Privacy Act Memo

Attachment 5 Privacy Act Memo.pdf

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

Privacy Act Memo

OMB: 0925-0774

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DATE:

March 21, 2024

TO:

Amy Williams
Office of Advocacy Relations
Office of the Director, National Cancer Institute (NCI)

FROM:

NIH Privacy Act Officer

SUBJECT: Applicability of the Privacy Act: “Stakeholder Measures and Advocate Forms at the National
Cancer Institute (NCI)”
I have reviewed the NCI submission to OMB entitled, “Stakeholder Measures and Advocate Forms at the
National Cancer Institute (NCI)” to collect data from different stakeholder constituencies for the purpose of
program development, monitoring and improvement.
I have determined that the Privacy Act will apply to this data collection which involves the collection of
personally identifiable information such as gender, age, race/ethnicity, address, telephone number, email
address, income, education, medical /health status, years at NCI and work focus (scientific or communications).
Information provided by respondents will be kept confidential and private, and the presentation of data in
reports will be in aggregate form, with no links to individuals preserved. Data will not be retrieved by personal
identifiers unless the respondent voluntarily agrees to provide the information, so he/she can be contacted for
follow-up.
This data collection is covered by NIH Privacy Act Systems of Record 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.”
If you have any questions, please contact my office at (301) 402-6201.

Dustin B.
Close -S
Dustin Close
Cc: Diane Kreinbrink, NCI PRA Liaison

Digitally signed by
Dustin B. Close -S
Date: 2024.03.22
07:30:38 -04'00'


File Typeapplication/pdf
File TitleMicrosoft Word - NCI A Generic Submission for Formative Research, Pre-testing, Stakeholder Measures and Advocate Forms at NCI
AuthorClose, Dustin (NIH/OD) [E]
File Modified2024-03-22
File Created2024-03-22

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