National Quitline Data Warehouse

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Quitline Services Questionnaire	Form	New	Available
Follow-up for Callers who Received a Quitline Service	Form	New	Available
Intake Information for Callers who Contact the Quitline for Personal Use	Form	New	Available
Intake Information for Callers who Contact the Quitline for Someone Else	Form	New	Available
NQDW SS Part B 05-04-10.docx	Supporting Statement B	Uploaded 2010-05-17	Available
NCCDPHP 684 Non-Research Determination 0920-10BT.xps	Supplementary Document	Uploaded 2010-05-17	Repair queued
H. Sample Table Shells.docx	Supplementary Document	Uploaded 2010-05-17	Available
D. Consultants.docx	Supplementary Document	Uploaded 2010-05-17	Available
C. Summary of Public Comments.doc	Supplementary Document	Uploaded 2010-05-17	Available
B. Federal Register Notice.pdf	Supplementary Document	Uploaded 2010-05-17	Available
A2. Public Health Service Act.doc	Supplementary Document	Uploaded 2010-05-17	Available
A1. ARRA of 2009.pdf	Supplementary Document	Uploaded 2010-05-17	Available
G3. Reminder Email for Services Questionnaire.docx	Supplementary Document	Uploaded 2010-05-17	Available
G2. Advance Email for Services Questionnaire.docx	Supplementary Document	Uploaded 2010-05-17	Available
F2. NQDW Advance Letter for Folllow-up.doc	Supplementary Document	Uploaded 2010-05-17	Repair queued
NQDW SS Part A 05-13-10.doc	Supporting Statement A	Uploaded 2010-05-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193102	Quitline Services Questionnaire	Form	New
193101	Follow-up for Callers who Received a Quitline Service	Form	New
193100	Intake Information for Callers who Contact the Quitline for Personal Use	Form	New
193099	Intake Information for Callers who Contact the Quitline for Someone Else	Form	New

ICR Details

OMB Control No: 0920-0856	ICR Reference No: 201006-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Quitline Data Warehouse
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2010
	Date Received in OIRA: 06/01/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	24 Months From Approved
Responses	759,112	0	0
Time Burden (Hours)	90,563	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC will collect newly standardized information from Quitline service providers in 50 states, DC, Puerto Rico and Guam. Data about each program will be collected, as well as caller intake and follow-up data. Information will be used for program improvement and to evaluate the expenditure of funding provided by the ARRA of 2009.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009
   US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 9224	03/01/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 28620	05/21/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Intake Information for Callers who Contact the Quitline for Someone Else	none	NQDW intake questionnaire
Intake Information for Callers who Contact the Quitline for Personal Use	none	NQDW intake questionnaire
Follow-up for Callers who Received a Quitline Service	none	NQDW follow-up questionnaire
Quitline Services Questionnaire	none	NQDW services questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	759,112	0	0	759,112	0	0
Annual Time Burden (Hours)	90,563	0	0	90,563	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new one-time ICR necessary for the improvement and evaluation of the National Tobacco Control Program. Information also will be used to assist in the evaluation of funding provided by the ARRA of 2009.

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Annual Cost to Federal Government: $3,125,962

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/01/2010

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