Information Collection

Evaluation Report for National and State Tobacco Control Program

IC 255281 under ICR 202603-0920-001 · OMB 0920-1390.

Documents and Forms

Document Name Document Type
NTCP Report Template Evaluation Report for National and State Tobacco Control Program Form and Instruction
Form 0920-1390 Annual Evaluation Reporting Guidance and Template for CDC-RFA-DP20-2001: National and State Tobacco Control Program _24MAR2026 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
0920-1390 Annual Evaluation Reporting Guidance and Template for CD ERT Att 2 NTCPET Eval Rptng Tmplt RK JRL.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation Report for National and State Tobacco Control Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	0920-1390	Annual Evaluation Reporting Guidance and Template for CDC-RFA-DP20-2001: National and State Tobacco Control Program _24MAR2026	ERT Att 2 NTCPET Eval Rptng Tmplt RK JRL.docx	N/A	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 %

	Requested	Previously Approved
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.

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