Intake Information for Callers who Contact the Quitline for Personal Use

National Quitline Data Warehouse

OMB: 0920-0856

IC ID: 193100

Information Collection (IC) Details

View Information Collection (IC)

Intake Information for Callers who Contact the Quitline for Personal Use
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction E1(a) NQDW Intake Questionnaire E1(a) NQDW Intake Questionnaire_complete final.pdf No No Fillable Fileable

Health Illness Prevention

 

510,768 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 510,768 0 0 0 0 510,768
Annual IC Time Burden (Hours) 85,128 0 0 0 0 85,128
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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