2012 - 2014 National Youth Tobacco Survey (NYTS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Youth Tobacco Survey (NYTS) 2014 Questionnaire	Form and Instruction	Modified	Available
2014 NYTS Change Requst (CTG and OSH) 8 15 2013.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-08-29	Available
Attachment I-6. Parental permission form reminder notice (Spanish version) 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment I-5. Parental Permission Form Reminder Notice (English version) - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment I-3. Parental Permission Form and Fact Sheet (English version) - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment I-4. Parental Permission Form and Fact Sheet (Spanish Version) - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment H-2. Letter to Teachers in Participating Schools - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment G-3. Letter to Agreeing Schools - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment G-2. School Letter of Invitation and NYTS Fact Sheet - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment F-2. Districtl Letter of Invitation - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available
Attachment E-2. State Letter of Invitation - 06 08 2011.doc	Supplementary Document	Uploaded 2011-09-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7087	RECRUITMENT OF STATES	Other-WORD	Modified
185555	STUDENTS 2012 - 2014 NATIONAL YOUTH TOBACCO SURVEYS	Form and Instruction	Modified	National Youth Tobacco Survey (NYTS) 2014 Questionnaire
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: 201308-0920-013
Status: Historical Inactive	Previous ICR Reference No: 201210-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 20458
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OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 09/04/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/29/2013
Terms of Clearance:

table that charts list comparision

	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

---

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.

---

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

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

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

---

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:

---

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

---

Common Form ICR:  No

---

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: 08/29/2013

---