OMB_SS_A_highlightedrev 060418

Supporting Statement A Revision Request for Clearance:

NATIONAL SURVEY OF FAMILY GROWTH

OMB No. 0920-0314

(Exp. Date May 31, 2018)

June 4, 2018

Contact Information:

Anjani Chandra, Ph.D., Health Scientist

Principal Investigator and Team Lead

National Survey of Family Growth Team

Division of Vital Statistics/Reproductive Statistics Branch

CDC/National Center for Health Statistics

3311 Toledo Road, Room 5414

Hyattsville, MD. 20782

301-458-4138

301-458-4034 (fax)

achandra@cdc.gov

Supporting Statement A for Request for Clearance:

NATIONAL SURVEY OF FAMILY GROWTH

Table of Contents

Justification 5

1. Circumstances Making the Collection of Information Necessary 5

2. Purpose and Use of the Information Collection 8

3. Use of Improved Information Technology and Burden Reduction 12

4. Efforts to Identify Duplication and Use of Similar Information 13

5. Impact on Small Businesses or Other Small Entities 15

6. Consequences of Collecting the Information Less Frequently 15

7. Special Circumstances Relating to the Guidelines for 5CFR1320.5 17

8. Comments in Response to the Federal Register Notice and Efforts to

Consult Outside the Agency 17

9. Explanation of Any Payment or Gifts to Respondents 19

10. Protection of the Privacy and Confidentiality of Information Provided by Respondents 20

11. Institutional Review Board (IRB) and Justifications for Sensitive Questions 23

12. Estimates of Annualized Burden Hours and Costs 26

13. Estimate of Other Total Annual Cost Burden to Respondents or Record Keepers 27

14. Annualized Cost to the Federal Government 27

15. Explanation for Program Changes or Adjustments 27

16. Plans for Tabulation and Publication and Project Time Schedule 28

17. Reason(s) Display of OMB Expiration Date Is Inappropriate 29

18. Exceptions to Certification for Paperwork Reduction Act Submissions 29

List of Attachments:

1. Authorizing Legislation

A1. NCHS/NSFG Authorizing Legislation

A2. OPA Office of Family Planning Authorizing Legislation

A3. NICHD Authorizing Legislation

A4. Children's Bureau (ACF) Authorizing Legislation

A5. PHS Section 301 (applies to CDC/DHAP & CDC/DRH)

A6. Office of Planning, Research, & Evaluation, ACF, DHHS

A7. Division of Cancer Prevention and Control, CDC

A8. Division of Birth Defects and Developmental Disabilities, CDC

A9. Division of Adolescent and School Health, CDC

A10. Division of Nutrition, Physical Activity and Obesity, CDC

A11. Division of Sexually Transmitted Disease Prevention, CDC

2. 60-Day Federal Register Notice and comments

3. Justifications for Sensitive Questions in the Self-administered (ACASI) part of the Survey

4. A Review of the Use of Incentives in the NSFG

5. List of Publications from the Latest File Releases

E1. List of Publications from the 2006-2010 NSFG

E2. List of Publications from the 2011-2013, 2013-2015, and 2011-2015 NSFG

F. Memoranda from Other Offices and Agencies

F1 NCHS Public Affairs Office

F2. Healthy People 2020 Health Objectives on Family Planning, HIV, STDs

F3. DHHS/Office of Population Affairs

F4. DHHS/NIH/NICHD

F5. DHHS/ACF/Children's Bureau

F6. DHHS/ACF/Office of Planning, Research, & Evaluation (OPRE)

F7. DHHS/CDC/NCHHSTP/Division of HIV/AIDS Prevention (DHAP)

F8. DHHS/CDC/NCHHSTP/Division of Sexually Transmitted Disease Prevention (DSTDP)

F9. DHHS/CDC/NCHHSTP/Division of Adolescent and School Health (DASH)

F10. DHHS/CDC/NCCDPHP/Division of Cancer Prevention and Control (DCPC)

F11. DHHS/CDC/NCCDPHP/Division of Reproductive Health (DRH)

F12. DHHS/CDC/NCCDPHP/Division of Nutrition, Physical Activity, and Obesity (DNPAO)

F13. DHHS/CDC/Division of Birth Defects and Developmental Disabilities (DBDDD)

G. Consultation Outside the Agency

G1. Summary materials from Nov 2013 ACA Advisory Workshop

G2. Summary materials from Apr 2014 Advisory Workshop

H. Respondent Materials for the NSFG

H1. Advance household letters for phases 1 & 2 (English & Spanish)

H2. Advance respondent letters for phases 1 & 2 (English & Spanish)

H3. Consent and Assent Forms (English & Spanish; no difference by phase)

H4. Q&A Brochure in English

H5. Confidentiality Brochure in English

H6. Family Facts sheet

H7. Interviewer’s Letter of Authorization

1. Household Screener Questionnaire

J. Female Questionnaire

K. Male Questionnaire

L. Verification Questionnaires

L1. Description of verification questionnaires for 2017+

L2. NSFG Household Screener Verification questionnaire

L3. NSFG Main interview Verification questionnaire

M. Interviewer Observation Form

N. IRB Approval Form for the NSFG

O. Non-Response Bias Analyses for the continuous NSFG

P. Sexual Orientation Split Study Preliminary Results

• Goal of the study: To provide nationally representative, scientifically credible data on factors related to birth and pregnancy rates, family formation and dissolution patterns, and reproductive health for use by various Department of Health and Human Services (DHHS) programs, as well as for research.

• Intended use of the resulting data: Supplementing and complementing data from birth certificates on factors that affect birth and pregnancy rates, such as contraception, marriage and divorce, and infertility. Providing estimates of behavioral and demographic factors associated with reproductive health and use of related health services. Disseminating statistics on adoption and other aspects of family formation.

• Methods to be used to collect: Multi-stage probability based sample of respondents drawn from the U.S. household population. In-person interviews conducted by trained interviewers using a standardized, programmed questionnaire, including a self-interview component for the more sensitive survey content.

• Subpopulation to be studied: Males and females aged 15-49 in the U.S. household population, with special attention to substantively significant differences by key demographics such as age, race and Hispanic origin, marital or cohabiting status, education, and poverty level income.

• How data will be analyzed: The primary dissemination plan is to release public use NSFG data files and related documentation for general use in program planning and research. Descriptive and analytic reports will also be produced by survey staff, using statistical techniques appropriate for the analysis of complex, cross-sectional survey data.

