View Information Collection (IC)

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: 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 and Instruction	0920-0621	National Youth Tobacco Survey (NYTS) 2018 Questionnaire	I1_2018_NYTS_Questionnaire.docx		No		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: 24,000	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	24,000	0	3,923	0	0	20,077
Annual IC Time Burden (Hours)	18,000	0	2,942	0	0	15,058
Annual IC Cost Burden (Dollars)	0	0	0	0	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.