Information Collection

Students 2012 - 2014 National Youth Tobacco Surveys

IC 185555 under ICR 201109-0920-004 · OMB 0920-0621.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment I-7. Questionnaire Administration Guide_12 20 2011.doc	Other-Word
Attachment I-1. 2012 NYTS Questionnaire_12 20 2011.doc	Other-Word
Attachment I-2. Parental Permission Form Distribution Script - 06 08 2011.doc Attachment I-2	IC Document
Attachment I-4. Parental Permission Form and Fact Sheet (Spanish Version) - 06 08 2011.doc Attachment I-4	IC Document
Attachment I-3. Parental Permission Form and Fact Sheet (English version) - 06 08 2011.doc Attachment I-3	IC Document
Attachment I-5. Parental Permission Form Reminder Notice (English version) - 06 08 2011.doc Attachment I-5	IC Document
Attachment I-6. Parental permission form reminder notice (Spanish version) 06 08 2011.doc Attachment I-6	IC Document

IC Title:

STUDENTS 2012 - 2014 NATIONAL YOUTH TOBACCO SURVEYS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word			Attachment I-7. Questionnaire Administration Guide_12 20 2011.doc		Yes	Yes	Fillable Printable
Other-Word			Attachment I-1. 2012 NYTS Questionnaire_12 20 2011.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,591

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24,591	11,340	13,251
Annual IC Time Burden (Hours)	18,443	8,505	9,938
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment I-2	Attachment I-2. Parental Permission Form Distribution Script - 06 08 2011.doc	09/15/2011
Attachment I-4	Attachment I-4. Parental Permission Form and Fact Sheet (Spanish Version) - 06 08 2011.doc	09/15/2011
Attachment I-3	Attachment I-3. Parental Permission Form and Fact Sheet (English version) - 06 08 2011.doc	09/15/2011
Attachment I-5	Attachment I-5. Parental Permission Form Reminder Notice (English version) - 06 08 2011.doc	09/15/2011
Attachment I-6	Attachment I-6. Parental permission form reminder notice (Spanish version) 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.