Information Collection

Female Questionnaire

IC 216265 under ICR 202203-0920-004 · OMB 0920-0314.

⚠️ Notice: This information collection may be referencing outdated material.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
Female Questionnaire Form and Instruction
Female Questionnaire in Capilite Format (year 1 2022) ATT-I2-NSFG-female-capilite-Oct28.docx Form and Instruction
Female Questionnaire in Capilite Format (year 1 2022) ATT-I2-NSFG-female-capilite-Oct28.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Female Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Female Questionnaire in Capilite Format (year 1 2022)	ATT-I2-NSFG-female-capilite-Oct28.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: 2,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,750	2,750
Annual IC Time Burden (Hours)	3,438	3,438
Annual IC Cost Burden (Dollars)	102,988	102,988

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.