Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Modified 86 1 39 Form and Instruction none ASQ Intake questionnaire - Chinese - subset
Form and Instruction none ASQ Intake Questionnaire - Korean - subset
Form and Instruction none ASQ Intake Questionnaire - Vietnamese - subset
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Modified 1935 323 8708 Form none ASQ Questionnaire - Chinese
Form none ASQ Questionnaire - Korean
Form none ASQ Questionnaire - Vietnamese
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Modified 1587 185 4999 Form and Instruction none ASQ 7 month follow-up - English
Form and Instruction none ASQ 7 month follow-up - Chinese
Form and Instruction none ASQ 7 month follow-up - Korean
Form and Instruction none ASQ 7 month Follow-up - Vietnamese
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves Modified 488846 81474 2199807 Form none Intake Questionnaire
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else Modified 12217 204 5508 Form none NQDW Intake Questionnaire Subset
NQDW Quitline Services Survey Modified 108 36 972 Form and Instruction none Quitline Services Survey
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File to CDC Modified 1 1 27 Instruction
Submission of NQDW Intake Questionnaire Electronic Data File to CDC Modified 216 216 5832 Instruction
Total burden requested under this ICR: 504996 82440 2225892  
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