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⚠️ Notice: This information collection may be referencing outdated material.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	Previously Approved
Annual Number of Responses for this IC	816	816
Annual IC Time Burden (Hours)	204	204
Annual IC Cost Burden (Dollars)	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.