Fertility Knowledge Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Fertility Knowledge Survey	Form	New	Available
Attach_D_OMB_IRBNotice_2-5-19.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Attach_C_OMB_FRN_60D_2-5-19.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Attach_A_TitleXLeg_2-5-19.pdf	Supplementary Document	Uploaded 2019-02-22	Available
SSB_FertilityKnowledgeSurvey_OASH-OPA_Feb2019_V8_ROCIS_2-22-19.docx	Supporting Statement B	Uploaded 2019-02-22	Available
SSA_FertilityKnowledgeSurvey_OASH-OPA_V8_2-22-19_CLEAN.docx	Supporting Statement A	Uploaded 2019-02-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235067	Fertility Knowledge Survey	Form	New

ICR Details

OMB Control No: 0937-0208	ICR Reference No: 201902-0937-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: Fertility Knowledge Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 03/12/2019
	Date Received in OIRA: 02/28/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Abstract: The Office of the Assistant Secretary for Health/Office of Population Affairs (OPA) is seeking an approval by the Office of Management and Budget on a new information collection. We seek to collect information to increase understanding of (1) adolescent and young adult knowledge of human (female and male) fertility and (2) how this knowledge is related to behaviors and intentions involving childbearing. We propose to collect this information through a 20-minute web survey (Fertility Knowledge Survey) of 2,100 females and 1,900 males, aged 15 to 29 years, using an online panel that is based on a probability-based sample of the U.S. population. The survey will produce evidence and findings that are expected to be generalizable to the population of English-speaking females and males aged 15 to 29 years in the United States.

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Authorizing Statute(s): US Code: 42 USC 300 Name of Law: Title X Public Health Service Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 192	10/03/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 38	02/22/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Fertility Knowledge Survey	1	Fertility Knowledge Survey

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: We seek to collect a new survey of fertility awareness to increase understanding of adolescent and young adult knowledge of human fertility.

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Annual Cost to Federal Government: $561,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 02/28/2019

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