NSFG Life History Calendar Evaluation

Collaborating Center for Questionnaire Design and Evaluation Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0222 NSFG Life History Calendar Evaluation Form and Instruction
0920-0222 Attachment 1a: Questions to be cognitively tested Att 1a-NSFG LHC Questions.doc Form and Instruction
0920-0222 Attachment 1b - Life History Calendar Worksheet (Recall Att 1b-NSFG LHC-Recall Aide.pdf Form and Instruction
0920-0222 Attachment 3a – Telephone Screening Script – Respondent Att 3a-NSFG LHC-Screener adv&flyer.doc Form and Instruction
0920-0222 Attachment 3b – Telephone Screening Script – Respondent Att 3b-NSFG LHC-Screener adv&flyer.doc Form and Instruction
0920-0222 Attachment 5: Respondent Data Collection Sheet Att 5-NSFG LHC Resp Data Collect.doc Form and Instruction
NSFG LHC 10-Day Letter 121219.docx 10 Day Letter IC Document
Att 2-NSFG LHC Ad&Flyer.doc Attachment 2: Advertisement/flyer. IC Document
Att 4-NSFG LHC Consent.doc Attachment 4 – Adult Informed Consent IC Document
Att 6-NSFG LHC ThankYou ltr.doc Attachment 6 – Thank you letter IC Document

Information Collection (IC) Details

IC Title:	NSFG Life History Calendar Evaluation	Agency IC Tracking Number:	0920-20EH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0222	Attachment 1a: Questions to be cognitively tested	Att 1a-NSFG LHC Questions.doc	Yes	Yes	Fillable Printable
Form and Instruction	0920-0222	Attachment 1b - Life History Calendar Worksheet (Recall Aide)	Att 1b-NSFG LHC-Recall Aide.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222	Attachment 3a – Telephone Screening Script – Respondent recruited from newspaper advertisement/flyer	Att 3a-NSFG LHC-Screener adv&flyer.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222	Attachment 3b – Telephone Screening Script – Respondent recruited from CCQDER Respondent Database	Att 3b-NSFG LHC-Screener adv&flyer.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0222	Attachment 5: Respondent Data Collection Sheet	Att 5-NSFG LHC Resp Data Collect.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population 09-20-0164	FR Citation: 49 FR 37693

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
10 Day Letter	NSFG LHC 10-Day Letter 121219.docx	12/16/2019
Attachment 2: Advertisement/flyer.	Att 2-NSFG LHC Ad&Flyer.doc	12/16/2019
Attachment 4 – Adult Informed Consent	Att 4-NSFG LHC Consent.doc	12/16/2019
Attachment 6 – Thank you letter	Att 6-NSFG LHC ThankYou ltr.doc	12/16/2019

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