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
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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