Cognitive Testing

National Youth Tobacco Surveys (NYTS) 2021-2023

OMB: 0920-0621

IC ID: 214643

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0621 can be found here:

2024-01-19 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Cognitive Testing for NYTS.docx Instruction
Cognitive Testing for NYTS.docx Instruction
0920-0621 NYTS Cognitive Testing Parent/ Guardian Screener Attachment R2_NYTS Cog Testing Parent Screener_(2022.03.29).docx Form and Instruction
0920-0621 NYTS Cognitive Testing Parent/ Guardian Screener Attachment R2_NYTS Cog Testing Parent Screener_(2022.03.29).docx Form and Instruction
0920-0621 NYTS Cognitive Testing Youth Screener Attachment R5_NYTS Cog Testing Youth Screener_(2022.03.29).docx Form and Instruction
0920-0621 NYTS Cognitive Testing Youth Screener Attachment R5_NYTS Cog Testing Youth Screener_(2022.03.29).docx Form and Instruction
Attachment R3_Parental Consent_(2022.02.23).docx NYTS Cognitive Testing Parent/ Guardian Consent IC Document
Attachment R3_Parental Consent_(2022.02.23).docx NYTS Cognitive Testing Parent/ Guardian Consent IC Document
Attachment R6_Youth Consent_(2022.03.21).docx Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews IC Document
Attachment R6_Youth Consent_(2022.03.21).docx Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews IC Document
Attachment R1_Cognitive Testing Protocol (2022.03.21).docx NYTS Cognitive Testing Protocol IC Document
Attachment R1_Cognitive Testing Protocol (2022.03.21).docx NYTS Cognitive Testing Protocol IC Document
Attachment R7_Notice of Non-Selection_(2022.03.21).docx NYTS Cognitive Testing Notice of Non-Selection IC Document
Attachment R7_Notice of Non-Selection_(2022.03.21).docx NYTS Cognitive Testing Notice of Non-Selection IC Document
Attachment R8_Cognitive Guides_(2022.03.21).docx NYTS Cognitive Testing Guides IC Document
Attachment R8_Cognitive Guides_(2022.03.21).docx NYTS Cognitive Testing Guides IC Document
Attachment R8a_Cognitive Guide-Item Set 1_(2022.03.29).docx NYTS Interviewer Guide – Item Set 1 IC Document
Attachment R8a_Cognitive Guide-Item Set 1_(2022.03.29).docx NYTS Interviewer Guide – Item Set 1 IC Document
Attachment R8b_Cognitive Guide-Item Set 2_(2022.03.29).docx NYTS Interviewer Guide – Item Set 2 IC Document
Attachment R8b_Cognitive Guide-Item Set 2_(2022.03.29).docx NYTS Interviewer Guide – Item Set 2 IC Document
Attachment R8c_Cognitive Guide-Item Set 3_(2022.03.29).docx NYTS Interviewer Guide – Item Set 3 IC Document
Attachment R8c_Cognitive Guide-Item Set 3_(2022.03.29).docx NYTS Interviewer Guide – Item Set 3 IC Document
Attachment R4_Youth Screener Invite_(2022.03.21).docx NYTS Cognitive Testing Invitation to Youth Screener IC Document
Attachment R4_Youth Screener Invite_(2022.03.21).docx NYTS Cognitive Testing Invitation to Youth Screener IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive Testing	Agency IC Tracking Number:	0920-0621-22DZ

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Cognitive Testing for NYTS.docx	No		Fillable Fileable
Form and Instruction	0920-0621	NYTS Cognitive Testing Parent/ Guardian Screener	Attachment R2_NYTS Cog Testing Parent Screener_(2022.03.29).docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0621	NYTS Cognitive Testing Youth Screener	Attachment R5_NYTS Cog Testing Youth Screener_(2022.03.29).docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NYTS Cognitive Testing Parent/ Guardian Consent	Attachment R3_Parental Consent_(2022.02.23).docx	03/23/2022
Parent/Guardian Email and Youth Informed Consent for Cognitive Interviews	Attachment R6_Youth Consent_(2022.03.21).docx	03/23/2022
NYTS Cognitive Testing Protocol	Attachment R1_Cognitive Testing Protocol (2022.03.21).docx	03/23/2022
NYTS Cognitive Testing Notice of Non-Selection	Attachment R7_Notice of Non-Selection_(2022.03.21).docx	03/23/2022
NYTS Cognitive Testing Guides	Attachment R8_Cognitive Guides_(2022.03.21).docx	03/23/2022
NYTS Interviewer Guide – Item Set 1	Attachment R8a_Cognitive Guide-Item Set 1_(2022.03.29).docx	04/05/2022
NYTS Interviewer Guide – Item Set 2	Attachment R8b_Cognitive Guide-Item Set 2_(2022.03.29).docx	04/05/2022
NYTS Interviewer Guide – Item Set 3	Attachment R8c_Cognitive Guide-Item Set 3_(2022.03.29).docx	04/05/2022
NYTS Cognitive Testing Invitation to Youth Screener	Attachment R4_Youth Screener Invite_(2022.03.21).docx	04/05/2022

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