Information Collection

Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire

IC 218544 under ICR 202503-0920-037 · OMB 0920-0856.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Chinese) Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Korean) Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Vietnamese) Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction
ASQ 7-month Follow-up Questionnaire (English translation for reference) Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Chinese) 0856 NQDW Att E1_NQDW_ASQ_7-month follow-up questionnaire_CHINESE.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Chinese) 0856 NQDW Att E1_NQDW_ASQ_7-month follow-up questionnaire_CHINESE.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Korean) 0856 NQDW Att E2_NQDW_ASQ_7-Month follow-up questionnaire_KOREAN.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Korean) 0856 NQDW Att E2_NQDW_ASQ_7-Month follow-up questionnaire_KOREAN.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Vietnamese) 0856 NQDW Att E3_NQDW_ ASQ_7-Month follow-up questionnaire_VIETNAMESE.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (Vietnamese) 0856 NQDW Att E3_NQDW_ ASQ_7-Month follow-up questionnaire_VIETNAMESE.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (English translation 0856 NQDW Att E4_NQDW_ ASQ_7-Month follow-up questionnaire_ENGLISH.docx	Form and Instruction
ASQ 7-month Follow-up Questionnaire (English translation 0856 NQDW Att E4_NQDW_ ASQ_7-Month follow-up questionnaire_ENGLISH.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 236

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	236	236
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	744	744

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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