Information Collection

I1. National Youth Tobacco Survey(NYTS) 2018 Questionnaire

IC 185555 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⚠️ Notice: This information collection may be referencing outdated material.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 I1. National Youth Tobacco Survey(NYTS) 2018 Questionnaire	Form and Instruction
0920-0621 National Youth Tobacco Survey (NYTS) 2018 Questionnaire I1_2018_NYTS_Questionnaire.docx	Form and Instruction
I2_Parental Permission Form Distribution Script.docx Parental Permission Distribution Script	IC Document
I3_Parental Permission Form and Fact Sheet_(English).docx PARENTAL PERMISSION FORM /SURVEY FACT SHEET	IC Document
I4_Parental Permission Form and Fact Sheet_(Spanish).docx FORMULARIO DE AUTHORIZACION DE LOS PADRES	IC Document
I5_Parental Permission Form Reminder - English.docx Parental Permission REMINDER	IC Document
I6_Parental Permission Form Reminder - Spanish.docx RECORDATORIO	IC Document
I7_Questionnaire Administration Script.docx SURVEY ADMINISTRATOR SCRIPT	IC Document

IC Title:

I1. National Youth Tobacco Survey(NYTS) 2018 Questionnaire

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	National Youth Tobacco Survey (NYTS) 2018 Questionnaire	I1_2018_NYTS_Questionnaire.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24,000	3,923	20,077
Annual IC Time Burden (Hours)	18,000	2,942	15,058
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parental Permission Distribution Script	I2_Parental Permission Form Distribution Script.docx	04/25/2018
PARENTAL PERMISSION FORM /SURVEY FACT SHEET	I3_Parental Permission Form and Fact Sheet_(English).docx	04/25/2018
FORMULARIO DE AUTHORIZACION DE LOS PADRES	I4_Parental Permission Form and Fact Sheet_(Spanish).docx	04/25/2018
Parental Permission REMINDER	I5_Parental Permission Form Reminder - English.docx	04/25/2018
RECORDATORIO	I6_Parental Permission Form Reminder - Spanish.docx	04/25/2018
SURVEY ADMINISTRATOR SCRIPT	I7_Questionnaire Administration Script.docx	04/25/2018

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