Information Collection

Telehealth and Cancer: Studying its Role in Clinical Research and Cancer Workshop (NCI)

IC 249939 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⚠️ Notice: This information collection may be referencing outdated material.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 Telehealth and Cancer: Studying its Role in Clinical Research and Cancer Workshop (NCI)	Form
Form 1 Registration Telehealth and Cancer: Studying its Role in Clinical Research and Cancer Workshop (NCI)	Form
1 Registration Telehealth Registration Form_v2.pdf	Form
1 Registration Telehealth Registration Form_v2.pdf	Form
Telehealth and Cancer Draft Promo Email.docx email	IC Document
Telehealth and Cancer Draft Promo Email.docx email	IC Document
Sub-Study - Telehealth and Cancer Registration_v2.docx sub-study for Telehealth and Cancer registration	IC Document
Sub-Study - Telehealth and Cancer Registration_v2.docx sub-study for Telehealth and Cancer registration	IC Document

IC Title:

Telehealth and Cancer: Studying its Role in Clinical Research and Cancer Workshop (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	Registration	Telehealth Registration Form_v2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
email	Telehealth and Cancer Draft Promo Email.docx	10/28/2021
sub-study for Telehealth and Cancer registration	Sub-Study - Telehealth and Cancer Registration_v2.docx	10/28/2021

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