Justification

This is a revision request for the National Survey of Family Growth (NSFG) (OMB No. 0920-0314, Exp. Date 05/31/2018) to continue conducting the survey for the next three years. This survey is being conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), with the collaboration and support of several other groups within the Department of Health and Human Services (DHHS). The NSFG provides nationally representative data on factors related to birth and pregnancy rates, sexually transmitted diseases, and family formation including marriage, divorce, and adoption for NCHS and its cosponsors within DHHS. The survey is administered in person, in English and Spanish. About 5,000 people aged 15-49 are interviewed each year.

We are seeking approval to:

• Continue to conduct the NSFG; and

• Conduct two small scale methodological experiments in order to improve the survey’s response rates and reduce non-response bias.

1. Circumstances Making the Collection of Information Necessary

The National Center for Health Statistics (NCHS), under its duties specified in 42 U.S.C. 242k, Section 306(a and b)(1)(h) of the Public Health Service Act (Attachment A1), conducts the National Survey of Family Growth (NSFG) to collect and disseminate “statistics on family formation, growth, and dissolution.” The NSFG supplements and complements the data from birth certificates on factors (such as contraception, marriage and divorce, and infertility) that affect birth and pregnancy rates. In addition, the NSFG serves a variety of data needs in public health programs that sponsor and depend on it (listed below).

Six cycles of the NSFG were fielded periodically from 1973 to 2002--in 1973, 1976, 1982, 1988, 1995, and 2002. In the 1973 to 1995 surveys, the NSFG was based on national samples of women aged 15-44, and focused on factors affecting pregnancy and birth rates. In 2002, the NSFG began interviewing men age 15-44 as well as women, to obtain data on fatherhood involvement, behaviors related to HIV and other sexually transmitted diseases, and other closely related topics. The sample of men was independent from the sample of women. Beginning in the June 2006, the survey adopted a continuous fieldwork design in order to provide public use data on a more frequent, timely basis to our cosponsoring programs, and also to collect these data in a more cost-efficient manner (Lepkowski et al., 2013; Lepkowski et al., 2010; Groves et al., 2009;). After the initial period of the “continuous” survey fielded from June 2006 to June 2010, interviewing ceased while a new contract was awarded and OMB approvals could be obtained. NSFG interviewing resumed in September 2011 and has run continuously.

As with all prior survey periods, NCHS is collecting NSFG data in order to carry out its own responsibilities, as well as fulfilling the data needs for other agencies and programs in DHHS that contribute funding for the NSFG:

• the Office of Family Planning, Office of Population Affairs (OPA), DHHS, under 42 U.S.C. 300a (SEC. 1001 [300] and SEC. 1004 [300a-2] of Title X of the Public Health Service Act, Attachment A2);

• the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), of the National Institutes of Health (NIH), under Section 448 (285) Subpart 7 of the Public Health Service Act, Attachment A3);

• the Children’s Bureau of the Administration on Children, Youth, and Families of the Administration for Children and Families, under PL 96-272, the Adoption Assistance and Child Welfare Act of 1980 and other laws (Attachment A4);

• the CDC’s Division of HIV/AIDS Prevention (DHAP) of the National Center for HIV, Sexually Transmitted Disease, and Tuberculosis Prevention (NCHSTP), Section 301 of the Public Health Service Act, Attachment A5);

• the CDC’s Division of Reproductive Health (DRH), under Section 301 of the Public Health Service Act (Attachment A5);

• the Office of Planning, Research, & Evaluation of the Administration for Children and Families (OPRE), under Section 403 [42 U.S.C. 603] and Section 513. [42 U.S.C. 713] (Attachment A6);

• the CDC’s Division of Cancer Prevention and Control (DCPC), under the EARLY Act (Attachment A7);

• the CDC’s Division of Birth Defects and Developmental Disabilities (DBDDD), under Section 399H (2801) Part O of the Public Health Service Act (Attachment A8)

• the CDC’s Division of Adolescent and School Health (DASH), under 42 U.S.C. Section 247(b)(k)(2) Public Health Service Act General Powers and Duties, Project Grants for Preventive Health Services (Attachment A9);

• the CDC’s Division of Nutrition, Physical Activity and Obesity (DNPAO), under the Prevention and Public Health Fund (Attachment A10); and

• the CDC’s Division of Sexually Transmitted Disease Prevention (DSTDP), under 42 U.S.C. 247c The Public Health and Welfare, Sexually Transmitted Diseases; Prevention and Control Projects and Programs (Attachment A11);

The female and male questionnaires (Attachments J & K) included in this submission were most recently approved by OMB on 08/18/2017. The NSFG questionnaires reflect the evolving data needs of various federal agencies within and outside of CDC, as expressed in their letters of support for the NSFG (Attachments F1-F13). No further changes to the NSFG questionnaires are planned under the period covered for this revision request.

In light of response rate and cost management challenges faced in the field by NSFG, which other household -based surveys are experiencing as well, we propose to conduct two small-scale methodological studies, neither of which will impact the current burden hours nor the number of respondents. One is an experiment to test the use of a mailed, paper screener questionnaire for a subset of NSFG sample households instead of a face-to-face visit to conduct the screener interview. The second study is designed to test the feasibility of shifting the Phase 2 fieldwork protocol 1 week earlier (to week 10 instead of week 11).

Experiment to test the use of a mailed, paper Household Screener: The first methodological experiment is designed to assess whether the use of mailed screeners decrease fieldwork costs while maintaining accurate coverage of the eligible population. A second experimental treatment shares the same mailed screener protocol but adds an incentive of $2. Segments with likely age-ineligible households will be identified for the experiment, with 150 housing units assigned to each experimental treatment, for a total of 300 housing units in the experiment. These 300 units are included in total sample and therefore do not represent any additional respondents nor a different set of data collection items from those used in the face-to-face screening. We will provide a complete summary of this experiment and its results in 2018.

If the results are positive, that is, if return rates are estimated to be no less than 7.0% in the experiment without an incentive or 9.5% or higher with a $2 incentive, then we would conclude that the proposed mailed screener (either with or without an incentive) is cost effective. If both experimental treatments are judged to be cost efficient by these criteria, we would compare the two to determine which is more cost efficient and submit a nonsubstantive change request to OMB for potential approval to adopt the new screener strategy into our routine fieldwork protocol for the survey.

