Att I1_Computer Survey (Screenshots)

2017 NATIONAL YOUTH TOBACCO SURVEY Computer Based Pilot Survey

Documents and Forms

Document Name Document Type
2017_NYTS_Questionnaire_Final (20170110).docx Other-WORD
0920-16AWN National Youth Tobacco Survey (NYTS) 2017 Questionnaire Att I1 - Computer Survey Screenshot Example 1 .jpg Form
Att I1A - Computer Survey Screenshot Example 1 .jpg Att I1A_ 2017 NYTS Computer Based Pilot (screenshots) IC Document
Att I1B - Computer Survey Screenshot Example 2 .jpg Att I1B_NYTS Computer Based Pilot (sceenshots) IC Document
Att I2 & I3_Parental Permission Form Distribution Script .docx Att I2 & 3_Parental Permission Packet IC Document
Att I4_Parental Permission Form and Fact Sheet (Spanish Version).docx Att I3_Parental Permission Packet (Spanish) IC Document
Att I5_Parental Permission Form Reminder Notice (English Version).docx Att I5_Parental Reminder Notice IC Document
Att I6_Parental Permission Form Reminder Notice (Spanish Version).docx Att I6_Parental Reminder Notice (Spanish) IC Document
Att I7_NYTS QA Script.docx Att I7_Q&A IC Document
Att I8_Example Instrument Testing Activity - 11 09 16.docx Att I8 Example Instrument Testing Activity IC Document
Att I9_Example Testing Activity.docx Att I9 Example Testing Activity IC Document

Information Collection (IC) Details

IC Title:	Att I1_Computer Survey (Screenshots)	Agency IC Tracking Number:	16AWN

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
Other-WORD			2017_NYTS_Questionnaire_Final (20170110).docx		No		Paper Only
Form	0920-16AWN	National Youth Tobacco Survey (NYTS) 2017 Questionnaire	Att I1 - Computer Survey Screenshot Example 1 .jpg		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,100	6,100
Annual IC Time Burden (Hours)	3,558	3,558
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att I1A_ 2017 NYTS Computer Based Pilot (screenshots)	Att I1A - Computer Survey Screenshot Example 1 .jpg	03/01/2017
Att I1B_NYTS Computer Based Pilot (sceenshots)	Att I1B - Computer Survey Screenshot Example 2 .jpg	03/01/2017
Att I2 & 3_Parental Permission Packet	Att I2 & I3_Parental Permission Form Distribution Script .docx	03/01/2017
Att I3_Parental Permission Packet (Spanish)	Att I4_Parental Permission Form and Fact Sheet (Spanish Version).docx	03/01/2017
Att I5_Parental Reminder Notice	Att I5_Parental Permission Form Reminder Notice (English Version).docx	03/01/2017
Att I6_Parental Reminder Notice (Spanish)	Att I6_Parental Permission Form Reminder Notice (Spanish Version).docx	03/01/2017
Att I7_Q&A	Att I7_NYTS QA Script.docx	03/01/2017
Att I8 Example Instrument Testing Activity	Att I8_Example Instrument Testing Activity - 11 09 16.docx	03/01/2017
Att I9 Example Testing Activity	Att I9_Example Testing Activity.docx	03/01/2017

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