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

Monitoring and Reporting System for the National Tobacco Control Program

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

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
No associated records found

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