Information Collection

Students 2015 National Youth Tobacco Survey

IC 185555 under ICR 201501-0920-019 · 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⚠️ Notice: This information collection may be referencing outdated material.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
2015 NYTS 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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Parental Permission Distribution Script		12/15/2014
Parental Permission and Fact Sheet		12/15/2014
Parental Permission and Fact Sheet - Spanish		12/15/2014
Parental Permission Reminder - English		12/15/2014
Parental Permission Reminder - Spanish		12/15/2014
Questionnaire Administration Script		12/15/2014

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

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