Information Collection

Follow-up for Callers who Received a Quitline Service

IC 193101 under ICR 201203-0920-010 · OMB 0920-0856.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0856 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Follow-up for Callers who Received a Quitline Service	Form
NQDW 7month follow up questionnaire F1. NQDW 7-month Follow-up Questionnaire REVISED 5 13 2011.docx	Form
F2. NQDW Advance Letter for Folllow-up.doc Attachment F2 - Advance letter for follow-up	IC Document

IC Title:

Follow-up for Callers who Received a Quitline Service

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NQDW 7month follow up questionnaire	F1. NQDW 7-month Follow-up Questionnaire REVISED 5 13 2011.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28,900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	28,900	28,900
Annual IC Time Burden (Hours)	3,372	3,372
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F2 - Advance letter for follow-up	F2. NQDW Advance Letter for Folllow-up.doc	05/17/2010

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