12 Week Post Quit Date Questionnaire (Attachment 19)

The National Cancer Institute (NCI) SmokefreeTXT (Text Message) Program Evaluation

OMB: 0925-0676

IC ID: 206358

Information Collection (IC) Details

View Information Collection (IC)

12 Week Post Quit Date Questionnaire (Attachment 19)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5 12 Week Post Quit Date Questionnaire Attach19_SFTXT_12WeekSurvey_12062012.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

SORN #09-25-0156, "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

1,088 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 1,088 0 1,088 0 0 0
Annual IC Time Burden (Hours) 272 0 272 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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