Teachers Data Collection Checklist

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⚠️ Notice: This information collection may be referencing outdated material.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
Teachers Data Collection Checklist Form
Data Collection Checklist Attachment H1_Data Collection Checklist for the National Youth Tobacco Survey.doc Form
Attachment H2_Letter to Teachers in Participating Schools.doc Letter to Teachers IC Document

Information Collection (IC) Details

IC Title:	Teachers Data Collection Checklist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Data Collection Checklist	Attachment H1_Data Collection Checklist for the National Youth Tobacco Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 973	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	973	973
Annual IC Time Burden (Hours)	243	243
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Teachers	Attachment H2_Letter to Teachers in Participating Schools.doc	12/15/2014

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