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Federal forms, ICRs, and supporting documents

Information Collection

Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)

IC 218543 under ICR 202503-0920-037 · OMB 0920-0856.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None ASQ Intake Questionnaire (Chinese) 0856 NQDW Att C2_NQDW_ASQ_Intake Questionnaire_CHINESE.docx Yes Yes Fillable Fileable
Form and Instruction None ASQ Intake Questionnaire (Korean) 0856 NQDW Att C3_NQDW_ASQ_Intake Questionnaire_KOREAN.docx Yes Yes Fillable Fileable
Form and Instruction None ASQ Intake Questionnaire (Vietnamese) 0856 NQDW Att C4_NQDW_ASQ_Intake Questionnaire_VIETNAMESE.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

1,686 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 1,686 0 0 0 0 1,686
Annual IC Time Burden (Hours) 281 0 0 0 0 281
Annual IC Cost Burden (Dollars) 7,598 0 0 0 0 7,598

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