Form 5 VA Calls Back

Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI's Contact Center, Cancer Information Service (CIS) Clients (NCI)

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0925-0208 can be found here:

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NCI/Office of Communications and Public Liaison

APPENDIX 1E

VA Follow Up Calls

VA Follow Up Calls

https://livehelp.cancer.gov/ci/documents/detail/5/19/12/2c9810044bcf5284c3322f369266f4850fecf65d

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Smoking Cessation Intake Form (SCIF Screen Shots
Subject	SMOKING CESSATION INTAKE FORM (SCIF) with SCREEN SHOTS
Author	Burstyn, Ilene (NIH/NCI) [E]
File Modified	0000-00-00
File Created	2022-01-12