CIS Smoking Cessation Reactive Service "Demographic" Questions (Appendix 1C_REV)

Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0208 can be found here:

Documents and Forms

Document Name Document Type
Form 5 CIS Smoking Cessation Reactive Service "Demographic" Questions (Appendix 1C_REV) Form and Instruction
5 Smoking Cessation Reactive Service Demographic Questions Appendix 1C_REV_Reactive Smoking Cessation.doc Form and Instruction

Information Collection (IC) Details

IC Title:	CIS Smoking Cessation Reactive Service "Demographic" Questions (Appendix 1C_REV)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5	Smoking Cessation Reactive Service Demographic Questions	Appendix 1C_REV_Reactive Smoking Cessation.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"	FR Citation: 67 FR 60743

Number of Respondents: 1,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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