[NCCDPHP] National Quitline Data Warehouse

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ASQ Intake Questionnaire - subset (Vietnamese)	Form and Instruction	Unchanged	Available
ASQ Intake Questionnaire - subset (Korean)	Form and Instruction	Unchanged	Available
ASQ Intake Questionnaire - subset (Chinese)	Form and Instruction	Unchanged	Available
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	Form and Instruction	Unchanged	Missing upstream
ASQ 7-month Follow-up Questionnaire (English translation for reference)	Form and Instruction	Unchanged	Available
ASQ 7-month Follow-up Questionnaire (Vietnamese)	Form and Instruction	Unchanged	Repair queued
ASQ 7-month Follow-up Questionnaire (Korean)	Form and Instruction	Unchanged	Available
ASQ 7-month Follow-up Questionnaire (Chinese)	Form and Instruction	Unchanged	Available
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged	Available
ASQ Intake Questionnaire (Vietnamese)	Form and Instruction	Unchanged	Repair queued
ASQ Intake Questionnaire (Korean)	Form and Instruction	Unchanged	Repair queued
ASQ Intake Questionnaire (Chinese)	Form and Instruction	Unchanged	Available
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	Form and Instruction	Unchanged	Missing upstream
NQDW Quitline Services Survey	Form and Instruction	Unchanged	Repair queued
NQDW Quitline Services Survey	Form and Instruction	Unchanged	Repair queued
NQDW Intake Questionnaire	Form and Instruction	Modified	Available
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	Form and Instruction	Modified	Repair queued
NQDW Intake Questionnaire	Form and Instruction	Unchanged	Available
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else	Form and Instruction	Unchanged	Repair queued
Change Request Memo - EO14168 NQDW_final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-23	Repair queued
Change Request Memo - EO14168 NQDW_final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-23	Repair queued
0856 NQDW Att H_Sample Table Shells Updated 2025_tracked_072025_final.docx	Supplementary Document	Uploaded 2025-07-23	Available
0856 NQDW Att H_Sample Table Shells Updated 2025_tracked_072025_final.docx	Supplementary Document	Uploaded 2025-07-23	Repair queued
0856 NQDW Att G9_Intake or Survey Outstanding Data Prompt.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G9_Intake or Survey Outstanding Data Prompt.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G8_Intake, Survey, or 7-month Follow-up Past Due Prompt.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G8_Intake, Survey, or 7-month Follow-up Past Due Prompt.docx	Supplementary Document	Uploaded 2022-07-22	Available
0856 NQDW Att G7-Month Follow-up Data Request.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G7-Month Follow-up Data Request.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G6_Intake-Survey Data Request_With Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G6_Intake-Survey Data Request_With Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G5_Intake-Survey Data Request_Without Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G5_Intake-Survey Data Request_Without Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G4_Intake Data Request_With Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G4_Intake Data Request_With Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G3_Intake Data Request_Without Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G3_Intake Data Request_Without Outstanding Data.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G1_Data Collection Calendar.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att G1_Data Collection Calendar.docx	Supplementary Document	Uploaded 2022-07-22	Missing upstream
0856 NQDW Att B_Consultants on NQDW.docx	Supplementary Document	Uploaded 2022-07-22	Available
0856 NQDW Att B_Consultants on NQDW.docx	Supplementary Document	Uploaded 2022-07-22	Available
0856 NQDW Att A3_Summary of Public Comments.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att A3_Summary of Public Comments.docx	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att A2_Published 60-day FRN_2021-14441.pdf	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att A2_Published 60-day FRN_2021-14441.pdf	Supplementary Document	Uploaded 2022-07-22	Repair queued
0856 NQDW Att A1_Public Health Service Act_42 USC 241.pdf	Supplementary Document	Uploaded 2022-07-22	Available
0856 NQDW Att A1_Public Health Service Act_42 USC 241.pdf	Supplementary Document	Uploaded 2022-07-22	Missing upstream
0856 NQDW_SSB_clean.docx	Supporting Statement B	Uploaded 2022-07-22	Repair queued
0856 NQDW_SSB_clean.docx	Supporting Statement B	Uploaded 2022-07-22	Missing upstream
0856 NQDW_SSA rk_final.docx	Supporting Statement A	Uploaded 2025-07-23	Repair queued
0856 NQDW_SSA rk_final.docx	Supporting Statement A	Uploaded 2025-07-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218546	Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File	Instruction	Unchanged
218545	ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	Form and Instruction	Unchanged	ASQ Intake Questionnaire - subset (Vietnamese)
218545	ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	Form and Instruction	Unchanged	ASQ Intake Questionnaire - subset (Korean)
218545	ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	Form and Instruction	Unchanged	ASQ Intake Questionnaire - subset (Chinese)
218545	ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	Form and Instruction	Unchanged
218544	Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged	ASQ 7-month Follow-up Questionnaire (English translation for reference)
218544	Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged	ASQ 7-month Follow-up Questionnaire (Vietnamese)
218544	Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged	ASQ 7-month Follow-up Questionnaire (Korean)
218544	Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged	ASQ 7-month Follow-up Questionnaire (Chinese)
218544	Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	Form and Instruction	Unchanged
218543	Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	Form and Instruction	Unchanged	ASQ Intake Questionnaire (Vietnamese)
218543	Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	Form and Instruction	Unchanged	ASQ Intake Questionnaire (Korean)
218543	Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	Form and Instruction	Unchanged	ASQ Intake Questionnaire (Chinese)
218543	Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	Form and Instruction	Unchanged
204102	Submission of NQDW Intake Questionnaire Electronic Data File	Instruction	Unchanged
193102	NQDW Quitline Services Survey	Form and Instruction	Unchanged	NQDW Quitline Services Survey
193102	NQDW Quitline Services Survey	Form and Instruction	Unchanged
193100	NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	Form and Instruction	Modified	NQDW Intake Questionnaire
193100	NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	Form and Instruction	Modified
193099	NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else	Form and Instruction	Unchanged	NQDW Intake Questionnaire
193099	NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0856	ICR Reference No: 202503-0920-037
Status: Historical Active	Previous ICR Reference No: 202207-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0067
Title: [NCCDPHP] National Quitline Data Warehouse
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/08/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/23/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	03/31/2026	03/31/2026
Responses	408,368	0	408,368
Time Burden (Hours)	68,089	0	68,089
Cost Burden (Dollars)	1,841,076	0	1,841,076

