Information Collection

Follow-up for Callers who Received a Quitline Service

IC 193101 under ICR 201207-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form F1 Follow-up for Callers who Received a Quitline Service	Form and Instruction
F1 NQDW 7-Month Follow-Up questionnaire F1 NQDW 7-month Follow-up Questionnaire_Final.docx	Form and Instruction
F2. NQDW Advance Letter for Folllow-up.doc F2. NQDW Advance Letter for Folllow-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 and Instruction	F1	NQDW 7-Month Follow-Up questionnaire	F1 NQDW 7-month Follow-up Questionnaire_Final.docx		No		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
F2. NQDW Advance Letter for Folllow-up	F2. NQDW Advance Letter for Folllow-up.doc	09/17/2012

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