Submission of NQDW Intake Questionnaire Electronic Data File

National Quitline Data Warehouse

OMB: 0920-0856

IC ID: 204102

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Submission of NQDW Intake Questionnaire Electronic Data File
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 0856 NQDW Att G2_NQDW SFTP Instructions for States.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

54 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 216 0 0 0 0 216
Annual IC Time Burden (Hours) 216 0 0 0 0 216
Annual IC Cost Burden (Dollars) 5,841 0 9 0 0 5,832

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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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