Cannabis Consumption Questionnaire Request Form

OMB No.: 0925-0642
Expiration Date: 03/31/2026

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

Thank you for your interest in the NCI Cannabis Consumption Questionnaire. To support our tracking of its use, please complete the following form. You will have access to the questionnaire once you complete and submit your information.

If you have questions, please contact Kelly Filipski at kelly.filipski@nih.gov. We appreciate your cooperation and look forward to supporting your research efforts.

Researcher Information

Name:

Title:

Institution / Research Affiliation:

Email:

Phone Number:

Research Details

Brief Description of the Research Project (Please include the primary research objective and relevance of cannabis consumption in your study):

Planned Participant Population (e.g., age range, health status, demographics):

Planned Recruitment Timeline (Estimated start and end dates):

Expected Use of the Cannabis Consumption Questionnaire (Please outline how the questionnaire will be integrated into your study):

Additional Details

Is this research study already approved or pending approval from an institutional review board (IRB)?

Yes, approved

Pending approval

Not required for this study

Would you like to receive updates or related resources from NCI?

Yes

Last Updated: 14 Apr, 2025