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Att H1_Data Collection Checklist
2017 NATIONAL YOUTH TOBACCO SURVEY Computer Based Pilot Survey
OMB: 0920-1205
IC ID: 225827
OMB.report
HHS/CDC
OMB 0920-1205
ICR 201708-0920-020
IC 225827
( )
Documents and Forms
Document Name
Document Type
Att H1_Data Collection Checklist for the NYTS Pilot (Revised 1.12.2017) v2 (OSH).docx
Other-WORD
Att H2_Letter to Teachers in Participating Schools.docx
Att H2_Letters to Teachers
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att H1_Data Collection Checklist
Agency IC Tracking Number:
16AWN
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
Other-WORD
Att H1_Data Collection Checklist for the NYTS Pilot (Revised 1.12.2017) v2 (OSH).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:
292
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
95 %
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
292
0
292
0
0
0
Annual IC Time Burden (Hours)
73
0
73
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att H2_Letters to Teachers
Att H2_Letter to Teachers in Participating Schools.docx
03/01/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.