Teachers' Data Collection Checklist

2009 and 2011 National Youth Tobacco Survey (NYTS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0621 can be found here:

Documents and Forms

Document Name Document Type
Form J TEACHERS' DATA COLLECTION CHECKLIST Form and Instruction
J TEACHERS' DATA COLLECTION CHECKLIST Appendix J Data Collection Checklist for the NYTS.doc Form and Instruction
Appendix K. Data Collection Checklist Supplemental docs.doc TEACHERS' DATA COLLECTION CHECKLIST Supplemental Documents IC Document

Information Collection (IC) Details

IC Title:	TEACHERS' DATA COLLECTION CHECKLIST	Agency IC Tracking Number:

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	J	TEACHERS' DATA COLLECTION CHECKLIST	Appendix J Data Collection Checklist for the NYTS.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 635	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	635	635
Annual IC Time Burden (Hours)	159	159
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
TEACHERS' DATA COLLECTION CHECKLIST Supplemental Documents	Appendix K. Data Collection Checklist Supplemental docs.doc	06/06/2008

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