Monitoring and Reporting System for the National Tobacco Control Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1097 Annual Progress Report template for the National and State Tobacco Control Program	Form and Instruction	New	Available
Form 0920-1097 Annual Component Model of Infrastructure for the National and State Tobacco Control Program	Form and Instruction	New	Available
Form 0920-1097 Annual Performance Measures template for the National and State Tobacco Control Program	Form and Instruction	New	Available
Form 0920-1097 Annual Budget template for the National Tobacco Control Program	Form and Instruction	New	Available
Form 0920-1097 Annual Work Plan template for the National and State Tobacco Control Program	Form and Instruction	New	Available
Annual Budget Progress Report	Form	Removed	Available
Initial Population of Budget Tool	Form	Removed	Available
Annual Work Plan Progress Report	Form	Removed	Available
Initial Population of Work Plan Tool	Form	Removed	Available
1097 Att 2 Awardees Final.docx	Supplementary Document	Uploaded 2019-12-12	Available
1097 Att 1c CSTHEA Final.pdf	Supplementary Document	Uploaded 2019-12-12	Available
1097 Att 1b PL Final.pdf	Supplementary Document	Uploaded 2019-12-12	Available
1097 Att 1a PHSA Final.pdf	Supplementary Document	Uploaded 2019-12-12	Available
1097 Att 3b Public Comments Final.docx	Supplementary Document	Uploaded 2019-12-12	Available
1097 Att 3a_60 day FRN Published Final.pdf	Supplementary Document	Uploaded 2019-12-12	Available
1097 Privacy Narrative Final.pdf	Supplementary Document	Uploaded 2019-12-12	Available
Att 3b. Summary of Public Comments.pdf	Supplementary Document	Uploaded 2015-08-10	Available
Att 3a. FRN 6 05 2015.pdf	Supplementary Document	Uploaded 2015-08-10	Available
Att 2. Awardees.docx	Supplementary Document	Uploaded 2015-08-10	Available
1097 SSB FINAL.docx	Supporting Statement B	Uploaded 2020-02-04	Available
1097 SSA FINAL.docx	Supporting Statement A	Uploaded 2020-02-05	Available
Att 1c. CSTHEA.pdf	Supplementary Document	Uploaded 2015-08-10	Available
Att 1b. PL 98-474 07-15-2014.pdf	Supplementary Document	Uploaded 2015-08-10	Available
Att 1a. PHSA 07-15-2014.pdf	Supplementary Document	Uploaded 2015-08-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238892	Annual Progress Report template for the National and State Tobacco Control Program	Form and Instruction	New
238891	Annual Component Model of Infrastructure for the National and State Tobacco Control Program	Form and Instruction	New
238890	Annual Performance Measures template for the National and State Tobacco Control Program	Form and Instruction	New
238889	Annual Budget template for the National Tobacco Control Program	Form and Instruction	New
238888	Annual Work Plan template for the National and State Tobacco Control Program	Form and Instruction	New
217815	Annual Budget Progress Report	Form	Removed
217814	Initial Population of Budget Tool	Form	Removed
217813	Annual Work Plan Progress Report	Form	Removed
217812	Initial Population of Work Plan Tool	Form	Removed

ICR Details

OMB Control No: 0920-1097	ICR Reference No: 201912-0920-010
Status: Active	Previous ICR Reference No: 201508-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 15AME
Title: Monitoring and Reporting System for the National Tobacco Control Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2020
	Date Received in OIRA: 02/05/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved
Responses	265	0	0
Time Burden (Hours)	1,961	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC will collect work plan and budget information from State-based tobacco control programs. Information will be used to monitor progress toward achievement of program objectives, and to support program improvement.

---

Authorizing Statute(s): US Code: 42 USC 247b (k)(2) Name of Law: Public Health Service Act
   PL: Pub.L. 98 - 474 1 Name of Law: Comprehensive Smoking Education Act
   US Code: 15 USC 4401 Name of Law: Comprehensive Smokeless Tobacco Health Education Act of 1986
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 16868	04/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 3915	01/23/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Initial Population of Budget Tool	none	National State-based Tobacco Control Programs Budget Template
Annual Budget template for the National Tobacco Control Program	0920-1097	Budget Template
Annual Work Plan template for the National and State Tobacco Control Program	0920-1097	Work Plan
Annual Component Model of Infrastructure for the National and State Tobacco Control Program	0920-1097	CMI
Annual Budget Progress Report	none	National State-based Tobacco Control Programs Budget Template
Initial Population of Work Plan Tool	none	National Tobacco Control Programs Work Plan Template
Annual Work Plan Progress Report	none	National Tobacco Control Programs Work Plan Template
Annual Performance Measures template for the National and State Tobacco Control Program	0920-1097	Performance Meas Template
Annual Progress Report template for the National and State Tobacco Control Program	0920-1097	Performance Meas Template

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	265	0	0	141	-18	142
Annual Time Burden (Hours)	1,961	0	0	1,624	-108	445
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: CDC is requesting approval for 1,961 burden hours. This reinstatement with change request reflects an increase in burden by 1,516 hours due to the addition of three information collection tools.

---

Annual Cost to Federal Government: $127,758

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/05/2020

---