OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[NCCDPHP] National Quitline Data Warehouse

OMB 0920-0856 ยท HHS/CDC.

OMB 0920-0856

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 what services telephone quitlines offer to tobacco users as well as the number and type of tobacco users who receive services from telephone quitlines.

The latest form for [NCCDPHP] National Quitline Data Warehouse expires 2022-10-31 and is listed under ICR 201903-0920-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
ASQ Intake Questionnaire - subset (Vietnamese)Form and Instruction
ASQ Intake Questionnaire - subset (Korean)Form and Instruction
ASQ Intake Questionnaire - subset (Chinese)Form and Instruction
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset)Form and Instruction
ASQ 7-month Follow-up Questionnaire (English translation for reference)Form and Instruction
ASQ 7-month Follow-up Questionnaire (Vietnamese)Form and Instruction
ASQ 7-month Follow-up Questionnaire (Korean)Form and Instruction
ASQ 7-month Follow-up Questionnaire (Chinese)Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up QuestionnaireForm and Instruction
ASQ Intake Questionnaire (Vietnamese)Form and Instruction
ASQ Intake Questionnaire (Korean)Form and Instruction
ASQ Intake Questionnaire (Chinese)Form and Instruction
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese)Form and Instruction
NQDW Quitline Services SurveyForm and Instruction
NQDW Quitline Services SurveyForm and Instruction
NQDW Intake QuestionnaireForm and Instruction
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselvesForm and Instruction
NQDW Intake QuestionnaireForm and Instruction
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone elseForm and Instruction
Change Request Memo - EO14168 NQDW_final.docxJustification for No Material/Nonsubstantive Change
0856 NQDW Att H_Sample Table Shells Updated 2025_tracked_072025_final.docxSupplementary Document
0856 NQDW Att H_Sample Table Shells Updated 2025_tracked_072025_final.docx Supplementary Document
0856 NQDW Att G9_Intake or Survey Outstanding Data Prompt.docxSupplementary Document
0856 NQDW Att G9_Intake or Survey Outstanding Data Prompt.docx Supplementary Document
0856 NQDW Att G8_Intake, Survey, or 7-month Follow-up Past Due Prompt.docxSupplementary Document
0856 NQDW Att G8_Intake, Survey, or 7-month Follow-up Past Due Prompt.docx Supplementary Document
0856 NQDW Att G7-Month Follow-up Data Request.docxSupplementary Document
0856 NQDW Att G6_Intake-Survey Data Request_With Outstanding Data.docxSupplementary Document
0856 NQDW Att G6_Intake-Survey Data Request_With Outstanding Data.docx Supplementary Document
0856 NQDW Att G5_Intake-Survey Data Request_Without Outstanding Data.docxSupplementary Document
0856 NQDW Att G5_Intake-Survey Data Request_Without Outstanding Data.docx Supplementary Document
0856 NQDW Att G4_Intake Data Request_With Outstanding Data.docxSupplementary Document
0856 NQDW Att G4_Intake Data Request_With Outstanding Data.docx Supplementary Document
0856 NQDW Att G3_Intake Data Request_Without Outstanding Data.docxSupplementary Document
0856 NQDW Att G3_Intake Data Request_Without Outstanding Data.docx Supplementary Document
0856 NQDW Att G1_Data Collection Calendar.docxSupplementary Document
0856 NQDW Att B_Consultants on NQDW.docxSupplementary Document
0856 NQDW Att B_Consultants on NQDW.docx Supplementary Document
0856 NQDW Att A3_Summary of Public Comments.docxSupplementary Document
0856 NQDW Att A2_Published 60-day FRN_2021-14441.pdfSupplementary Document
0856 NQDW Att A2_Published 60-day FRN_2021-14441.pdf Supplementary Document
0856 NQDW Att A1_Public Health Service Act_42 USC 241.pdfSupplementary Document
0856 NQDW Att A1_Public Health Service Act_42 USC 241.pdf Supplementary Document
0856 NQDW_SSB_clean.docxSupporting Statement B
0856 NQDW_SSA rk_final.docxSupporting Statement A
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File Instruction
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Form and Instruction
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Form and Instruction
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Form and Instruction
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Form and Instruction
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire Form and Instruction
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Form and Instruction
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Form and Instruction
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Form and Instruction
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) Form and Instruction
Submission of NQDW Intake Questionnaire Electronic Data File Instruction
NQDW Quitline Services Survey Form and Instruction
NQDW Quitline Services Survey Form and Instruction
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves Form and Instruction
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves Form and Instruction
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else Form and Instruction
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202503-0920-037 No material or nonsubstantive change to a currently approved collection 2025-07-23
202207-0920-001 Revision of a currently approved collection 2022-07-25 Approved without change
201903-0920-001 Extension without change of a currently approved collection 2019-03-30 Approved with change
201509-0920-013 Revision of a currently approved collection 2015-10-14 Approved with change
201502-0920-013 No material or nonsubstantive change to a currently approved collection 2015-02-19 Approved without change
201401-0920-003 No material or nonsubstantive change to a currently approved collection 2014-01-09 Approved without change
201305-0920-014 No material or nonsubstantive change to a currently approved collection 2013-05-30 Approved without change
201207-0920-002 Revision of a currently approved collection 2012-07-10 Approved with change
201203-0920-010 No material or nonsubstantive change to a currently approved collection 2012-03-28 Approved without change
201203-0920-001 No material or nonsubstantive change to a currently approved collection 2012-03-02 Approved without change
201105-0920-009 No material or nonsubstantive change to a currently approved collection 2011-05-18 Approved without change
201006-0920-002 New collection (Request for a new OMB Control Number) 2010-06-01 Approved without change

OMB Details

NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else

Federal Enterprise Architecture: Health - Illness Prevention

Information collection instruments
FormNameElectronic accessType
Form noneNQDW Intake Questionnaire SubsetFillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.