Information Collection

Rands Nsfg

IC 248008 under ICR 201807-0920-004 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0222 RANDS NSFG Web Questionnaire RANDS NSFG	Form and Instruction
0920-0222 RANDS NSFG Web Questionnaire Att 1 - Questionnaire and Intro Script.docx	Form and Instruction
Att 3 - NCHS Non-Disclosure Affidavit for NORC Organization Staff working on RANDS.docx Att 3_ NCHS Non-Disclosure Affidavit for NORC	IC Document
Att 2 - NORC CIPESA Protection Plan.docx Att 2_NORC CIPESA Protection Plan	IC Document
OMB 10-day Letter_RANDS_NSFG_06 22 2021.docx 10-day Letter _RANDS NSFG	IC Document

IC Title:

RANDS NSFG

Agency IC Tracking Number:

0920-0222-21GD

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0222				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 2,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,200	2,200
Annual IC Time Burden (Hours)	734	734
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3_ NCHS Non-Disclosure Affidavit for NORC		06/22/2021
Att 2_NORC CIPESA Protection Plan		06/22/2021
10-day Letter _RANDS NSFG		06/22/2021

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

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