Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Modified 249 4 112 Form and Instruction None ASQ Intake Questionnaire - subset (Chinese)
Form and Instruction None ASQ Intake Questionnaire - subset (Korean)
Form and Instruction None ASQ Intake Questionnaire - subset (Vietnamese)
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Modified 1686 281 7598 Form and Instruction None ASQ Intake Questionnaire (Chinese)
Form and Instruction None ASQ Intake Questionnaire (Korean)
Form and Instruction None ASQ Intake Questionnaire (Vietnamese)
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Modified 236 28 744 Form and Instruction None ASQ 7-month Follow-up Questionnaire (Chinese)
Form and Instruction None ASQ 7-month Follow-up Questionnaire (Korean)
Form and Instruction None ASQ 7-month Follow-up Questionnaire (Vietnamese)
Form and Instruction None ASQ 7-month Follow-up Questionnaire (English translation for reference)
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves Modified 405053 67509 1825412 Form and Instruction None NQDW Intake Questionnaire
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else Modified 819 14 369 Form and Instruction None NQDW Intake Questionnaire
NQDW Quitline Services Survey Modified 108 36 973 Form and Instruction None NQDW Quitline Services Survey
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File Modified 1 1 27 Instruction
Submission of NQDW Intake Questionnaire Electronic Data File Modified 216 216 5841 Instruction
Total burden requested under this ICR: 408368 68089 1841076  
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