Feasibility pilot test of a shift of Phase 2 protocol to begin 1 week earlier: Specifically, this pilot test will assess the 1-week shift for a subset of the sample (5 PSUs) for 1 field work quarter, based on findings from other studies (Montaquila et al, 2013). All other aspects of fieldwork, including the incentive plan and consent/assent process remain as previously described for the phase boundary at week 11. The rationale for the test of this phase boundary change is based on observing trends in response rates for the two phases, over the course of NSFG fieldwork beginning in 2011. Phase 1 has become less effective over time as evidenced by declining response rates, while phase 2 response rates have remained steady. This test will be evaluated for adverse effects on response rates or costs. If there are no adverse effects, an experiment will be proposed, with the ultimate goal of testing for effects of the phase boundary shift on response rates, yield, and efficiency of operations. We will provide a more complete summary of this feasibility pilot test and its results in 2018 as well.

Once the feasibility pilot test has been implemented for one quarter, we will compare the five PSUs to their own past performance as well as to that of other PSUs in the current quarter. The metrics for the comparison will be HPI and response rate. If data collection operations do not produce substantially lower response rates or higher costs in the test quarter, we will then submit a nonsubstantive change request to propose a full-scale experiment. The full-scale experiment would be powered based on the results of the feasibility pilot test and may run for several quarters with large sample sizes in the experimental condition. A decision would then be made on whether or not to request approval to implement this phase boundary change into the main NSFG fieldwork protocol, based on the efficiency and response rate outcomes.

2. Purpose and Use of the Information Collection

The NSFG responds to the congressional mandate for NCHS to collect and publish reliable national statistics on “family formation, growth, and dissolution” (Sec. 306(a and b), paragraph 1(H) of the Public Health Service Act) as well as vital statistics on births and deaths, and a number of aspects of health status and health care. The NSFG collects and publishes the most reliable, and in most cases the only, national data on such major topics as: adoption, unplanned births, contraceptive use and effectiveness, infertility and use of infertility services, pelvic infection and sexually transmitted disease, sterilization, expected future births, the sexually active population, and the use of and need for family planning services. Under continuous interviewing, the NSFG is continuing the time series of these variables, while improving sample sizes at an affordable cost.

NSFG data are typically summarized in national estimates of the numbers and percentages of the population of reproductive age who experience these events, and are presented in statistical tables and written reports published by NCHS and in professional journals. Statistical techniques such as regression analysis, life tables and hazard models are also used to refine estimates and clarify possible causal connections between events. The research community has always made heavy use of the NSFG: as of August 2017, more than 900 articles in scientific journals, book chapters, and NCHS reports had been published from the NSFG. More than 275 reports and articles have been published from the 2006-2010 NSFG data, released publicly in October 2011. (Attachment E1) The release of the 2011-2013 public use files in December 2014 and the 2013-2015 NSFG public use files in October 2016 have already generated more than 90 reports and articles based on these separate files or the combined 2011-2015 data (Attachment E2).

While limited print copies of reports are produced and may be provided upon request, all NCHS reports, including those based on the NSFG, continue to be posted in PDF format on the NCHS website: https://www.cdc.gov/nchs/ . The NSFG-based NCHS reports in PDF format can also be accessed directly from the NSFG website: https://www.cdc.gov/nchs/nsfg/. Reports posted in 2008 or later are compliant with Section 508 of the Americans with Disabilities Act (ADA).

The dissemination effort for the 2011-2013 and 2013-2015 public use data is described further in Section 16 of this document. The effort includes release of the full 2011-2013 and 2013-2015 public use data files in December 2014 and October 2016, respectively. In addition, a set of 4-year sample weights were also released in October 2016 for use with the combined 2011-2015 data. Researchers can download public use data files in ASCII format from the NCHS website, along with program statements for 3 commonly used statistical packages among NSFG users -- SAS, Stata, and SPSS. As described under Section 16 of this document, we expect to publish several NCHS reports in the coming 1 to 1 ½ years, and we will continue making presentations at a variety of professional meetings. The NSFG’s website page called “Key Statistics from the NSFG” has also been updated with 2011-2015 data so that the public will have quick and easy access to published statistics from the survey, at:

https://www.cdc.gov/nchs/nsfg/key_statistics.htm

The media use NSFG results in several ways, as breaking news, and as a factual base for feature articles, editorials, and commentaries (Attachment E1). NSFG statistics are used as background data for programs and initiatives at the federal, state, and local level, and to benchmark data when smaller or local studies are conducted. Recently, statistics on usage of the NCHS web site have become available.  For example, data for Year 2016 include: 

• 39,057 views of the NSFG homepage

• 20,725 views of the “Key Statistics” described above, 

• 16,488 views of the NSFG’s page for data file documentation

NSFG provides data for various substantive areas of Healthy People 2020 (Attachment F2). NSFG is used as the primary source of data for the Family Planning objectives. In addition, NSFG is an important contributor of data for objectives in the areas of HIV, Sexually Transmitted Diseases, and Maternal, Infant, and Child Health. NSFG data for these objectives have been used to brief the Secretary of DHHS, the Surgeon General, and others. One of the NSFG-based objectives (on receipt of reproductive health services in the past 12 months) was selected as one of 26 “leading health indicators” for the nation (Attachment F2).

NSFG data are used by many DHHS agencies. Some examples of these uses include the following:

• The Office of Population Affairs (OPA) uses NSFG data to estimate the characteristics of women who use Title X-funded clinics for family planning and related health services, as well as for research on factors affecting contraceptive use, unintended pregnancy, teenage sexual activity, and use of medical services for family planning and reproductive health (regardless of provider type). Data on men’s reproductive behavior are also used by the Office of Population Affairs to improve family planning and related health services targeting men. (Attachment F3)

• The Population Dynamics Branch, NICHD, NIH, uses the data from men and women as a resource for intramural and extramural research on marriage, cohabitation, fertility and infertility, contraceptive use, sexually transmitted infections, and breastfeeding in the United States. (Attachment F4)

• The Children’s Bureau, ACF, DHHS, has a special research interest in the data collected on children in foster care, and the fertility and family formation behaviors of adults who experienced foster care as children. (Attachment F5)

• The Administration for Children and Families, Office of Planning, Research, and Evaluation (ACF/OPRE), DHHS, relies on NSFG data on fatherhood, marriage, and teen pregnancy risk behaviors, for planning programs to improve the economic and social well-being of children and families. (Attachment F6)

• The Division of HIV/AIDS Prevention (DHAP), CDC, undertakes research based on NSFG data on behaviors that affect the risk of transmission of HIV—including condom use, numbers of sexual partners, and others. (Attachment F7)

• The Division of Sexually Transmitted Disease Prevention (DSTDP), CDC, relies on the NSFG’s data on sexual behavior and related sexual and reproductive health services to inform their STD prevention programs and research. DSTDP has also supported more recent questionnaire enhancements to improve measurement of preventive service utilization and access among adolescents and young adults. (Attachment F8)

• Division of Adolescent and School Health (DASH) – Within CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), NSFG has long been supported by the Divisions of HIV/AIDS Prevention (DHAP) and Sexually Transmitted Disease Prevention (DSTDP). Since 2016, NCHHSTP/DASH has begun cosponsoring the NSFG to support the collection of data on sexual activity, contraception, and sexual/reproductive health of young people. DASH is particularly interested in improving data collection on sex education to gain a better understanding of the formal instruction that may occur within school settings. (Attachment F9).

