2017 NATIONAL YOUTH TOBACCO SURVEY Computer Based Pilot Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SupSta B_NYTS Pilot Revised 1.12.2017 v2 (OSH).docx	Supporting Statement B	Uploaded 2017-08-23	Available
NYTS Pilot SupSta A_OMB_OSH.docx	Supporting Statement A	Uploaded 2017-08-23	Available
Att K_Sample Table Shells.xlsx	Supplementary Document	Uploaded 2017-03-01	Available
Att J_IRB Determination Notice.pdf	Supplementary Document	Uploaded 2017-03-01	Available
Att D_Publications from Prior Cycles of the National Youth Tobacco Survey.docx	Supplementary Document	Uploaded 2017-02-27	Available
Att C_State Tobacco Control Reports that Cite National Youth Tobacco Survey Data.docx	Supplementary Document	Uploaded 2017-03-01	Available
Att B_60day FRN.pdf	Supplementary Document	Uploaded 2017-02-27	Available
Att A_Authorizing Legislation.docx	Supplementary Document	Uploaded 2017-02-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225941	Att I1_Computer Survey (Screenshots)	Other-WORD	Modified
225827	Att H1_Data Collection Checklist	Other-WORD	Unchanged
225826	Att G1_School-level Recruitment Script	Other-WORD	Unchanged
225825	Att F1_District_level Recruitment Script	Other-WORD	Unchanged
225824	Att E1_State-level Recruitment Script	Other-WORD	Unchanged

ICR Details

OMB Control No: 0920-1205	ICR Reference No: 201708-0920-020
Status: Historical Active	Previous ICR Reference No: 201702-0920-016
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16AWN
Title: 2017 NATIONAL YOUTH TOBACCO SURVEY Computer Based Pilot Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/17/2017
	Date Received in OIRA: 08/23/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved
Responses	6,507	0	0
Time Burden (Hours)	3,689	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests OMB approval for one year to conduct a pilot evaluation of an electronic mode of administration of the National Youth Tobacco Survey (NYTS). This Pilot is an electronic-based version of the NYTS previously administered via paper and pencil (PAPI) by CDC in 2004, 2006, 2009, and on an annual basis for years 2011-2016.

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Authorizing Statute(s): PL: Pub.L. 104 - 134 101(d) Name of Law: Research and Investigations
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 52869	08/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 10362	02/10/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Att E1_State-level Recruitment Script
Att F1_District_level Recruitment Script
Att G1_School-level Recruitment Script
Att H1_Data Collection Checklist
Att I1_Computer Survey (Screenshots)	0920-16AWN	National Youth Tobacco Survey (NYTS) 2017 Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	6,507	0	0	6,507	0	0
Annual Time Burden (Hours)	3,689	0	0	3,689	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a one time data collection to test the effectiveness of conducting an approved collection (The National Youth Tobacco Survey, OMB Control No. 0920-0621) in an electronic format.

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Annual Cost to Federal Government: $951,466

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/23/2017

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