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
CIS LiveHelp Questionnaire (Appendix 1B_REV) Removed 0 0 0 Form and Instruction 3
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
CIS Smoking Cessation Reactive Service "Intake" Questions (Appendix 1C_REV) Removed 0 0 0 Form and Instruction 4
CIS Telephone Customer Service Questions (Appendix 1A_REV) Removed 0 0 0 Form and Instruction 1
CIS Telephone Demographic Questions (Appendix 1A_REV) Removed 0 0 0 Form and Instruction 2
Customer Satisfaction Survey New 15665 522 0 Form and Instruction 6
E-mail Clients New 1000 167 0 Form and Instruction 8
LiveHelp Clients New 6119 204 0 Form and Instruction 7
Smoking Cessation Clients Demographic Questions New 3995 133 0 Form and Instruction 4
Smoking Cessation Clients Smoking Cessation "Intake" Questions New 5707 380 0 Form and Instruction 3
Telephone Clients Customer Service New 65500 1092 0 Form and Instruction 1
Telephone Clients Demographic Questions New 23580 786 0 Form and Instruction 2
VA Smoking Cessation Clients Call Backs New 6160 103 0 Form and Instruction 5
Total burden requested under this ICR: 127726 3387 0  
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