Information Collection

NQDW Quitline Services Survey

IC 193102 under ICR 202503-0920-037 · OMB 0920-0856.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NQDW Quitline Services Survey	Form and Instruction
NQDW Quitline Services Survey 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	None				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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	973	973

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.

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