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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	05/31/2026
Responses	53	53
Time Burden (Hours)	424	424
Cost Burden (Dollars)	0	0

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

Agency Contact: Jeffrey Zirger 404 639-7118 wtj5@cdc.gov

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