• The Division of Cancer Prevention and Control (DCPC), CDC, uses NSFG data on screening for cervical cancer, human papillomavirus (HPV), and breast cancer, which can be analyzed in relation to the NSFG’s extensive data on pregnancy histories, sexual behavior, and reproductive health. DCPC has also supported recent questionnaire additions to evaluate adherence to revised cancer screening guidelines. (Attachment F10)

• The Division of Reproductive Health (DRH), CDC, uses NSFG data for surveillance of reproductive health outcomes and research on teen pregnancy prevention, sexual activity, and contraceptive use. DRH also uses NSFG data for their work on establishing recommendations for family planning services including contraceptive services. (Attachment F11)

• Division of Nutrition Monitoring, Physical Activity, and Obesity (DNPAO) – Within CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), NSFG has long been supported by the Divisions of Cancer Prevention and Control (DCPC) and Reproductive Health (DRH). Since 2016, NCCDPHP/DNPAO has begun cosponsoring the NSFG to support the overall data collection on fertility and infant feeding practices including breastfeeding. DNPAO’s support has also bolstered data collection on nutrition-related counseling that mothers of young children receive from health care providers and other sources. (Attachment F12)

• The Division of Birth Defects and Developmental Disabilities (DBDDD), CDC, uses estimates of the number and characteristics of women at risk of an alcohol-exposed pregnancy that could lead to Fetal Alcohol Syndrome. (Attachment F13)

3. Use of Improved Information Technology and Burden Reduction

Respondent burden for the NSFG is kept to a minimum through the use of sampling procedures that permit the generation of statistically valid national estimates for roughly 149 million people 15-49 years of age with about 20,000 interviews over 4 years of interviewing. Burden is also contained by keeping the average length of the questionnaires to the previously approved 80 minutes for women and 60 minutes for men. Burden is further reduced by using faster and more efficient laptop computers and the latest edition of BLAISE Computer-Assisted Personal Interviewing (CAPI) software.

CAPI reduces burden for the respondent because it collects the data using a laptop computer, along with a highly skilled interviewer. The computer customizes the questionnaire and question wording for the respondent, based on answers given during the administration of the instrument.

A portion of the NSFG interview, roughly 15-20 minutes, is conducted using Audio Computer-Assisted Self-Interview (ACASI). In ACASI, the respondent hears the questions through the headphones, or reads the questions on the computer screen, and enters the answers him or herself. ACASI ensures maximum privacy, so it is used for the most sensitive questions in the survey. However, the self-administered aspect of ACASI requires that both the questions and the answer choices be as simple as possible.

Thus, only material that is sensitive and fairly simple to ask and answer can be collected in ACASI. Respondents often report that they enjoy the ACASI part of the interview because they can control the pace of the interview themselves, and be more active participants in it. Despite the appeal of ACASI, it is not practicable to use ACASI to conduct the entire survey because much of the questionnaire material is too complex to be self-administered. The complex sections of the questionnaire requires a well-trained interviewer – to give instructions, to explain terms and definitions, to ensure that answers are relevant and are entered accurately, and to help maintain the respondent’s privacy from other household members. Based on feedback received since ACASI was first used with the NSFG in 1995, most respondents have reported that they enjoy the interaction with the interviewer during the CAPI part of the interview, as well as the enhanced privacy of ACASI.

4. Efforts to Identify Duplication and Use of Similar Information.

On an ongoing basis, at least annually, the NSFG staff has consulted with NICHD, OPA, and other funding partners to make certain that their data needs are being met, and that NSFG data remain useful and valuable, particularly when there may be other sources of related data. Over the years since moving to a continuous fieldwork design, NSFG staff have also consulted with a number of private organizations (e.g., The National Campaign to Prevent Teen and Unplanned Pregnancy; Child Trends; Guttmacher Institute; Urban Institute; and others), as well as data users in the academic community.

The NSFG is the only nationally representative household survey that is specifically focused on childbearing experience, family formation, sexual behavior, contraceptive use, and reproductive health of men and women in the entire childbearing age range (15-49 years of age), and including retrospective histories of key events related to fertility and family formation. A few other surveys, mostly within the federal sector, have obtained data related to topics covered in the NSFG, but most were more limited in the questions they ask, the population they represent, or both. For example:

• The Census Bureau’s Survey of Income and Program Participation (SIPP, OMB No. 0607-0977, Expires 11/30/2019 ) currently collects marital and birth histories, but it does not collect cohabitation histories, sexual partner histories, or pregnancies not ending in live birth (as collected in the NSFG).

• The CDC’s Youth Risk Behavior Survey (YRBS) (OMB No. 0920-0493, Exp. Date 11/30/2019) collects data on sexual activity and contraceptive use among high school students, but this survey excludes older teens (who have the highest rates of unintended pregnancy and sexually transmitted disease) and those not currently in school. The YRBS is also limited with respect to explanatory variables other than age, grade, and race, and has limited information on first sexual intercourse and first contraceptive use and does not collection information on partner characteristics.

• The National Health and Nutrition Examination Survey (NHANES) (OMB Number 0920-0237, Discontinued 10/18/13 / OMB Number 0920-0950, Exp. Date 12/31/2019), also conducted by NCHS, collects some data on sexual behavior and sexual orientation in their ACASI section, but from comparatively small samples of men and women 15-44 years of age. Unlike the NSFG, NHANES does not have data on sexual attraction which is a measure often used with sexual orientation and behavior to measure HIV/STI risk.

• The National Health Interview Survey (NHIS)(OMB No. 0920-0214, Exp. Date 12/31/2020) also collects information on sexual orientation in large national samples of adult men and women, based on several years of intensive cognitive and field testing (Dahlhamer et al., 2014; Ward et al., 2014). However, unlike the NSFG, NHIS does not contain measures of sexual attraction and sexual behaviors that are often used with sexual orientation to measure HIV/STI risk.

