Information Collection

Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination (NCI)

IC 249049 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⚠️ Notice: This information collection may be referencing outdated material.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 Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination (NCI)	Form
1 Cancer and EM Registration form Cancer and EM Registration Form.pdf	Form
1 Cancer and EM Registration form Cancer and EM Registration Form.pdf	Form
Fast Track_OMB Clearance_Cancer and EM.docx Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination	IC Document
Fast Track_OMB Clearance_Cancer and EM.docx Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination	IC Document
Cancer and EM Promo Email.docx email invite	IC Document
Cancer and EM Promo Email.docx email invite	IC Document

IC Title:

Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination (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	Cancer and EM Registration form	Cancer and EM Registration Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination	Fast Track_OMB Clearance_Cancer and EM.docx	08/26/2021
email invite	Cancer and EM Promo Email.docx	08/26/2021

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