2012 - 2014 National Youth Tobacco Survey (NYTS)

Forms and Documents

Document Name	Status
Attachment I-8 (rev). Summary of Changes for 2013.docx Supplementary Document	2012-10-10
0920-0621 Change Request for 2013 NYTS.docx Justification for No Material/Nonsubstantive Change	2012-10-10
Attachment I-6. Parental permission form reminder notice (Spanish version) 06 08 2011.doc Supplementary Document	2011-09-15
Attachment I-5. Parental Permission Form Reminder Notice (English version) - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment I-3. Parental Permission Form and Fact Sheet (English version) - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment I-4. Parental Permission Form and Fact Sheet (Spanish Version) - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment I-2. Parental Permission Form Distribution Script - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment H-2. Letter to Teachers in Participating Schools - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment G-3. Letter to Agreeing Schools - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment G-2. School Letter of Invitation and NYTS Fact Sheet - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment F-2. Districtl Letter of Invitation - 06 08 2011.doc Supplementary Document	2011-09-15
Attachment E-2. State Letter of Invitation - 06 08 2011.doc Supplementary Document	2011-09-15

IC Document Collections

IC ID	Document Title	Status
7087	RECRUITMENT OF STATES Other-WORD	Modified
185555	STUDENTS 2012 - 2014 NATIONAL YOUTH TOBACCO SURVEYS Other-Word	Modified
185554	TEACHERS' DATA COLLECTION CHECKLIST Other-WORD	Modified
185553	RECRUITMENT OF SCHOOLS Other-WORD	Modified
185552	RECRUITMENT OF DISTRICTS Other-WORD	Modified

ICR Details

OMB Control No: 0920-0621	ICR Reference No: 201210-0920-006
Status: Historical Active	Previous ICR Reference No: 201109-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: 2012 - 2014 National Youth Tobacco Survey (NYTS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/26/2012
	Date Received in OIRA: 10/12/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	01/31/2015	01/31/2015
Responses	25,836	0	25,836
Time Burden (Hours)	18,862	0	18,862
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests minor changes to the National Tobacco Youth Survey questionnaire to cycle out Center for Tobacco Products questions from 2012 and cycle in Office of Smoking and Health questions for 2013.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
RECRUITMENT OF STATES
RECRUITMENT OF DISTRICTS
RECRUITMENT OF SCHOOLS
TEACHERS' DATA COLLECTION CHECKLIST
STUDENTS 2012 - 2014 NATIONAL YOUTH TOBACCO SURVEYS	none	National Youth Tobacco Survey 2013

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	25,836	25,836	0	0	0	0
Annual Time Burden (Hours)	18,862	18,862	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $615,400

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

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? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/12/2012

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