NQDW Quitline Services Survey

National Quitline Data Warehouse

Documents and Forms

Document Name Document Type
NQDW Quitline Services Survey Form and Instruction
NQDW Quitline Services Survey 0856 NQDW Att F_NQDW Quitline Services Survey.docx Form and Instruction
NQDW Quitline Services Survey 0856 NQDW Att F_NQDW Quitline Services Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NQDW Quitline Services Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	NQDW Quitline Services Survey	0856 NQDW Att F_NQDW Quitline Services Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	108	0	108
Annual IC Time Burden (Hours)	36	0	36
Annual IC Cost Burden (Dollars)	973	1	972

Documents for IC

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.