National Youth Tobacco Survey 2017 Questionnaire

National Youth Tobacco Surveys (NYTS) 2015-2017

OMB: 0920-0621

IC ID: 185555

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National Youth Tobacco Survey 2017 Questionnaire 15EA
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Attachment I-1 NYTS 2017 Questionnaire 2017_NYTS_Draft_Instrument_final draft.docx No   Paper Only

Health Public Health Monitoring

 

20,077 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 20,077 0 0 0 0 20,077
Annual IC Time Burden (Hours) 15,058 0 0 0 0 15,058
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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