Information Collection

Initial Population of Work Plan Tool

IC 217812 under ICR 201912-0920-010 · OMB 0920-1097.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Initial Population of Work Plan Tool	Form
National Tobacco Control Programs Work Plan Template Att 4a. NTCP MIS Work Plan_Template.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	National Tobacco Control Programs Work Plan Template	Att 4a. NTCP MIS Work Plan_Template.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-18	18
Annual IC Time Burden (Hours)	-108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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