Data Collection Checklist

National Youth Tobacco Surveys (NYTS) 2021-2023

⚠️ Notice: This information collection may be referencing outdated material.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 Data Collection Checklist Form and Instruction
0920-0621 Data Collection Checklist H1_Data Collection Checklist.docx Form and Instruction
0920-0621 Data Collection Checklist H1_Data Collection Checklist.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Data Collection Checklist	Agency IC Tracking Number:	0920-0621

Is this a Common Form? No		IC Status: Unchanged

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	Data Collection Checklist	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: 1,177	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,177	1,177
Annual IC Time Burden (Hours)	295	295
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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