Information Collection

H1. Data Collection Checklist -- Nyts - Active

IC 185554 under ICR 201801-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0621 H1. DATA COLLECTION CHECKLIST -- NYTS - ACTIVE	Form and Instruction
0920-0621 DATA COLLECTION CHECKLIST -- NYTS - ACTIVE H1_Data Collection Checklist.docx	Form and Instruction
H2_ Letter to Teachers in Participating Schools.docx 2018 National Youth Tobacco Survey (Letter to Teachers)	IC Document

IC Title:

H1. DATA COLLECTION CHECKLIST -- NYTS - ACTIVE

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 and Instruction	0920-0621	DATA COLLECTION CHECKLIST -- NYTS - ACTIVE	H1_Data Collection Checklist.docx		No		Fillable Fileable

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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
2018 National Youth Tobacco Survey (Letter to Teachers)	H2_ Letter to Teachers in Participating Schools.docx	04/25/2018

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