Research Advocate System

Generic Submission for Formative Research, Pre-testing, Stakeholder Measures and Advocate Forms at NCI

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0641 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Research Advocate System Form and Instruction
1 Registration/Annual Update Form Attachment 3 Screenshots.pdf Form and Instruction
2 Telephone Screening Form Attachment 7 Telephone Screener Script.docx Form and Instruction
Attachment 1_PIA_OAR.xml PIA IC Document
Attachment 2 OHSRP Exclusion.pdf IRB Letter IC Document
Attachment 4_Invitations.doc Invitations IC Document
Attachment 5 Auto-Reply Email.docx Attachment 5 Auto-Reply E-mail IC Document
Attachment 6 Annual Update Reminder.docx Attachment 6 Annual Update Remiinder IC Document
miniSSA OAR Applications 7 3 2014.docx Justification/Mini SSA IC Document

Information Collection (IC) Details

IC Title:	Research Advocate System	Agency IC Tracking Number:

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 and Instruction	1	Registration/Annual Update Form	Attachment 3 Screenshots.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Telephone Screening Form	Attachment 7 Telephone Screener Script.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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	120	120
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PIA	Attachment 1_PIA_OAR.xml	07/01/2014
IRB Letter	Attachment 2 OHSRP Exclusion.pdf	07/01/2014
Invitations	Attachment 4_Invitations.doc	07/01/2014
Attachment 5 Auto-Reply E-mail	Attachment 5 Auto-Reply Email.docx	07/03/2014
Attachment 6 Annual Update Remiinder	Attachment 6 Annual Update Reminder.docx	07/03/2014
Justification/Mini SSA	miniSSA OAR Applications 7 3 2014.docx	07/03/2014

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