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

OMB: 0925-0208

IC ID: 189805

Information Collection (IC) Details

View Information Collection (IC)

CIS Smoking Cessation Reactive Service "Demographic" Questions (Appendix 1C_REV)
 
No Modified
 
Voluntary
 

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

Health Illness Prevention

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

1,300 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,300 0 0 0 0 1,300
Annual IC Time Burden (Hours) 43 0 0 0 0 43
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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