Form 1 GCHD Supplement survey

OMB No.: 0925-0766
Expiration Date: 04/30/2023
Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of participants are protected by
The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing at any time. Refusal to
participate will not affect your benefits in any way. The information collected will be kept private to the extent provided by law. Names and
other identifiers will not appear in any report. Information provided will be combined for all participants and reported as summaries. You are
being contacted by email to complete this form so that NCI can learn about the accomplishments and any lessons learned that may inform
future efforts to advance cancer health disparities research globally.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays
a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925-0766). Do not return the completed form to this address.

Administrative Supplements to Stimulate or Strengthen Global
Cancer Health Disparities Research
PI Request
The National Cancer Institute’s Center for Global Health is requesting the completion of this information
collection request by the recipients of the administrative supplements to stimulate or strengthen global
cancer health disparities research (NOT-CA-20-032). The supplements were issued to support NCIfunded investigators to add global populations, biospecimens, and/or data to their currently funded
research projects to advance/accelerate the progress in understanding and addressing cancer health
disparities in the U.S. and globally. The purpose is to learn about accomplishments and lesions learned
from this supplement award to inform future efforts to advance cancer health disparities research
globally.
Objectives of this request:
1. Determine the outcomes of the supplements towards understanding cancer health disparities
globally
2. Identify facilitators and challenges towards meeting the aims of the supplement award
This request should be completed by the investigator who has sufficient knowledge of the
supplement project. Your responses to this request will not be used to evaluate your project
specifically nor inform current or future funding decisions for your projects. This request is voluntary
and should take approximately 15 minutes to complete. If you have any questions, please contact
the supplement program director at james.alaro@nih.gov. Thank you for your help.

1.

Please provide your name.

2.

Provide the parent award number.

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3.

Where did you learn about the Administrative Supplement to Stimulate or Strengthen Global
Cancer Health Disparities Research?
❑ U.S. NIH Guide
❑ U.S. NIH Program Officer
❑ Colleague
❑ Conference
❑ Institution
❑ Webinar
❑ Other

4.

Please select one that best describes your experience in cancer health disparities research prior
to this supplement award.
❑ Experience conducting research focused only on domestic (US) cancer health
disparities
❑ Experience conducting research focused only on global (outside US) cancer health
disparities
❑ Experience conducting research focused on both domestic and global cancer health
disparities
❑ No prior experience conducting research focused on cancer health disparities

5.

Provide the supplement project tittle.

6.

Briefly state the primary objective or scientific aim of the supplement project.

7.

Which world region did the global population/sample/data originate?
❑ North America
❑ Latin America-Caribbean
❑ Africa
❑ Asia
❑ Europe

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❑ Other (specify)

8.

Did the global population included in your supplement relate/correspond to any of the U.S.
populations listed below? Select all that apply.
❑ Hispanic or Latino
❑ Not Hispanic or Latino
❑ Black or African American
❑ American Indian and Alaska Native
❑ Asian
❑ Native Hawaiian and Other Pacific Islander
❑

9.

White

Briefly describe the primary findings and/or outcomes of your research.

10. Indicate how the inclusion of the global population contributed to advancing the understanding

of cancer health disparities.

11. List any scientific products, such as publications or presentations that are directly associated

with this supplement award.

12. Are you interested in continuing this line of research?

❑ Yes
❑ No
If yes, briefly describe any follow-up plans or future interests/direction.

13. Did the research involve any foreign collaborators?

❑ Yes
❑ No
If yes, specify role played.
❑ Research question
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❑ Study design
❑ Data/sample collection
❑ Data analysis/interpretation
❑ Results dissemination
❑ Other (Specify)
For questions 14 and 15, you may consider but not limited to funding level, access to
populations/samples/data, policies and regulations, collaborators, past relationships.
14. List the top three aspects that facilitated or contributed to the accomplishment of the objectives

of the supplement.

15. List the top three most challenging aspects in accomplishing the objectives of the supplement

and how you addressed them.

16. Did you receive any additional funding, outside of this award to support the supplement

project?
❑ Yes
❑ No
If yes, what were the sources of the additional funds?
❑ Funds from my institution
❑ Funds from U.S. government (non-NIH, e.g., CDC, USAID)
❑ Funds from U.S. corporate/private sector/non-profit organization
❑ Funds from international government
❑ Funds from international corporate/private sector/non-profit organization
❑ Other
17. Please provide recommendation/s and/or lessons learned on how best to advance cancer health

disparities research globally.

18. Please indicate whether you would like to continue to be engaged in NCI’s efforts to advance

cancer health disparities research globally.
❑ Yes
❑ No
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