Profile Completion

Stakeholder Measures and Advocate Forms at the National Cancer Institute (NCI)

Documents and Forms

Document Name Document Type
Form 1 Profile Completion Form
1 Questionnaire Attachment 1 Profile Completion Questionaire 8.15.24_FINAL.docx Form
1 Questionnaire Attachment 1 Profile Completion Questionaire 8.15.24_FINAL.docx Form

Information Collection (IC) Details

IC Title:	Profile Completion	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Questionnaire	Attachment 1 Profile Completion Questionaire 8.15.24_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0156, “Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD”	FR Citation: 67 FR 60742

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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