[NCCDPHP] Evaluation Reporting Template for the National and State Tobacco Control Program

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
255281	Evaluation Report for National and State Tobacco Control Program Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1390	ICR Reference No: 202603-0920-001
Status: Received in OIRA	Previous ICR Reference No: 202204-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0126
Title: [NCCDPHP] Evaluation Reporting Template for the National and State Tobacco Control Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/24/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2026
Responses	53	53
Time Burden (Hours)	424	424
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this request is to evaluate the National Center for Chronic Disease Prevention and Health Promotion cooperative agreement CDC-RFA-DP20-2001: National and State Tobacco Control Program. Information will be used for measuring the progress made by National and State Tobacco Control programs and to respond to inquiries from the Department of Health and Human Services (HHS), the U.S. Congress, and other sources about outcomes of funding. This is an Extension ICR submitted to request an additional three-year approval period.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 98 - 474 1 Name of Law: Comprehensive Smoking Education Act (CSEA)
   US Code: 15 USC 4401 Name of Law: Comprehensive Smokeless Tobacco Health Education Act (CSTHEA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46889	09/30/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 11312	03/09/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Evaluation Report for National and State Tobacco Control Program	0920-1390, None	NTCP Report Template ,   Annual Evaluation Reporting Guidance and Template for CDC-RFA-DP20-2001: National and State Tobacco Control Program _24MAR2026

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	53	53	0	0	0	0
Annual Time Burden (Hours)	424	424	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $53,785

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/24/2026

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