Information Collection

VA Smoking Cessation

IC 219413 under ICR 202504-0925-001 · OMB 0925-0208.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 VA Smoking Cessation	Form
Form 1 Smoking Call Back Task VA Smoking Cessation	Form
1 Smoking Call Back Task Appendix 1D Smoking Call Back Task.docx	Form
1 Smoking Call Back Task Appendix 1D Smoking Call Back Task.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0156, âRecords of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service

FR Citation: 67 FR 60742

Number of Respondents: 8,840

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,840	8,840
Annual IC Time Burden (Hours)	589	589
Annual IC Cost Burden (Dollars)	0	0

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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