OMB control number

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

OMB 0925-0208 · HHS/NIH.

OMB 0925-0208

This is an information collection request for a reinstatement with change for three years. NCI’s Cancer Information Service (CIS) currently collects demographic, customer service, and smoking cessation information from clients contacting the CIS by telephone, email, and through LiveHelp (an online instant messaging service). Information is collected to properly plan, implement, and evaluate cancer education efforts and provide smoking cessation services tailored to the individual client’s needs. Since its inception in 1976, the CIS has handled approximately 12 million calls from the public. The potential universe of the Cancer Information Service (CIS) clients is almost 262 million respondents based on the U.S. Census estimate for 2023 of adults who are 18 years and older. Changes to this submission include 3 updated Appendices to include the new SPD 15 guidelines and 1 Appendix update to include three new questions.

The latest form for Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI's Contact Center, Cancer Information Service (CIS) Clients (NCI) expires 2028-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Cancer Information Call Backs Form
Form 1 Cancer Info Call Backs Form
Form 1 VA Call Backs Form
Form 1 VA Calls Backs Form
Form 1 Email Intake Form Form
Form 1 E-mail Intake form Form
Form 1 Live Help Questions Form
Form 1 LiveHelp Questions Form
Form 1 Smoking Call Back Task Form
Form 1 VA Smoking Cessation Form
Form 1 Customer Service and Demographic Questions Form
Form 1 Demographic & Customer Satisfaction Questions (App. 9) Form
Form 1 Smoking Cessation Intake Questions Form
Form 1 Smoking Cessation "Intake" Questions Form
Form 1AB Customer Service and Demographic Questions Form
Form 1A Customer Service and Demographic Questions Form
Form 1A Demographic & Customer Satisfaction Questions (App.1A or 1 AB) Form
Appendix 11 Public Comments for 60-Day FRN.docx Supplementary Document
Appendix 10 Electronic Contact Record Form and Screen Shots.docx Supplementary Document
Appendix 9 Customer Satisfaction Survey Questions.docx Supplementary Document
Appendix 8 CC Annual Data Report.docx Supplementary Document
Appendix 8 CC Annual Data Report.docx Supplementary Document
Appendix 7 Confidentiality of Communications Policy.docx Supplementary Document
Appendix 7 Confidentiality of Communications Policy.docx Supplementary Document
Appendix 6 Office of Human Subject Research Not Applicable.docx Supplementary Document
Appendix 6 Office of Human Subject Research Not Applicable.docx Supplementary Document
Appendix 5 Privacy Act Memo.pdf Supplementary Document
Appendix 5 Privacy Act Memo.pdf Supplementary Document
Appendix 4 PIA 10.31.2024_modified.pdf Supplementary Document
Appendix 4 PIA 10.31.2024_modified.pdf Supplementary Document
Appendix 3 Social Media.docx Supplementary Document
Appendix 3 Social Media.docx Supplementary Document
0208 30-Day Published FRN.pdf Supplementary Document
SSA CIS 2025 FINAL - 4.10.2025.docx Supporting Statement A
SSA CIS 2025 FINAL - 4.10.2025.docx Supporting Statement A
Cancer Info Call Backs Form
Cancer Info Call Backs Form
VA Calls Backs Form
VA Calls Backs Form
E-mail Intake form Form
E-mail Intake form Form
LiveHelp Questions Form
LiveHelp Questions Form
VA Smoking Cessation Form
VA Smoking Cessation Form
Demographic & Customer Satisfaction Questions (App. 9) Form
Demographic & Customer Satisfaction Questions (App. 9) Form
Smoking Cessation "Intake" Questions Form
Smoking Cessation "Intake" Questions Form
Demographic & Customer Satisfaction Questions (App.1A or 1 AB) Form
Demographic & Customer Satisfaction Questions (App.1A or 1 AB) Form
Demographic & Customer Satisfaction Questions (App.1A or 1 AB) Form

All Historical Document Collections

202504-0925-001	Reinstatement with change of a previously approved collection	2025-05-28
202201-0925-001 Approved without change	Revision of a currently approved collection	2022-01-11
201807-0925-001 Approved without change	Revision of a currently approved collection	2018-08-14
201512-0925-003 Approved with change	Revision of a currently approved collection	2015-12-28
201210-0925-004 Approved with change	Revision of a currently approved collection	2012-10-31
201208-0925-003 Withdrawn and continue	Revision of a currently approved collection	2012-08-20
200907-0925-001 Approved without change	Extension without change of a currently approved collection	2009-07-02
200706-0925-002 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2007-06-19
200607-0925-004 Approved without change	Revision of a currently approved collection	2006-07-07
200309-0925-002 Approved without change	Revision of a currently approved collection	2003-09-26
200008-0925-001 Approved without change	Revision of a currently approved collection	2000-08-07
199705-0925-003 Approved without change	Reinstatement with change of a previously approved collection	1997-05-23
198906-0925-012 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-06-30
198904-0925-008 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-07
198809-0925-004 Approved without change	Reinstatement with change of a previously approved collection	1988-09-14
198611-0925-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-11-20
198510-0925-004 Approved without change	Reinstatement with change of a previously approved collection	1985-10-23
198305-0925-004 Approved without change	New collection (Request for a new OMB Control Number)	1983-05-20

OMB Details

Demographic & Customer Satisfaction Questions (App.1A or 1 AB)

Federal Enterprise Architecture: Health - Health Care Services

Form 1A	Customer Service and Demographic Questions	Fillable Fileable	Form
Form 1AB	Customer Service and Demographic Questions	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.