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Abstract: Since 2010, the National Quitline Data Warehouse (NQDW) has collected a core set of information from the 50 U.S. states, the District of Columbia, Guam, and Puerto Rico regarding the services telephone quitlines offer to tobacco users as well as the number and type of tobacco users who receive services from telephone quitlines. This change request makes minor changes based on recent executive orders.

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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
  

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:
	86 FR 35797	07/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 43862	07/22/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)	None, None, None	ASQ Intake Questionnaire - subset (Chinese) ,   ASQ Intake Questionnaire - subset (Korean) ,   ASQ Intake Questionnaire - subset (Vietnamese)
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)	None, None, None	ASQ Intake Questionnaire (Chinese) ,   ASQ Intake Questionnaire (Korean) ,   ASQ Intake Questionnaire (Vietnamese)
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire	None, None, None, None	ASQ 7-month Follow-up Questionnaire (Chinese) ,   ASQ 7-month Follow-up Questionnaire (Korean) ,   ASQ 7-month Follow-up Questionnaire (Vietnamese) ,   ASQ 7-month Follow-up Questionnaire (English translation for reference)
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	None	NQDW Intake Questionnaire
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else	None	NQDW Intake Questionnaire
NQDW Quitline Services Survey	None	NQDW Quitline Services Survey
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File
Submission of NQDW Intake Questionnaire Electronic Data File

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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	408,368	408,368	0	0	0	0
Annual Time Burden (Hours)	68,089	68,089	0	0	0	0
Annual Cost Burden (Dollars)	1,841,076	1,841,076	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: Burden for 4 ICs decreased due to reductions in the estimated number of responses. Burden for 1 IC increased due to an increase in the estimated number of responses. The burden estimate did not change for 3 ICs. There is a net reduction in total annuzlied burden hours.

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Annual Cost to Federal Government: $1,337,262

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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)? No

Is this ICR related to the Pandemic Response? No

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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: 07/23/2025

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