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Agenda
Reg Review
ICR
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
To view an IC, click on IC Title