Quitline Services Questionnaire

National Quitline Data Warehouse

OMB: 0920-0856

IC ID: 193102

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-WORD
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Quitline Services Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction G1 Quitline Serivces Online Survey G1 Quitline Services Online Survey_file 1.pdf Yes Yes Fillable Fileable
Form and Instruction G1 (2) G1 Quitline Services Online Survey file 2 G1 Quitline Services Online Survey_file 2.pdf Yes Yes Fillable Fileable
Other-WORD G2. NQDW Quitline Services Survey_Rev 2013.docx Yes Yes Fillable Printable

Health Illness Prevention

 

53 0
   
State, Local, and Tribal Governments
 
   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 212 0 0 0 0 212
Annual IC Time Burden (Hours) 71 0 0 0 0 71
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
G2 G2. Advance Email for Services Questionnaire.docx 09/19/2012
G3 G3. Reminder Email for Services Questionnaire.docx 09/19/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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