Household Screener Instrument

National Survey of Family Growth

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0314 can be found here:

Documents and Forms

Document Name Document Type
Household Screener Instrument Form and Instruction
NSFG Household Screener Instrument in Capilite Format ATT-H-NSFG-screener-capilite-Sep2021.docx Form and Instruction
NSFG Household Screener Instrument in Capilite Format ATT-H-NSFG-screener-capilite-Sep2021.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Household Screener Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	NSFG Household Screener Instrument in Capilite Format	ATT-H-NSFG-screener-capilite-Sep2021.docx		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: 13,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,500	13,500
Annual IC Time Burden (Hours)	675	675
Annual IC Cost Burden (Dollars)	20,223	20,223

Documents for IC

Title	Document	Date Uploaded
No associated records found

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