FORM 4 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

JACOBS CINDY
2. Issuer Name and Ticker or Trading Symbol

ACHIEVE LIFE SCIENCES, INC. [ ACHV ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

__X__ Director                    _____ 10% Owner
__X__ Officer (give title below)    _____ Other (specify below)
President & CMO
(Last)          (First)          (Middle)

22722 29TH DR SE, SUITE 100
3. Date of Earliest Transaction (MM/DD/YYYY)

1/3/2022
(Street)

BOTHELL, WA 98021
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/Group Filing (Check Applicable Line)

_X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)11. Nature of Indirect Beneficial Ownership (Instr. 4)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Performance Restricted Stock Unit (PRSU)  (1)1/3/2022  A   32500     (2)1/3/2026 Common Stock 32500 $0.00 32500 D  
Stock Option (right to buy) $8.26 1/3/2022  A   32500     (3)1/3/2032 Common Stock 32500 $0.00 32500 D  

Explanation of Responses:
(1) Each PRSU represents a contingent right to receive one share of the issuer's common stock at settlement.
(2) Pursuant to the terms of the PRSU 50% of the total shares underlying the PRSU vest on the achievement of a performance-based milestone, and 50% vest on the first anniversary of the achievement of such milestone. The PRSUs will lapse in full if achievement of such milestone is not met.
(3) The options vest one-third on the first anniversary of January 3, 2022 and thereafter in monthly installments over 24 months.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
JACOBS CINDY
22722 29TH DR SE
SUITE 100
BOTHELL, WA 98021
X
President & CMO

Signatures
Sandra Thomson as attorney-in-fact for Cindy Jacobs1/5/2022
**Signature of Reporting PersonDate

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