Information Collection

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

IC 189804 under ICR 201512-0925-003 · OMB 0925-0208.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 CIS Smoking Cessation Reactive Service "Intake" Questions (Appendix 1C_REV)	Form and Instruction
4 Smoking Cessation Reactive Service Client Questions Appendix 1C_REV_Reactive Smoking Cessation.doc	Form and Instruction

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Smoking Cessation Reactive Service Client 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: 4,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-4,200	4,200
Annual IC Time Burden (Hours)	-350	350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.