• The Pregnancy Risk Assessment Monitoring System (PRAMS) is a coordinated effort among the CDC and state health departments to collect information on the health of mothers and infants. There is some overlap with information collected in the NSFG, such as contraceptive use before the last pregnancy leading to a live birth, and wantedness of pregnancies leading to live births. However, because PRAMS is based on a sample of recent live births it does not include information on pregnancies that do not end in a live birth and does not include information on women’s full pregnancy/birth histories.

• While other data sources obtain information on selected forms of infertility treatment (e.g., the Assisted Reproductive Technologies Registry System, the National Study of Fertility Barriers), the NSFG is the only source of nationally representative information on the use of any medical services for infertility from the perspective of individuals, rather than service providers.

These occasional, partial overlaps in content between the NSFG and other surveys make it possible to compare some of our statistics with other data to verify their reliability, and assess possible contextual effects based on survey placement. However, most of the statistics that the NSFG provides are unique and cannot be supplied by other surveys, public or private. There may be differences in population coverage or in level of detail that make the NSFG a critical source for nationally representative information and a frequent source of benchmarking for other surveys with similar content. For example:

• all teens compared with teens currently enrolled in school

• all individuals potentially in need of services instead of just those receiving particular services or visiting selected providers

• all pregnancies reported by women compared with only those resulting in live birth

5. Impact on Small Businesses or Other Small Entities.

No small businesses will be involved in this study. This is a survey of individuals, not of firms or organizations.

6. Consequences of Collecting the Information Less Frequently

Conducting the NSFG every 6 or 7 years, as was the case before the move to continuous fieldwork in 2006, is not frequent enough for the needs of NCHS or the other DHHS programs that use the survey. Interviewing and releasing public use files periodically rather than continuously would mean that the information would be too old for most policy and program uses. Many of the fertility and family formation-related behaviors measured in the NSFG can change significantly in less than 6 or 7 years, and the data needs of the programs served by the NSFG also change more frequently than that.

One example of population level change that NSFG can help to explain with behavioral data collected in the survey is the change in the teen birth rate over the last two decades. Between 1991 and 2015, vital statistics data indicate that the US teen birth rate dropped by 64%. The decline occurred among all racial and ethnic subgroups, but rates remained higher among non-Hispanic black and Hispanic teens than among non-Hispanic whites. Because the NSFG provides detailed and relatively frequent data (roughly every 2 years) on sexual activity and contraceptive use among teenagers in the US, NSFG data can help shed light on the key behaviors underlying this trend in teen birth rates and the differentials among subgroups. For example, a recent report using NSFG data for 2011-2015 demonstrated an increase in the use of newer hormonal contraceptives among teen females, specifically, injectable contraception, the hormonal patch, the hormonal ring, emergency contraception, and long-acting reversible contraception (the IUD and implants) (Abma and Martinez, 2017). This is likely to have played a role in the decline in teen births.

Another type of behavioral change the NSFG can monitor more effectively with more frequent data collection is the acceptance of new contraceptive methods; the NSFG helps shed light on how commonly and effectively these methods are used and can track changes in the use of specific method over time. For example, the NSFG can be used to track male methods of contraception, such as vasectomy, withdrawal and the male condom. Compared to data from 2002 and 2006-2010, data from the 2011-2015 showed that the use of the male condom among unmarried men remained stable, while the use of withdrawal nearly doubled during this time period. (Daniels & Abma, 2017).

An example of changing data needs is that the NSFG supplies data for most of the Healthy People 2020 Objectives on Family Planning (Attachment F2). Healthy People 2020 requires that the data be available at least 3 times per decade, and many of the objectives focus on small sub-populations that require large samples (for example, 15-17 year old white, black, and Hispanic females). New legislation, policy initiatives and medical practice guidelines also make new information necessary. Some of these new developments include: new medical guidelines on breast cancer and cervical cancer screening; continued debates about the effects of “abstinence education” and “comprehensive sex education” on teenagers’ behavior; speculation about the effects of emergency contraception; and controversies surrounding contraceptive coverage by insurance plans and providers. The implementation of continuous interviewing allows the NSFG to respond to the most important data needs with revised survey questions and recent data more promptly than before.

7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

None. This request complies fully with 5 CFR 1320.5.

8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

A copy of the 60-day Federal Register Notice for the NSFG, Volume 82, No. 246, pages 61000-61001, published December 26, 2017, is shown in Attachment B1. The 4 comments received by February 26, 2018 are shown in Attachment B2.

The NSFG staff has held periodic (at least annual) in-person discussions with representatives of the funding agencies mentioned above since the early 1990s. In March 2004, the collaborating agencies made the decision to move toward continuous interviewing as soon as possible, to provide larger samples and more frequent data at a more affordable cost per case. In April 2006, OMB approved the continuous interviewing plan, and in June 2006, continuous interviewing began.

Funding agency representatives, as a group, are given updates several times a year, with email reports on the progress of fieldwork, notifications of file or report releases, and other NSFG news. Frequent e-mail and phone exchanges with individual funding agencies also occur often, to keep them up to date and to seek their advice on matters of concern to them. In the last 3 years, there were 3 formal, in-person meetings of the NSFG funding agencies on April 14, 2015, April 20, 2016, and May 23, 2017.  The agenda for these meetings cover recent data and report releases; preparation for upcoming data releases; the status of fieldwork for data collection in progress; planning for upcoming data collection years including questionnaire changes; budget overviews and projections, and for more recent meetings, plans for the long term after the end of the current contract. In addition, since 2014 multiple meetings have been held with individual funding partners, including a visit with all of the CDC/Atlanta-based funding partners in June 2016.

The NSFG staff conducts other outreach efforts as well. For example, we present workshops and papers at professional meetings such as the Population Association of America, the American Sociological Association, the Maternal and Child Health Epidemiology meetings, Society of Adolescent Health and Medicine, American Association of Public Opinion Research, and the American Public Health Association, so that we can meet with data users and obtain feedback on the survey’s data and user support. We maintain an “NSFG Announcements” listserv, which currently has over 350 subscribers, and we regularly use it to inform our user community of new NSFG file releases and published reports. The NSFG staff also maintains an email address [email protected] to allow users of our data files an easy way to ask questions and make suggestions for the survey or our web-posted user tools.

