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National Network of Tobacco Cessation Quitlines Evaluation
National Network of Tobacco Censation Quitlines Evaluation
OMB: 0925-0576
IC ID: 45695
OMB.report
HHS/NIH
OMB 0925-0576
ICR 200610-0925-003
IC 45695
( )
Documents and Forms
Document Name
Document Type
Form 3
National Network of Tobacco Cessation Quitlines Evaluation
Form
3 Vendor
Attachment 2c Vendor.doc
Form
1 Partner Survey
Attachment 2d partner instrument.doc
Form
2 State Quitline
Attachment 2a state TCM instrument.doc
Form
4 Rep
Attachment 2e NAQC rep.doc
Form
5 SQ
Attachment 2b QA instrument.doc
Form
Attachment 3 letter.doc
Attachment 3 letter
IC Document
Attachment 6a confidentiality.doc
Attachment 6a confidentiality
IC Document
Attachment 4 IRB.doc
Attachment 4 IRB
IC Document
Attachment 6b system of records.doc
Attachment 6b system of records
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
National Network of Tobacco Cessation Quitlines Evaluation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
3
Vendor
Attachment 2c Vendor.doc
No
No
Paper Only
Form
1
Partner Survey
Attachment 2d partner instrument.doc
No
No
Paper Only
Form
2
State Quitline
Attachment 2a state TCM instrument.doc
No
No
Paper Only
Form
4
Rep
Attachment 2e NAQC rep.doc
No
No
Paper Only
Form
5
SQ
Attachment 2b QA instrument.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
228
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
228
0
228
0
0
0
Annual IC Time Burden (Hours)
171
0
171
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 3 letter
Attachment 3 letter.doc
10/16/2006
Attachment 6a confidentiality
Attachment 6a confidentiality.doc
10/16/2006
Attachment 4 IRB
Attachment 4 IRB.doc
10/16/2006
Attachment 6b system of records
Attachment 6b system of records.doc
10/16/2006
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.