Attachment_26_-_Cumulative_Inclusion_Enrollment_Report.pdf
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- Attached to
- Surveillance, Epidemiology, and End Results (SEER) Program Federal contract opportunity
- Solicitation number
- 75N91019R00029
About this file
This document contains a Cumulative Inclusion Enrollment Report template for tracking participant demographics in a study titled "Surveillance, Epidemiology, and End Results (SEER) Program". The template includes fields for tracking enrollment numbers by sex, ethnicity, race and other demographic categories.
The related federal contract opportunity is a solicitation to ramp up additional cancer registries to participate in the Surveillance, Epidemiology, and End Results Program. The solicitation number is 75N91019R00029 and is being issued by the Surveillance Research Program within the National Cancer Institute and National Institutes of Health. The SEER Program collects and publishes cancer incidence and survival data to support cancer research and reduce the cancer burden. Interested parties should respond to the solicitation to provide their cancer registry data to the SEER Program.
Attachment 26 - Cumulative Inclusion Enrollment Report
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Text version
Cumulative Inclusion Enrollment Report
This report format should NOT be used for collecting data from study participants.
Study Title:
Comments:
Ethnic Categories
Racial Categories Not Hispanic or Latino Hispanic or Latino Unknown/Not Reported Ethnicity Total
Female Male Unknown/
Not Reported
Female Male Unknown/
Not Reported
Female Male Unknown/
Not Reported
American Indian/ Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Black or African American
White
More Than One Race
Unknown or Not Reported
Total
PHS 398 / PHS 2590 (Rev. 08/12 Approved Through 8/31/2015) OMB No. 0925-0001/0002 Page Cumulative Inclusion Enrollment Report oliverlj Typewritten Text Attachment 26: Cumulative Inclusion Enrollment Report
RFP: 75N91019R00029
| StudyTitle: |
| Comments: |
| PageNumber: |
| F_NotLatino_Indian: |
| M_NotLatino_Indian: |
| U_NotLatino_Indian: |
| F_Latino_Indian: |
| M_Latino_Indian: |
| U_Latino_Indian: |
| Total_Indian: 0 |
| F_NotLatino_Asian: |
| M_NotLatino_Asian: |
| U_NotLatino_Asian: |
| F_Latino_Asian: |
| M_Latino_Asian: |
| U_Latino_Asian: |
| Total_Asian: 0 |
| F_NotLatino_Pacific: |
| M_NotLatino_Pacific: |
| U_NotLatino_Pacific: |
| F_Latino_Pacific: |
| M_Latino_Pacific: |
| U_Latino_Pacific: |
| Total_Pacific: 0 |
| F_NotLatino_Black: |
| M_NotLatino_Black: |
| U_NotLatino_Black: |
| F_Latino_Black: |
| M_Latino_Black: |
| U_Latino_Black: |
| Total_Black: 0 |
| F_NotLatino_White: |
| M_NotLatino_White: |
| U_NotLatino_White: |
| F_Latino_White: |
| M_Latino_White: |
| U_Latino_White: |
| Total_White: 0 |
| F_NotLatinoMultiRace: |
| M_NotLatinoMultiRace: |
| U_NotLatinoMultiRace: |
| F_LatinoMultiRace: |
| M_LatinoMultiRace: |
| U_LatinoMultiRace: |
| Total_MultiRace: 0 |
| F_LatinoUnknwnRace: |
| M_LatinoUnknwnRace: |
| U_LatinoUnknwnRace: |
| Total_MaleNotLatino: 0 |
| Total_FemaleNotLatino: 0 |
| Total_FemaleLatino: 0 |
| Total_MaleLatino: 0 |
| F_NotLatinoUnknwnRace: |
| M_NotLatinoUnknwnRace: |
| U_NotLatinoUnknwnRace: |
| FUknwnEthnicityRace: |
| MUknwnEthnicityRace: |
| UUknwnEthnicityRace: |
| FUknwnEthnicityIndian: |
| FUknwnEthnicityAsian: |
| FUknwnEthnicityPacific: |
| FUknwnEthnicityWhite: |
| FUknwnEthnicityMultiRace: |
| MUknwnEthnicityIndian: |
| MUknwnEthnicityAsian: |
| MUknwnEthnicityPacific: |
| FUknwnEthnicityBlack: |
| MUknwnEthnicityWhite: |
| MUknwnEthnicityMultiRace: |
| UUknwnEthnicityIndian: |
| UUknwnEthnicityAsian: |
| UUknwnEthnicityPacific: |
| UUknwnEthnicityBlack: |
| UUknwnEthnicityWhite: |
| UUknwnEthnicityMultiRace: |
| Total_UnknownSexEthnicity: 0 |
| Total_UnknownRace: 0 |
| Total_UnknownSexNotLatino: 0 |
| Total_UnknownSexLatino: 0 |
| Total_FemaleUnknownEthnicity: 0 |
| Total_MaleUnknownEthnicity: 0 |
| MUknwnEthnicityBlack: |
| Total_AllParticipants: 0 |
File details come from the government source that posted it. Updated .