Key persons representing the NSFG’s cosponsoring agencies are consulted on an ongoing basis. These persons include:

Agency	Contact Person(s)	Address/ Email/ Phone
OPA	Katherine Ahrens, PhD	1101 Wooten Parkway, Suite 700 Rockville, MD 20852 [email protected], 240-453-2831
NICHD	Rosalind B. King, PhD	Population Dynamics Branch 6100 Executive Boulevard Bethesda, MD 20892-7151 [email protected] , 301-435-6986
ACF/Children’s Bureau	Sharon Newburg-Rinn, PhD	Switzer Building, Room 3042 330 C Street, SW Washington, DC 20201 Sharon.Newburg-Rinn@acf.hhs.gov, 202-205-0749
ACF/OPRE	Tia Zeno, PhD	370 L’Enfant Promenade, SW 7th Floor West Washington, DC 20447 [email protected], 202-401-5079
CDC/DBDDD	Patricia P. Green, MSPH	Fetal Alcohol Syndrome Prevention Team 1825 Century Center Atlanta, GA. 30329 [email protected], 404-498-3953
CDC/NCCDPHP/DCPC	Mary White, ScD, MPH Jin Qin, ScD, MS	David Building Atlanta, GA 30341 MW: [email protected] , 770-488-3032 JQ: [email protected], 770-488-7869
CDC/NCCDPHP/DRH	Wanda Barfield, MPH, MD Karen Pazol, MPH, PhD	4770 Buford Highway, MS F-74 Atlanta, GA 30341 WB: [email protected], 770-488-5574 KP: [email protected], 770-488-6305
CDC/NCCDPHP/DNPAO	Heather Hamner, PhD, MS, MPH Ellen Boundy, RN, CNM, MS, ScD	4770 Buford Highway, MS F-77 Atlanta, GA 30341 HH:[email protected], 770-488-7672 EB: [email protected], 770-488-4438
CDC/NCHHSTP/DSTDP	Patricia Dittus, PhD Jami Leichliter, PhD	Corporate Square Atlanta, GA 30329 PD: Building 12, [email protected] ,404-639-8299 JL: Building 1, [email protected], 404-639-1821
CDC/NCHHSTP/DHAP	Marc Pitasi, MPH Kevin Delaney, MPH, PhD	Corporate Square, Building 8 Atlanta, GA 30329 MP: [email protected], 404-639-6361 KD: [email protected], 404-639-8630
CDC/NCHHSTP/DASH	Lisa Barrios, DrPH Riley Steiner, MPH	1600 Clifton Rd. NE, MS E-75 Atlanta, GA 30329 LB: [email protected], 404-718-8180 RS: [email protected] , 404-718-8192

Other continuing contacts with these and other agencies have been described in Section 2 of this document ("Purpose and Use of Information Collection"). There are no unresolved issues between NCHS and any of these agencies.

9. Explanation of any Payment or Gift to Respondents

As approved for NSFG data collection since 2002 and as justified in prior clearance requests, we plan to continue to offer $40 in cash as a token of appreciation to respondents. Attachment D describes the overall rationale for this incentive use and also summarizes the most recent experiment we conducted on incentive use. Based on the results of this latter experiment, we decided to continue with the current NSFG incentive plan, a 2-phase structure which has been in use since the NSFG’s move from periodic to continuous interviewing in 2006.

This 2-phase fieldwork and incentive structure was implemented beginning in 2006 to obtain the most benefit from the continuous interviewing design. Each quarter, during week 10 (the feasibility pilot study described in section B would shift this timeframe up by 1 week), a subsample of active, non-responding cases (among both households that have not completed a screener and individuals who have not completed a main interview) is selected for continued follow-up. In weeks 11 and 12 (or week 10-12 for the feasibility pilot study to shift the phase boundary), this subsample receives a special mailed advance incentive ($5 if a household screener and $40 if a main study respondent) and the interviewers focus their effort on the fewer cases left in the subsample. These advance incentives are in addition to the $40 given to respondents in person when agreeing to complete the main interview.

Meanwhile, the proposed mailed household screener experiment would also include an incentive of $2 for half of the up to 300 households that would potentially participate in this experiment designed to assess whether the use of mailed screeners decrease fieldwork costs while maintaining accurate coverage of the eligible population. Since this experiment will be directed to segments with likely age-ineligible households, it is unlikely that persons participating in this methodological study will also go on to complete the main study.

10. Protection of the Privacy and Confidentiality of Information Provided by Respondents

This submission has been reviewed by the NCHS Privacy Act Officer and the NCHS Confidentiality office who determined that the Privacy Act does apply. This study is covered under Privacy Act System of Records Notice 09-20-0164 (“Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population”).

Social Security numbers are not collected at any stage of the NSFG. The only Information in Identifiable Form (IIF) that is collected includes the respondent’s name, address, and telephone number. IIF is used for 4 purposes: (1) the address is used for screening, (2) the name is used for informed consent, (3) the telephone number is used for verification, in which a sample of respondents is re-contacted to verify that the interview occurred; and (4) the address is used for geocoding of the contextual data file. These IIF data are stored encrypted, and separately from the survey data, using secure storage procedures as required by the Office of the Chief Information Security Officer (OCISO) of CDC. At the time of this writing, contract modification has been submitted and is in processing, requiring the contractor to destroy and transmit all data including PII to NCHS upon completion of the contract in 2020. Date of birth and age are collected, but the day of birth is not released as part of the public use files.

Items of Information to be Collected

The NSFG collects the following information from a national sample of men and women 15-49 years of age:

• Demographic characteristics including age, marital status, educational attainment, religious affiliation, and labor force participation;

• Births and pregnancies (had, from women; or fathered, from men);

• Marriage and cohabitation (current and past);

• Contraceptive methods used currently and in the past;

• Use of medical care for contraception, infertility, and reproductive health;

• Attitudes about marriage, children, and parenting;

• From men, father involvement in raising their children.

In the ACASI section, data are collected on numbers of opposite-sex and same-sex partners, alcohol and drug use, and sexual attraction and orientation.

The confidentiality of individuals participating in NSFG is protected by section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (CIPSEA) of 2002. Section 308(d) states:

"No information, if an establishment or person supplying the information or described in it is identifiable, obtained in the course of activities undertaken or supported under section...306,...may be used for any purpose other than the purpose for which it was supplied unless such establishment or person has consented (as determined under regulations of the Secretary) to its use for such other purpose and (1) in the case of information obtained in the course of health statistical or epidemiological activities under section...306, such information may not be published or released in other form if the particular establishment or person supplying the information or described in it is identifiable unless such establishment or person has consented (as determined under regulations of the Secretary) to its publication or release in other form..."

