Assessment of Tobacco Control Program (TCP) Infrastructure

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Assessment of Tobacco Control Program (TCP) Infrastructure Form and Instruction
CMI Measurement Tool Att. A Interview Guide.docx Form and Instruction
TCP-CMI-SSA REVISED.docx TCP-CMI SSA IC Document
Att. B Introductory Email.docx Introductory Email IC Document
Att. C_Email and Telephone Reminders.docx Email and Telephone Reminder IC Document
Att. D Follow up email.docx Follow Up Email IC Document
TCP-CMI-SSB REVISED.docx TCP-CMI SSB IC Document

Information Collection (IC) Details

IC Title:	Assessment of Tobacco Control Program (TCP) Infrastructure	Agency IC Tracking Number:	15AMD

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	CMI Measurement Tool	Att. A Interview Guide.docx	None	No		Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
TCP-CMI SSA	TCP-CMI-SSA REVISED.docx	05/28/2015
Introductory Email	Att. B Introductory Email.docx	05/28/2015
Email and Telephone Reminder	Att. C_Email and Telephone Reminders.docx	05/28/2015
Follow Up Email	Att. D Follow up email.docx	05/28/2015
TCP-CMI SSB	TCP-CMI-SSB REVISED.docx	05/28/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.