Fertility Knowledge Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Fertility Knowledge Survey	Form	Modified	Available
Attach_F_OMB_Consent_Adult_Revised_May2019_R_Aug2019_Clean.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_E_OMB_Invitation_AdultKP&AllYP_May2019_R_Aug2019_Clean.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_B_FertilityKnowledgeSurvey_Version20_8-13-19_PRA_Final_Clean.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_K_CoC_All_May2019_R_Aug2019.pdf	Supplementary Document	Uploaded 2019-10-03	Repair queued
Attach_J_OMB_IpsosPrivacyCommitment_May2019__Aug2019.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_H_OMB_BillofRights_TheDeal_May2019_R_Aug2019.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_I_OMB_Minor Assent_Revised_May2019.pdf	Supplementary Document	Uploaded 2019-06-06	Available
Attach_H_OMB_Parent Permission_KPMinors_Revised_May2019.pdf	Supplementary Document	Uploaded 2019-06-06	Available
Attach_F_OMB_Consent_Adult_Revised_May2019_R_Aug2019_Clean.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_D_IRB_All_Sep2019.pdf	Supplementary Document	Uploaded 2019-10-03	Available
Attach_C_OMB_FRN_60D&30D_All.pdf	Supplementary Document	Uploaded 2019-06-06	Available
Attach_B_FertilityKnowledgeSurvey_Version20_8-13-19_PRA_Final_Clean.pdf	Supplementary Document	Uploaded 2019-10-03	Available
30-dayFRN 0937-Fertility Knowledge Study.pdf	Supplementary Document	Uploaded 2019-03-25	Available
SSB_FertilityKnowledgeSurvey_9-6-19_OMB_Clean_9-23-19.docx	Supporting Statement B	Uploaded 2019-10-03	Available
SSA_FertilityKnowledgeSurvey_9-6-19_OMB_Clean_9-23-19.docx	Supporting Statement A	Uploaded 2019-10-03	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

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0937-0208	ICR Reference No: 201903-0937-003
Status: Active	Previous ICR Reference No: 201902-0937-001
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: Approved with change	Conclusion Date: 10/04/2019
	Date Received in OIRA: 03/26/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved
Responses	4,000	0	0
Time Burden (Hours)	1,333	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of the Assistant Secretary for Health/Office of Population Affairs (OPA) is seeking approval from the Office of Management and Budget on a new information collection. OPA seeks to collect information through the Fertility Knowledge Survey that will increase OPA’s understanding of fertility knowledge among young men and women and the relationships between fertility knowledge and demographic and other related factors (e.g., childbearing preferences, plans, attitudes and behaviors). OPA intends to use this information to identify those individuals in the study sample who could benefit from improved or increased fertility-related education, information, counseling, and services. The survey will be administered via the internet to a non-probability sample of English-speaking women and men in the United States (U.S.) who are aged 18–29 years and able to get pregnant or father a child.

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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 49936	10/03/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 11112	03/25/2019
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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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	4,000	0	0	4,000	0	0
Annual Time Burden (Hours)	1,333	0	0	1,333	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: New

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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: 03/26/2019

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