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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
CIS Email Intake Form (Appendix 2_REV)
Removed
0
0
0
Form and Instruction
6
Email Intake
CIS LiveHelp Questionnaire (Appendix 1B_REV)
Removed
0
0
0
Form and Instruction
3
LiveHelp Questionnaire
CIS Smoking Cessation Proactive Follow-ups (Appendix 1D_REV)
Removed
0
0
0
Instruction
CIS Smoking Cessation Reactive Service "Demographic" Questions (Appendix 1C_REV)
Removed
0
0
0
Form and Instruction
5
Smoking Cessation Reactive Service Demographic Questions
CIS Smoking Cessation Reactive Service "Intake" Questions (Appendix 1C_REV)
Removed
0
0
0
Form and Instruction
4
Smoking Cessation Reactive Service Client Questions
CIS Telephone Customer Service Questions (Appendix 1A_REV)
Removed
0
0
0
Form and Instruction
1
Telephone Customer Service Questions
CIS Telephone Demographic Questions (Appendix 1A_REV)
Removed
0
0
0
Form and Instruction
2
Telephone Demographic Questions
Customer Satisfaction Survey
New
15665
522
0
Form and Instruction
6
Appendix 9 Customer Satisfaction Survey Questions
E-mail Clients
New
1000
167
0
Form and Instruction
8
Appendix 2 Email Intake Form on Cancer,gov
LiveHelp Clients
New
6119
204
0
Form and Instruction
7
Appendix 1B LiveHelp Demographic Questions and Sample Transcript
Smoking Cessation Clients Demographic Questions
New
3995
133
0
Form and Instruction
4
Appendix 1C Smoking Cessation Questions
Smoking Cessation Clients Smoking Cessation "Intake" Questions
New
5707
380
0
Form and Instruction
3
Appendix 1C Smoking Cessation Questions
Telephone Clients Customer Service
New
65500
1092
0
Form and Instruction
1
Appendix 1A Customer Service and Demographic Questions
Telephone Clients Demographic Questions
New
23580
786
0
Form and Instruction
2
Appendix 1A Customer Service and Demographic Questions
VA Smoking Cessation Clients Call Backs
New
6160
103
0
Form and Instruction
5
Appendix 1D VA Smoking Cessation Callback
Total burden requested under this ICR:
127726
3387
0
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