Attach 1o - CTSU Patient Enrollment Transmittal Form

Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)

Documents and Forms

Document Name Document Type
Form 15 Attach 1o - CTSU Patient Enrollment Transmittal Form Form and Instruction
15 CTSU Patient Enrollment Transmittal Form Attachment 1o ENR 61 01 04 e1.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Attach 1o - CTSU Patient Enrollment Transmittal Form	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 and Instruction	15	CTSU Patient Enrollment Transmittal Form	Attachment 1o ENR 61 01 04 e1.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD	FR Citation: 67 FR 60776

Number of Respondents: 200	Number of Respondents for Small Entity: 60

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	400	400
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.