Information Collection

Att I1_Computer Survey (Screenshots)

IC 225941 under ICR 201708-0920-020 · OMB 0920-1205.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-16AWN National Youth Tobacco Survey (NYTS) 2017 Questionnaire Att I1_Computer Survey (Screenshots)	Form
2017_NYTS_Questionnaire_Final (20170110).docx	Other-WORD
0920-16AWN National Youth Tobacco Survey (NYTS) 2017 Questionnaire Att I1 - Computer Survey Screenshot Example 1 .jpg	Form
Att I1A - Computer Survey Screenshot Example 1 .jpg Att I1A_ 2017 NYTS Computer Based Pilot (screenshots)	IC Document
Att I1B - Computer Survey Screenshot Example 2 .jpg Att I1B_NYTS Computer Based Pilot (sceenshots)	IC Document
Att I2 & I3_Parental Permission Form Distribution Script .docx Att I2 & 3_Parental Permission Packet	IC Document
Att I4_Parental Permission Form and Fact Sheet (Spanish Version).docx Att I3_Parental Permission Packet (Spanish)	IC Document
Att I5_Parental Permission Form Reminder Notice (English Version).docx Att I5_Parental Reminder Notice	IC Document
Att I6_Parental Permission Form Reminder Notice (Spanish Version).docx Att I6_Parental Reminder Notice (Spanish)	IC Document
Att I7_NYTS QA Script.docx Att I7_Q&A	IC Document
Att I8_Example Instrument Testing Activity - 11 09 16.docx Att I8 Example Instrument Testing Activity	IC Document
Att I9_Example Testing Activity.docx Att I9 Example Testing Activity	IC Document

IC Title:

Agency IC Tracking Number:

16AWN

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	0920-16AWN				Yes	Yes	Fillable Fileable
Other-WORD					No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,100	6,100
Annual IC Time Burden (Hours)	3,558	3,558
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att I1A_ 2017 NYTS Computer Based Pilot (screenshots)		03/01/2017
Att I1B_NYTS Computer Based Pilot (sceenshots)		03/01/2017
Att I2 & 3_Parental Permission Packet		03/01/2017
Att I3_Parental Permission Packet (Spanish)		03/01/2017
Att I5_Parental Reminder Notice		03/01/2017
Att I6_Parental Reminder Notice (Spanish)		03/01/2017
Att I7_Q&A		03/01/2017
Att I8 Example Instrument Testing Activity		03/01/2017
Att I9 Example Testing Activity		03/01/2017

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

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