Information Collection

National Network of Tobacco Cessation Quitlines Evaluation

IC 45695 under ICR 200610-0925-003 · OMB 0925-0576.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Vendor National Network of Tobacco Cessation Quitlines Evaluation	Form
Form 1 Partner Survey National Network of Tobacco Cessation Quitlines Evaluation	Form
Form 2 State Quitline National Network of Tobacco Cessation Quitlines Evaluation	Form
Form 4 Rep National Network of Tobacco Cessation Quitlines Evaluation	Form
Form 5 SQ National Network of Tobacco Cessation Quitlines Evaluation	Form
3 Vendor Attachment 2c Vendor.doc	Form
1 Partner Survey Attachment 2d partner instrument.doc	Form
2 State Quitline Attachment 2a state TCM instrument.doc	Form
4 Rep Attachment 2e NAQC rep.doc	Form
5 SQ Attachment 2b QA instrument.doc	Form
Attachment 3 letter.doc Attachment 3 letter	IC Document
Attachment 6a confidentiality.doc Attachment 6a confidentiality	IC Document
Attachment 4 IRB.doc Attachment 4 IRB	IC Document
Attachment 6b system of records.doc Attachment 6b system of records	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3	No	No	Paper Only
Form	1	No	No	Paper Only
Form	2	No	No	Paper Only
Form	4	No	No	Paper Only
Form	5	No	No	Paper Only

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 228

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	228	228
Annual IC Time Burden (Hours)	171	171
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3 letter		10/16/2006
Attachment 6a confidentiality		10/16/2006
Attachment 4 IRB		10/16/2006
Attachment 6b system of records		10/16/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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