National Quitline Data Warehouse

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form GI (2) Quitline Services Online Survey	Form and Instruction	Modified	Available
Form G1 Quitline Serivces Online Survey	Form and Instruction	Modified	Available
Form F1 NQDW 7-Month Follow-Up questionnaire	Form and Instruction	Modified	Available
Form E1(a) NQDW Intake Questionnaire	Form and Instruction	Modified	Available
Form E1(b) NQDW Intake Questionnaire Subset Final	Form and Instruction	Modified	Available
NQDW_SS_Part_B_9 10 2012.docx	Supporting Statement B	Uploaded 2012-09-17	Available
H. Sample Table Shells.docx	Supplementary Document	Uploaded 2012-09-17	Available
NCCDPHP 684 NonResearch Determination.pdf	Supplementary Document	Uploaded 2012-09-17	Available
D. Consultants.docx	Supplementary Document	Uploaded 2012-09-17	Available
C. Summary of Public Comments and CDC Response.pdf	Supplementary Document	Uploaded 2012-09-17	Available
A3. ARRA of 2009.pdf	Supplementary Document	Uploaded 2012-09-17	Available
A2. ACA Section 4002 PPHF (1).pdf	Supplementary Document	Uploaded 2012-09-17	Available
A1. PHSA.doc	Supplementary Document	Uploaded 2012-09-17	Available
G2. Advance Email for Services Questionnaire.docx	Supplementary Document	Uploaded 2012-09-17	Available
F2. NQDW Advance Letter for Folllow-up.doc	Supplementary Document	Uploaded 2012-09-17	Available
NQDW_SS_Part_AFinal final.doc	Supporting Statement A	Uploaded 2012-09-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204102	Instructions for submitting caller intake and follow up	Instruction	New
193102	Quitline Services Questionnaire	Form and Instruction	Modified	Quitline Services Online Survey
193102	Quitline Services Questionnaire	Form and Instruction	Modified	Quitline Serivces Online Survey
193101	Follow-up for Callers who Received a Quitline Service	Form and Instruction	Modified	NQDW 7-Month Follow-Up questionnaire
193100	Intake Information for Callers who Contact the Quitline for Personal Use	Form and Instruction	Modified	NQDW Intake Questionnaire
193099	Intake Information for Callers who Contact the Quitline for Someone Else	Form and Instruction	Modified	NQDW Intake Questionnaire Subset Final

ICR Details

OMB Control No: 0920-0856	ICR Reference No: 201207-0920-002
Status: Historical Active	Previous ICR Reference No: 201203-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Quitline Data Warehouse
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/01/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/10/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved	09/30/2012
Responses	564,621	0	759,112
Time Burden (Hours)	89,035	0	90,563
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's Office on Smoking and Health requests a continuation of current OMB approval for operation of the National Quitline Data Warehouse (NQDW, OMB no. 0920-0856, exp. 7/31/2012). The NQDW was established in 2010 with funding provided by the American Recovery and Reinvestment Act of 2009. , CDC proposes minor changes to the original OMB clearance. Changes from the initial OMB approval include 1) implementation of an electronic reporting option for state submission of the NQDW Intake and 7-month Follow-up Questionnaires to CDC, 2) an increase in the estimated burden per response for the NQDW Quitline Services Online Survey, and 3) adjustments to the estimated number of respondents based on experience with the NQDW over the past two years.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care Act PPHF
   PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009
  

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:
	77 FR 20400	04/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40359	07/09/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up for Callers who Received a Quitline Service	F1	NQDW 7-Month Follow-Up questionnaire
Instructions for submitting caller intake and follow up
Intake Information for Callers who Contact the Quitline for Personal Use	E1(a)	NQDW Intake Questionnaire
Intake Information for Callers who Contact the Quitline for Someone Else	E1(b)	NQDW Intake Questionnaire Subset Final
Quitline Services Questionnaire	G1, GI (2)	Quitline Serivces Online Survey ,   Quitline Services Online Survey

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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	564,621	759,112	0	53	-194,544	0
Annual Time Burden (Hours)	89,035	90,563	0	53	-1,581	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: CDC/OSH received ARRA funding to standardize quitline data collection across states, and established the National Quitline Data Warehouse. This activity is being continued and expanded with ACA/PPHF funding. Although there is an increase in burden due to an increase in the number of quitline callers, this ICR has an overall decrease due to a technical correction of a previous error. In addition, there is an increase in burden hours due to an increase in the estimated burden per response for one information collection component.

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Annual Cost to Federal Government: $2,085,301

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]? No

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: 07/10/2012

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