National Quitline Data Warehouse

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 National Quitline Data Warehouse expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) 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 subset) - Callers who contact Quitline on behalf of someone else Form and Instruction
0856 NQDW Att H_Sample Table Shells.pdf Supplementary 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.docx Supplementary Document
0856 NQDW Att G7-Month Follow-up Data Request.docx Supplementary 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.docx Supplementary Document
0856 NQDW Att G4_Intake Data Request_With Outstanding Data.docx Supplementary Document
0856 NQDW Att G3_Intake Data Request_Without Outstanding Data.docx Supplementary Document
0856 NQDW Att G1_Data Collection Calendar.docx Supplementary Document
0856 NQDW Att B_Consultants on NQDW.docx Supplementary Document
0856 NQDW Att A3_Summary of Public Comments.docx Supplementary 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.pdf Supplementary Document
0856 NQDW_SSB_clean.docx Supporting Statement B
0856 NQDW_SSA_clean.docx Supporting Statement A
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File 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) 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 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

All Historical Document Collections

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

OMB Details

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

Federal Enterprise Architecture: Health - Illness Prevention

Form none

NQDW Intake Questionnaire Subset

Fillable Fileable

Form

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