In addition, legislation covering confidentiality is provided according to section 513 of the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA) (PL-107-347), which states:

“Whoever, being an officer, employee, or agent of an agency acquiring information for exclusively statistical purposes, having taken and subscribed the oath of office, or having sworn to observe the limitations imposed by section 512, comes into possession of such information by reason of his or her being an officer, employee, or agent and, knowing that the disclosure of the specific information is prohibited under the provisions of this title, willfully discloses the information in any manner to a person or agency not entitled to receive it, shall be guilty of a Class E felony and imprisoned for not more than 5 years, or fined not more than $250,000, or both.”

NCHS also complies with the Federal Cybersecurity Enhancement Act of 2015, which permits monitoring information systems for the purpose of protecting a network from hacking, denial of service attacks and other security vulnerabilities.¹ Monitoring under the Cybersecurity Act may be done by a system owner or another entity the system owner allows to monitor its network and operate defensive measures on its behalf. The software used for monitoring may scan information that is transiting, stored on, or processed by the system. If the information triggers a cyber threat indicator, the information may be intercepted and reviewed for cyber threats. The cyber threat indicator or defensive measure taken to remove the threat may be shared with others only after any information not directly related to a cybersecurity threat has been removed. In addition, sharing of information can occur only after removal of personal information of a specific individual or information that identifies a specific individual.

NCHS policy requires physical protection of records in the field, and has delineated these requirements for the data collection contractor. The contractor also has its own policy and procedures regarding assurance of confidentiality and a pledge that all employees involved in the NSFG must sign. The contractor provides all safeguards mandated by the Privacy Act and Confidentiality legislation to protect the confidentiality of the data. Data collection contractor employees who have access to the IIF and other confidential data sign formal Designated Agent Agreements (DAA). The contractor’s data security procedures comply fully with security requirements delineated by OCISO. As of August 14, 2017, the NSFG’s Certification and Accreditation and Authority to Operate has been accepted and is being processed by CDC’s OCISO.

It is the responsibility of NCHS employees, including NCHS contract staff, to protect and preserve all NSFG data from unauthorized persons and uses. All NCHS employees as well as all contract staff have received appropriate training, made a commitment to assure confidentiality, and have signed a “Nondisclosure Affidavit” every year. Protection of the confidentiality of records is a vital and essential element of the operation of NCHS, and it is understood that Federal law demands that NCHS provide full protection at all times of the confidential data in its custody. Only authorized personnel are allowed access to confidential records and only when their work requires it. When confidential materials are moved between locations, records are maintained to ensure that there is no loss in transit and when confidential information is not in use, it is stored in secure conditions.

Confidential data will never be released to the public. For example, all IIF and other personal information that could be potentially identifiable (including participant name, address, survey location number, sample person number) are removed from the public release data files. The NCHS Disclosure Review Board reviews all public use files, including those of the NSFG, to assure that directly or indirectly identifiable data are not included. Thus, when NCHS releases public use data files as part of its mission to disseminate the data widely, any information that could be identifiable is removed.

Respondents are notified of the voluntary nature of the survey through the Advance Letter for Households, the Advance Letter for Respondents (Attachments H1 and H2), the respondent’s Q&A brochure (Attachment H4), and the informed consent forms (Attachment H3). Information for respondents on the uses of the data is provided in the advance letters, consent forms, and the Question and Answer Brochures (Attachments H1-H4).

11. Institutional Review Board and Justifications for Sensitive Questions

The NCHS Research Ethics Review Board (RERB) most recently reviewed and approved the NSFG survey materials in July 2017, to continue this protocol for the maximum allowable period of 1 year (expiring July 2018) (Attachments N). Subsequent annual submissions to the ERB are planned to allow for continued data collection.

Since the survey focuses on childbearing and pregnancy (in the main interview) and reproductive health (in the self-administered ACASI portion), it necessarily deals with a number of topics that may be sensitive for some people. But prior NSFG survey experience shows that this is not a serious problem: most questions in the interview (e.g., such as infertility, adoption, divorce, contraceptive use, and sexual activity) have been asked of more than 56,000 people since the 1995 survey with no problems, in part because family formation, sexual activity, and having and raising children are important and positive aspects of the lives of most people in this age range.

The questions in the NSFG questionnaires may be divided into 2 groups:

(a) Questions that have generally been asked in some form in the NSFG since the 1970s—including demographic characteristics like education and marital status, and behaviors such as contraceptive use, marriage, divorce, and unmarried cohabitation.

(b) More sensitive questions that are asked in ACASI, and have mostly been asked only since 2002.

Attachment C discusses the more sensitive items that are administered in the self-administered ACASI section of the questionnaire, as shown below:

• Incarceration

• Drug Use

• Non-voluntary sexual experience

• Sexually transmitted diseases (STDs)

• Sexual behavior

• Sexual identity and attraction

• Same-sex sexual activity

• Income, including sources of income

Minimizing sensitivity - The context in which questions are asked and the demonstrated statistical uses of the survey are important factors in overcoming the potential sensitivity of the subject matter. The NSFG takes at least 6 steps to create a context which minimizes sensitivity and makes clear to respondents the legitimate need for the information:

(1) First, it is always possible to answer “I don’t know” (I can’t recall, I don’t remember, or I never knew that) or “Refuse (or choose not) to answer” for any question. To save space on the simplified paper “CAPI-lite” versions of the questionnaires (Attachments J & K), “refused” or “don’t know” were not listed as explicit answer choices for every question, but interviewers are trained to accept "don't know" or "refused" for any question. Similarly, in the ACASI portion of the survey, respondents are informed that these are accepted responses for any question, and they are shown how to enter these responses.

(2) Advance letters, brochures, and other materials (Attachments H1-H6) are used to make clear that the survey is sponsored by the U.S. Department of Health and Human Services, and that the information is put to important uses. Our advance materials cite the NSFG web site (http://www.cdc.gov/nchs/nsfg.htm), and respondents who want to verify the sponsorship of the survey for themselves are shown the Interviewer’s Letter of Authorization (Attachment H7). They can also call the toll-free number at NCHS (866-227-8347) or the University of Michigan (855-891-8891). The toll-free phone lines at NCHS are answered by the Principal Investigator (Dr. Anjani Chandra), the Contract Officer Representative (Dr. Joyce Abma) and another senior staff person (Dr. Gladys Martinez, who is also bilingual in Spanish). The toll-free phone number at the contractor’s office (ISR/University of Michigan) is answered 6 days a week, including weekday evenings.

(3) Only professional female interviewers are used. Based on consultation with survey directors of several large, national surveys, both female and male respondents in the U.S. typically express a preference to be interviewed by women on sensitive topics.

