Attachment_09_-_Planned_Enrollment_Report.pdf

PDF 1 MB Posted

Attached to
Surveillance, Epidemiology, and End Results (SEER) Program Federal contract opportunity
Solicitation number
75N91019R00029
Issued by
Department of Health and Human Services National Institutes of Health National Cancer Institute

About this file

This document contains a planned enrollment report template for a domestic study being conducted by the National Cancer Institute. The template requires projected enrollment numbers by sex, ethnicity, and race to be provided for a study titled with an unspecified name. Data should be recorded for both Hispanic or Latino and Not Hispanic or Latino individuals across several racial categories including American Indian/Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, Black or African American, White, and More Than One Race. Additional information requested includes study title, domestic/foreign designation, and comments. All projected enrollment fields in the template are currently blank.

The related federal contract opportunity is a solicitation by the National Cancer Institute to ramp-on additional registries to its Surveillance, Epidemiology, and End Results Program. The solicitation number is 75N91019R00029 and is seeking to expand the Surveillance Research Program and Prevention, Control and Population Sciences Branch. No further details are provided on the required services, response deadline, or place of performance.

Attachment 09 - Planned Enrollment Report

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Text version

Planned Enrollment Report

This report format should NOT be used for collecting data from study participants.

Study Title:

Domestic/Foreign: Domestic

Comments:

Ethnic Categories

Racial Categories Not Hispanic or Latino Hispanic or Latino Total

Female Male Female Male

American Indian/ Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Black or African American

White

More Than One Race

Total

PHS 398 / PHS 2590 (Rev. 08/12 Approved Through 8/31/2015) OMB No. 0925-0001/0002 Page Planned Enrollment Report oliverlj Typewritten Text oliverlj Typewritten Text oliverlj Typewritten Text Attachment 09: Planned Enrollment Report Page 1 of 1

RFP: 75N91019R00029

M_NotLatino_Indian:
F_NotLatino_Asian:
F_NotLatino_Pacific:
F_NotLatino_Black:
F_NotLatino_White:
F_NotLatinoMultiRace:
M_NotLatino_Asian:
M_NotLatino_Pacific:
M_NotLatino_Black:
M_NotLatino_White:
M_NotLatinoMultiRace:
F_Latino_Indian:
F_Latino_Asian:
F_Latino_Pacific:
M_Latino_Indian:
F_Latino_Black:
F_Latino_White:
F_LatinoMultiRace:
M_Latino_Asian:
M_Latino_Pacific:
M_Latino_Black:
M_LatinoMultiRace:
DomesticForeign: [Domestic]
Comments:
StudyTitle:
Total_Indian: 0
Total_Asian: 0
Total_Pacific: 0
Total_Black: 0
M_Latino_White:
Total_White: 0
Total_MultiRace: 0
Total_FemaleNotLatino: 0
Total_MaleNotLatino: 0
Total_FemaleLatino: 0
Total_MaleLatino: 0
Total_AllStudyParticipants: 0
PageNumber:
F_NotLatino_Indian:

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