National Quitline Data Warehouse

OMB 0920-0856

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
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OMB Details

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

Federal Enterprise Architecture: Health - Illness Prevention

Form noneNQDW Intake Questionnaire SubsetFillable FileableForm

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


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