National Survey of Family Growth

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Household Screening Questionnaire	Form and Instruction	Modified	Available
Form K National Survey of Family Growth, Verification Questionnaires	Form and Instruction	Modified	Available
ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire (Mark-Up for Year 3 with red highlights)	Form and Instruction	Modified	Available
ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire(Mark-Up for Year 3)	Form and Instruction	Modified	Available
Attachment 2: 2011-2015 National Survey of Family Growth FEMALE Questionnaire (Mark-Up for Year 3)	Form and Instruction	Modified	Available
Attachment 2: 2011-2015 National Survey of Family GrowthFEMALE Questionnaire(Mark-Up for Year 3 with red highlights)	Form and Instruction	Modified	Available
Copy of Attach 1--Y3-ChangesSummary (2) rev 011913.xlsx	Supplementary Document	Uploaded 2013-01-30	Available
Attach 5 Contact Info.docx	Supplementary Document	Uploaded 2013-01-29	Available
2013 Change Req-D4.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-01-29	Available
Attach 4-Res Conf Agenda.doc	Supplementary Document	Uploaded 2013-01-29	Available
NSFG 2009 G2b-Confidentiality.pdf	Supplementary Document	Uploaded 2009-03-31	Available
NSFG 2009 G2a -QA Brochure.pdf	Supplementary Document	Uploaded 2009-03-31	Available
NSFG 2009 ATT G3-ConsentForms.doc	Supplementary Document	Uploaded 2009-03-31	Available
NSFG 2013 Attach 6-Incentive Expt--D8 rev 040113.docx	Supplementary Document	Uploaded 2013-04-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188705	Household Screener	Form and Instruction	Modified	Household Screening Questionnaire
188703	Verification form	Form and Instruction	Modified	National Survey of Family Growth, Verification Questionnaires
188702	National Survey of Family Growth--Male Interview	Form and Instruction	Modified	ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire (Mark-Up for Year 3 with red highlights)
188702	National Survey of Family Growth--Male Interview	Form and Instruction	Modified	ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire(Mark-Up for Year 3)
184020	Female Interview Questionnaire --	Form and Instruction	Modified	Attachment 2: 2011-2015 National Survey of Family Growth FEMALE Questionnaire (Mark-Up for Year 3)
184020	Female Interview Questionnaire --	Form and Instruction	Modified	Attachment 2: 2011-2015 National Survey of Family GrowthFEMALE Questionnaire(Mark-Up for Year 3 with red highlights)

ICR Details

OMB Control No: 0920-0314	ICR Reference No: 201302-0920-002
Status: Historical Active	Previous ICR Reference No: 201203-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 18656
Title: National Survey of Family Growth
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/05/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/04/2013
Terms of Clearance: NCHS must report back to OMB regarding the results of the incentive experiment well in advance of submitting a package that recommends any changes to the incentive schema for the full study. OMB’s is particularly interested in whether a change in the incentive schema will reduce non-response bias.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	04/30/2015	04/30/2015
Responses	20,400	0	20,400
Time Burden (Hours)	7,192	0	7,192
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Survey of Family Growth NSFG) is a nationally-representative sample survey conducted by personal interview among a sample of approximately 5,000 men and women annually. Data will be collected on pregnancy, contraception, parenting, and related attitudes. This request describes minimal questionnaire changes and a test to study changes in incentive levels.

---

Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act 242k
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Female Interview Questionnaire --	None, None	Attachment 2: 2011-2015 National Survey of Family GrowthFEMALE Questionnaire(Mark-Up for Year 3 with red highlights) ,   Attachment 2: 2011-2015 National Survey of Family Growth FEMALE Questionnaire (Mark-Up for Year 3)
Household Screener	3	Household Screening Questionnaire
National Survey of Family Growth--Male Interview	None, None	ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire(Mark-Up for Year 3) ,   ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire (Mark-Up for Year 3 with red highlights)
Verification form	K	National Survey of Family Growth, Verification Questionnaires

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20,400	20,400	0	0	0	0
Annual Time Burden (Hours)	7,192	7,192	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $5,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/04/2013

---