Students 2015 National Youth Tobacco Survey

National Youth Tobacco Surveys (NYTS) 2015-2017

⚠️ Notice: This information collection may be referencing outdated material.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
Students 2015 National Youth Tobacco Survey Form
2015 NYTS Attachment I1_2015 NYTS Instrument 2015.01.12.docx Form
Attachment I2_Parental Permission Form Distribution Script.doc Parental Permission Distribution Script IC Document
Attachment I3_Parental Permission Form and Fact Sheet (English Version).doc Parental Permission and Fact Sheet IC Document
Attachment I4_Parental Permission Form and Fact Sheet (Spanish Version).doc Parental Permission and Fact Sheet - Spanish IC Document
Attachment I5_Parental Permission Form Reminder Notice (English Version).doc Parental Permission Reminder - English IC Document
Attachment I6_Parental Permission Form Reminder Notice (Spanish Version).doc Parental Permission Reminder - Spanish IC Document
Attachment I7_Questionnaire Administration Script.doc Questionnaire Administration Script IC Document

Information Collection (IC) Details

IC Title:	Students 2015 National Youth Tobacco Survey	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
Form	none	2015 NYTS	Attachment I1_2015 NYTS Instrument 2015.01.12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,077	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,077	20,077
Annual IC Time Burden (Hours)	15,058	15,058
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Parental Permission Distribution Script	Attachment I2_Parental Permission Form Distribution Script.doc	12/15/2014
Parental Permission and Fact Sheet	Attachment I3_Parental Permission Form and Fact Sheet (English Version).doc	12/15/2014
Parental Permission and Fact Sheet - Spanish	Attachment I4_Parental Permission Form and Fact Sheet (Spanish Version).doc	12/15/2014
Parental Permission Reminder - English	Attachment I5_Parental Permission Form Reminder Notice (English Version).doc	12/15/2014
Parental Permission Reminder - Spanish	Attachment I6_Parental Permission Form Reminder Notice (Spanish Version).doc	12/15/2014
Questionnaire Administration Script	Attachment I7_Questionnaire Administration Script.doc	12/15/2014

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