-CONNECT screenshot NCI-CONNECT Survivorship Registration Screenshot.pdf	Form
1 2021 NCI-CONNECT screenshot NCI-CONNECT Survivorship Registration Screenshot.pdf	Form
Request - NCI-CONNECT Survivorship 2.8.2021 (1).docx sub-study request for 2021 NCI -CONNECT Registration	IC Document
Request - NCI-CONNECT Survivorship 2.8.2021 (1).docx sub-study request for 2021 NCI -CONNECT Registration	IC Document
2021 NCI-CONNECT Survivorship Email Invite (1).docx NCI-CONNECT Survivorship email invite	IC Document
2021 NCI-CONNECT Survivorship Email Invite (1).docx NCI-CONNECT Survivorship email invite	IC Document

IC Title:

2021 NCI-CONNECT Survivorship Workshop Registration (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	1	2021 NCI-CONNECT screenshot	NCI-CONNECT Survivorship Registration Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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	75	75
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
sub-study request for 2021 NCI -CONNECT Registration	Request - NCI-CONNECT Survivorship 2.8.2021 (1).docx	02/09/2021
NCI-CONNECT Survivorship email invite	2021 NCI-CONNECT Survivorship Email Invite (1).docx	02/09/2021

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