Evaluation Report for National and State Tobacco Control Program

Evaluation Reporting Template for the National and State Tobacco Control Program

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.