Information Collection

Evaluation Report for National and State Tobacco Control Program

IC 255281 under ICR 202204-0920-006 · OMB 0920-1390.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1390 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evaluation Report for National and State Tobacco Control Program	Form and Instruction
NTCP Report Template Att 2 DP20-2001_NTCP_EvaluationReportTemplate_Y1_Y2_v4_20220729.xlsx	Form and Instruction
NTCP Report Template Att 2 DP20-2001_NTCP_EvaluationReportTemplate_Y1_Y2_v4_20220729.xlsx	Form and Instruction

IC Title:

Evaluation Report for National and State Tobacco Control Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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 and Instruction	None	NTCP Report Template	Att 2 DP20-2001_NTCP_EvaluationReportTemplate_Y1_Y2_v4_20220729.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	424	424
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.