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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Students 2015 National Youth Tobacco Survey
Agency IC Tracking Number:
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Students National Youth Tobacco Survey
Attachment I1_2015 NYTS Instrument 2014.10.28.docx
Yes
Yes
Fillable Printable
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:
20,077
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,077
0
-4,514
0
0
24,591
Annual IC Time Burden (Hours)
15,058
0
-3,385
0
0
18,443
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Parental Permission Distribution Script
Attachment I2_Parental Permission Form Distribution Script.doc
12/15/2014
Parental Permission and Fact Sheet
Attachment I3_Parental Permission Form and Fact Sheet (English Version).doc
12/15/2014
Parental Permission and Fact Sheet - Spanish
Attachment I4_Parental Permission Form and Fact Sheet (Spanish Version).doc
12/15/2014
Parental Permission Reminder - English
Attachment I5_Parental Permission Form Reminder Notice (English Version).doc
12/15/2014
Parental Permission Reminder - Spanish
Attachment I6_Parental Permission Form Reminder Notice (Spanish Version).doc
12/15/2014
Questionnaire Administration Script
Attachment I7_Questionnaire Administration Script.doc
12/15/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.