(4) The questionnaire is carefully crafted to lead smoothly from one topic to another. As new topics are introduced, the need for the information is explained briefly to the respondent. A considerable effort was made to use the experience of the nearly 56,000 NSFG respondents since 2002 (12,571 in 2002, 22,682 in 2006-2010, and 20,621 in 2011-2015) to improve the current survey questions.

(5) NSFG interviewers ask most of the questions using a laptop computer with Blaise programming. When paper-and-pencil questionnaires were used for interviewing (before the 1995 NSFG), one principal privacy concern of respondents was the possibility that spouses, parents, or other family members would see their answers; CAPI and ACASI help to prevent those situations.

(6) ACASI is used for the most sensitive questions (Female Section J and Male Section K). The questions are asked over headphones (and on the computer screen) and the respondent enters his or her answers into the laptop computer. ACASI helps to ensure that other members of the respondent’s own household (if any) will not know what the questions were, or what the answers were. The screen can be made blank with one keystroke if anyone walks into the room while the interview is going on. ACASI concludes with the respondent initiating a locking mechanism that prevents the interviewer or anyone else from seeing the respondent’s answers.

12. Estimates of Annualized Burden Hours and Costs

On an annual basis, up to 15,000 persons may complete a household screener interview (Attachment I) yielding 7,500 households with an eligible respondent aged 15-49. From these households, about 5,000 respondents will complete a main interview: 2,750 females and 2,250 males. The mean interview length remains at about 80 minutes for females and 60 minutes for males. Finally, the NSFG selects a random 10% sub-sample of the cases completed by each interviewer (both screener and main interview) to be rechecked using a brief interview to verify the completeness and accuracy of the interviewer’s work. This results in roughly 1,500 of the respondents to the screener interview and 500 respondents to the main survey being re-contacted by telephone for a short (2-minutes for screener and 5-minutes for main) verification interview (Attachment L1-L3).

12.A Estimated Annualized Respondent Table

Respondents	Form	No. of Responses	Responses per Respondent	Average Burden/ Response (in hours)	Total Burden Hours
Household member	Screener Interview	15,000	1	3/60	750
Household Female 15-49 years of age	Female Interview	2,750	1	80/60	3,667
Household Male 15-49 years of age	Male Interview	2,250	1	1	2,250
Household member	Screener Verification	1,500	1	2/60	50
Household Individual 15-49 years of age	Main Verification	500	1	5/60	42
TOTAL	6,759

The average response burden cost for the NSFG is estimated to $178,370 (Wage information is from the Bureau of Labor Statistics: http://www.bls.gov/news.release/empsit.t19.htm).

12.B Estimated Annualized Respondent Costs

Total Burden Hours	Respondent Wage Rate per Hour	Total Respondent Costs
6,759	$26.39	$178,370

13. Estimate of Other Total Annual Cost to Respondents or Record Keepers

There are no costs to respondents other than the time necessary to respond to the information collection.

14. Annualized Cost to the Federal Government

The Annualized cost to the government based on FY 2017 figures is:

CONTRACT $5,800,000

NCHS Staff 1,300,000

TOTAL $7,100,000

Most of the contract costs are for data collection, including hourly wages for interviewers, plus the costs of hiring and training them. Contract costs also include specification and programming of the male and female questionnaires; and data processing, editing, and documentation of the data file. NCHS actively monitors and reviews this work in all its stages.

15. Explanations for Program Changes or Adjustments

Apart from the request to continue the NSFG beyond our current expiration in May 2018, we wish to test some small methodologic changes to see if we can curb the declines NSFG and all household surveys are seeing in participation rates. These methodologic studies are described further in supporting statement B. No further changes are planned for the survey content under the current NSFG contract.

The currently approved burden is 7,318 hours. This figure has been reduced by 559 hours due to a more accurate estimate for female interviews (80 minutes instead of the 90 minutes previously used) and a deletion of the testing burden due to use of the previously approved questionnaires. The requested burden for this submission is 6,759 hours.

16. Plans for Tabulation and Publication and Project Time Schedule

Letters sent to respondents 3-5 months after OMB approval

Data collection: 5-36 months after OMB approval

Data collection completed Continuous after OMB approval

Main Study coding, edits, imputation, prepare

recoded variables & document data files Continuous after OMB approval

Release public use data files for

Interviews in 2015-2017: 6 months after OMB approval

Release public use data files for

Interviews in 2017-2019: 30 months after OMB approval

First published reports: 6 months after OMB approval,

then periodically.

The data from the NSFG are analyzed using SAS, STATA, and other statistical software for tabulation and analysis. SUDAAN, SAS, STATA, and similar software are being used for variance estimation. Results will be published in standard NCHS Reports, and as articles in professional journals. Over 800 reports from Cycles 1-6 are shown on the NSFG web site. Over 275 publications from the 2006-10 NSFG and 100 publications thus far from the 2011-2013, 2013-2015, and 2011-2015 NSFG are shown in Attachments E1 and E2.

Publications – All NSFG-based reports published by NCHS are available as PDF files on the NSFG website: http://www.cdc.gov/nchs/nsfg.htm. Publications released in 2008 or later are compliant with Section 508 of the Americans with Disabilities Act. A short report on birth expectations of U.S. women was published with the October 2016 release of the 2013-2015 public use data files. In addition, at this same time, the 4-year sample file weights were also made available for use with the combined 2011-2015 NSFG data, and three NCHS reports have been published using these data at the time of this writing:

• NHSR on teen sexual activity and contraception (6/22/17)

• NHSR on condom use (8/10/17)

• Data Brief on unmarried men’s contraceptive use (8/31/17)

Several more NCHS reports are in preparation from 2011-15 NSFG data are expected to be published within the next year, though the precise timing could change, including the addition or deletion of other reports based on organizational priorities. The NCHS Public Affairs Office maintains a website of upcoming reports that will include NSFG reports planned for the next 6-9 months (https://www.cdc.gov/nchs/pressroom/default.htm). These are, of course, only the initial publications planned by the NSFG team at NCHS, with several more likely to be published. Also, these plans do not include publications in peer-reviewed journals or authored by academic and other researchers.

17. Reason(s) Display of OMB Expiration Data is Inappropriate.

N/A

18. Exceptions to Certification for Paperwork Reduction Act Submissions.

None

1 "Monitor" means "to acquire, identify, or scan, or to possess, information that is stored on, processed by, or transiting an information system"; "information system" means "a discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination or disposition of information"; "cyber threat indicator" means "information that is necessary to describe or identify security vulnerabilities of an information system, enable the exploitation of a security vulnerability, or unauthorized remote access or use of an information system.