Information Collection

Follow-up for Callers who Received a Quitline Service

IC 193101 under ICR 201006-0920-002 · OMB 0920-0856.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0856 can be found here:

Documents and Forms

Document Name Document Type
Follow-up for Callers who Received a Quitline Service Form
NQDW follow-up questionnaire F1. NQDW 7-month Follow-up Questionnaire_05-04-10.docx Form
F2. NQDW Advance Letter for Folllow-up.doc Attachment F2 - Advance letter for follow-up IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Follow-up for Callers who Received a Quitline Service	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NQDW follow-up questionnaire	F1. NQDW 7-month Follow-up Questionnaire_05-04-10.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	28,900	28,900
Annual IC Time Burden (Hours)	3,372	3,372
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F2 - Advance letter for follow-up	F2. NQDW Advance Letter for Folllow-up.doc	05/17/2010

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