Change Request Justification

Non-substantive Change Request

OMB Control Number 0920-0856

National Quitline Data Warehouse

Date Submitted: 03/13/2025

Summary of request: CDC/NCCDPHP is requesting a change request to revise questions to align with EO 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.

Description of Changes Requested: This request updates sex questions used in National Quitline Data Warehouse Intake Questionnaire (English complete) - Callers who contact Quitline for themselves and wording used in Sample Table Shells and the SSA to be in accordance with EO 14168.

This request includes:

x Revision of an existing question(s)

x Deletion of an existing question(s)

Table A: Description of Changes	Type of Change	Question/Item	Requested Change
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	Question Revision	What sex were you assigned at birth, on your original birth certificate? MALE FEMALE SOMETHING ELSE (PLEASE SPECIFY) _____________ PREFER NOT TO SAY	I need to verify: are you male or female? • Male • Female • REFUSED
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves	Question Deletion	What is your gender? Please select all that apply MALE FEMALE TRANSGENDER ANOTHER GENDER (PLEASE SPECIFY) _____________	Question removed
Sample Table Shells	Word Modification	Heading of “Gender”	Heading changed to “Sex”

Description of Changes to Burden:

There is no change in Burden Hours associated with the modifications made to comply with EO 14168

Attachments:

0856 NQDW Att C1 NQDW Intake_Questionnaire 2025_tracked changes

0856 NQDW Att C1 NQDW_Intake_Questionnaire 2025

0856 NQDW Att H_Sample Table Shells Updated 2025

0856 NQDW Att H_Sample Table Shells Updated 2025_tracked

SSA