Teacher Proctor Questionnaire Administration Script

OMB Control Number 0910-0932 

Expiration Date 05/31/2027

NATIONAL YOUTH TOBACCO SURVEY

Proctor Script for Survey Day

Script to be read to students:

“You are being asked to participate in the National Youth Tobacco Survey, an annual nationwide survey, funded for by Food and Drug Administration. The FDA is interested in your opinions on the use of cigarettes, e-cigarettes, vapes, hookah, and other products. The results help in planning programs and policies that can improve health for youth.

Our school was chosen to participate at random—like pulling a name out of a hat. The survey is anonymous—meaning you will not provide your name—and confidential. You are one of thousands of students across the nation taking this survey and your answers will be combined with other students so you will not be identified. Please answer questions as accurately as possible as your unique experience is important.

Taking part in this survey may not have direct benefits to you, but it will help provide national data that helps with the design, implementation, and evaluation of comprehensive tobacco prevention and control programs. There are no foreseeable risks for participation since the survey is anonymous and confidential.

The survey will take approximately 15-20 minutes. You can skip any questions you do not want to answer. This survey is not part of your regular school program, and your grades will not be affected by your choice to participate. No one from your school, including your teacher or principal, will know how you answered.

Are there any questions about what I just read?”

Survey Instructions to be read to students:

1. Type the survey link into your browser.

2. Enter your classroom ID

3. If you need to log out, use the same computer and browser to log in and continue where you left off.

4. You can now get started by reading your onscreen instructions.

Public reporting burden for this collection of information is estimated to average 30 minutes per survey, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Office of Operations, Food and Drug Administration, Three White Flint North, 10A-12M, 11601 Landsdown St., North Bethesda, MD 20852, PRAStaff@fda.hhs.gov, ATTN: PRA (0910-0932).