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Data Submission Form

    Submission Form
  1. Choose the data submission type.
    • 24–Month data
    • 12–Month Data
    • Both (24 month and 12 month data)
  2. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Death Clearance Conducted'.
    Input the 'Name' as Primary contact for data submission and 'Phone Number' with (xxx)xxx–xxxx format.
    Choose 'Yes or No' for 'Death Clearance Conducted' for each 'Diagnosis Year' or
    Choose 'Yes or No' for 'Repeat for all years?' to select all diagnosis years together.
  3. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – IHS Linkage'.
    Choose 'Yes or No or Not Applicable' for 'IHS Linkage' for each 'Diagnosis Year' or
    Choose 'Yes or No or Not Applicable' for 'Repeat for all years?' to select all diagnosis years together.
  4. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – VHA Data Source '.
    Choose 'VHA Only or Any VHA or Neither' for 'VHA Data Source' for each 'Diagnosis Year' or
    Choose 'VHA Only or Any VHA or Neither' for 'Repeat for all years?' to select all diagnosis years together.
  5. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – NHAPIIA Run and NHIA Exclusion'.
    • NHAPIIA Run
      Run the NAACCR Hispanic and Asian/Pacific Islander Identification Algorithm and record the derived NHIA and NHAPIIA variable. For details, refer to 2013 Submission Specification. Enter "S" if the NAACCR NHAPIIA SAS algorithm(NHIA v2.2.1 and NHAPIIA v1.2.1) was run, "R" if algorithm programmed into registry software, "O" if used another program that follows the NHIA algorithm, or "N" if not done.
    • NHIA Exclusion
      In running the NHIA algorithm, we strongly recommend that registries choose option 1, which limits the Spanish surname portion of the algorithm to cases coded as surname only (item 190=7) or unknown whether Hispanic (item 190=9) in counties that are less than 5% Hispanic. Enter "No Exclusion", "Option 1", "Option 2" or "Other".
      Definitions:
      No Exclusions were Applied(this is the default in the SAS program).
      Option 1: In counties in which less than 5% of the population is of Hispanic ethnicity, the surname portion of the algorithm was only applied to cases coded as "Spanish surname only" or "Unknown whether Spanish or not" (item 190 – codes 7 or 9).
      Option 2: In counties in which less than 5% of population is of Hispanic ethnicity, the surname portion of the algorithm was only applied to cases coded as "Spanish surname only" (item 190 – code 7). All cases coded to "Unknown whether Spanish or not" (item 190 – code 9) were converted to non–Hispanic in NHIA.
  6. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Data Item Not Transmitted'.
    • Click 'Delete' to delete the Data Item
    • Select the data item(s) from the drop-down list for each diagnosis year. Multiple data items may be selected by checking the checkbox as you make your selections and press "Add" button. Provide an explanation in "Comments" for each added data item. Please select "None" if you don't have any selection from Data Item Not Transmitted
  7. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Duplicate Protocol'.
  8. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Conducted active follow up to determine vital status'.
    Choose 'All Sites or Selected Site(s) or Not Done' for each Diagnosis Year or
    Choose 'All Sites or Selected Site(s) or Not Done' for 'Repeat for all years?' to select all diagnosis years together.
    • Choose 'Selected Site(s)', the 'Select site(s) from the listed' will be enabled to select.
    • Choose 'All Sites or Not Done', the 'Select site(s) from the listed' will be disabled.
  9. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Linked with state vital statistics records to update vital status, including date and cause of death'.
    Has same functionality as step 8.
  10. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Linked with National Death Index to update vital status, including date of death'.
    Has same functionality as step 8.
  11. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Linked with National Death Index to update vital status, including date and cause of death'.
    Has same functionality as step 8.
  12. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Linked with Social Security Death Master File'.
    Has same functionality as step 8.
  13. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – Linked with other sources to update vital status (please specify below)'.
    Has same functionality as step 8.
  14. Click 'Next' button and navigate to 'NPCR–CSS Submission Form – No linkages performed'.
    Has same functionality as step 8.
  15. Click 'Next' button and navigate to the review page of 'NPCR–CSS Submission Form', modify each section by clicking the corresponding button.
  16. Click 'Submit and Get Participation Agreement form' button and navigate to 'Attachment 10 2013 NPCR–CSS Dataset Participation Agreement' form.
    Click 'Back to Introduction Page' and navigate to 'Introduction' page.
    Submission Form Review     Re-submit Data Submission Form

       Click 'Re-submit Data Submission Form' link on the Introduction page and start to re-submit.

    Participation Agreement

       Click 'Go to Participation Agreement' link on the Introduction page to review the Participation Agreement form.

    Re-submit Participation Agreement Form

       Click 'Go to Participation Agreement' link on the Introduction page and navigate to the Participation Agreement form to re-submit.

Print Blank Submission Form

    Click 'Print Blank Submission Form' link to print the blank submission form.

Print Blank Attachment 10 2013 NPCR–CSS Dataset Participation Agreement

    Click 'Print Blank Attachment 10' link to print the blank Attachment 10 – 2013 NPCR–CSS Dataset Participation Agreement.

Download Adobe Reader

    Click 'Download Adobe Reader' link to download the Adobe Reader to view Portable Document Format (PDF) files.

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