CCSS Application of Intent

Asterisk (*) indicates a required field.

Contact Information
Project Requirements and Description

Requirements to submit AOI

Does this project require contact of CCSS study subjects for:

What CCSS Working Group(s) would likely be involved? (Check all that apply)

Outcomes or Correlative Factors

To describe the anticipated scope of the study, please indicate the specific CCSS data to be included as outcome (primary or secondary) or correlative factors. (Check all that apply)

Health Behaviors


Medical Conditions


Psychologic/Quality of Life



Cancer treatment

Anticipated Sources of Statistical Support
Other General Comments