Information Collection

Annual Performance Measures template for the National and State Tobacco Control Program

IC 238890 under ICR 201912-0920-010 · OMB 0920-1097.

Documents and Forms

Document Name Document Type
Form 0920-1097 Annual Performance Measures template for the National and State Tobacco Control Program Form and Instruction
0920-1097 Performance Meas Template 1097 Att 4c NTCP Performance Meas Template Final.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Performance Measures template for the National and State Tobacco Control Program	Agency IC Tracking Number:	0920-1097

Is this a Common Form? No		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	0920-1097	Performance Meas Template	1097 Att 4c NTCP Performance Meas Template Final.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	265	265
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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