Information Collection

I1. National Youth Tobacco Survey(NYTS) 2018 Questionnaire

IC 185555 under ICR 201809-0920-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	I1. National Youth Tobacco Survey(NYTS) 2018 Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-24,000	24,000
Annual IC Time Burden (Hours)	-18,000	18,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.