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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
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
To view an IC, click on IC Title