Teachers' Data Collection Checklist

2012 - 2014 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment H-1. Data Collection Checklist for the NYTS - 06 08 2011.doc Other-WORD
Attachment H-2. Letter to Teachers in Participating Schools - 06 08 2011.doc Attachment H-2 IC Document

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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
Other-WORD			Attachment H-1. Data Collection Checklist for the NYTS - 06 08 2011.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 816	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	Previously Approved
Annual Number of Responses for this IC	816	181	635
Annual IC Time Burden (Hours)	204	45	159
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment H-2	Attachment H-2. Letter to Teachers in Participating Schools - 06 08 2011.doc	09/15/2011

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