[NCHS] National Survey of Family Growth

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0314 INTERVIEW OBSERVATION FORM	Form and Instruction	Unchanged	Available
Form 0920-0314 Interviews Observation Form (Screener Verification)	Form and Instruction	Unchanged	Repair queued
Form 0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - MALE QUESTIONNAIRE CAPI-LITE	Form and Instruction	Modified	Available
Form 0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) MALE QUESTIONNAIRE in CAPI-LITE FORMAT	Form and Instruction	Modified	Available
Form 0920-0314 Male Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - FEMALE QUESTIONNAIRE CAPI-LITE	Form and Instruction	Modified	Repair queued
Form 0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) FEMALE QUESTIONNAIRE in CAPI-LITE FORMAT	Form and Instruction	Modified	Available
Form 0920-0314 Female Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOLD SCREENER INSTRUMENT in CAPI-LITE FORMAT	Form and Instruction	Unchanged	Available
Form 0920-0314 Household Screener Instrument	Form and Instruction	Unchanged	Repair queued
0920-0314_NSFG-Attach1-Year5proposedchanges.docx	Supplementary Document	Uploaded 2025-07-25	Available
0920-0314_NSFG-Attach1-Year5proposedchanges.docx	Supplementary Document	Uploaded 2025-07-25	Repair queued
0920-0314_NSFG-NonSubChangeRequest_07-10-2025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-25	Available
0920-0314_NSFG-NonSubChangeRequest_07-10-2025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-25	Available
0920-0314_ChangeRequest_REV10APR2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-10	Available
0920-0314_ChangeRequest_REV10APR2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-10	Repair queued
0920-0314_NSFG-NonSubChangeRequest_April_1_2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-03	Available
0920-0314_NSFG-NonSubChangeRequest_April_1_2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-03	Available
NSFG-Att4-AdvR-VisualDesign_QR.docx	Supplementary Document	Uploaded 2024-04-03	Available
NSFG-Att4-AdvR-VisualDesign_QR.docx	Supplementary Document	Uploaded 2024-04-03	Repair queued
NSFG-Att3-AdvR-RegularText_QRV2.docx	Supplementary Document	Uploaded 2024-04-03	Available
NSFG-Att3-AdvR-RegularText_QRV2.docx	Supplementary Document	Uploaded 2024-04-03	Repair queued
NSFG-Att2-AdvHH-VisualDesign_QR.docx	Supplementary Document	Uploaded 2024-04-03	Available
NSFG-Att2-AdvHH-VisualDesign_QR.docx	Supplementary Document	Uploaded 2024-04-03	Repair queued
NSFG_Att1-AdvHH-RegularText_QR.docx	Supplementary Document	Uploaded 2024-04-03	Repair queued
NSFG_Att1-AdvHH-RegularText_QR.docx	Supplementary Document	Uploaded 2024-04-03	Repair queued
ATT-B3-American Atheists Letter_Dec_1_2021.pdf	Supplementary Document	Uploaded 2021-12-02	Available
ATT-B3-American Atheists Letter_Dec_1_2021.pdf	Supplementary Document	Uploaded 2021-12-02	Repair queued
ATT-N2-NSFG-Phase4NRFUletters-2021.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-N2-NSFG-Phase4NRFUletters-2021.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-N1-NonresponseBiasAnalysisPlan-Apr21.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-N1-NonresponseBiasAnalysisPlan-Apr21.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-M-ERBdetermination_081121sig.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-M-ERBdetermination_081121sig.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-L-InterviewObsForm_revJun2021.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-L-InterviewObsForm_revJun2021.docx	Supplementary Document	Uploaded 2021-09-16	Missing upstream
ATT-J1-NSFG-MaleQuexChangeSummary-Oct28_2021.docx	Supplementary Document	Uploaded 2021-11-29	Available
ATT-J1-NSFG-MaleQuexChangeSummary-Oct28_2021.docx	Supplementary Document	Uploaded 2021-11-29	Repair queued
ATT-I1-NSFG-FemQuexChangeSummary-Oct28_2021.docx	Supplementary Document	Uploaded 2021-11-29	Available
ATT-I1-NSFG-FemQuexChangeSummary-Oct28_2021.docx	Supplementary Document	Uploaded 2021-11-29	Repair queued
ATT-G9-NSFG-EmailTextScripts-English.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G9-NSFG-EmailTextScripts-English.docx	Supplementary Document	Uploaded 2021-09-16	Missing upstream
ATT-G8-NSFG-WebIncentiveChoiceText.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G8-NSFG-WebIncentiveChoiceText.pdf	Supplementary Document	Uploaded 2021-09-16	Missing upstream
ATT-G7-NSFG-InterviewerAuthorizationLetter-English.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G7-NSFG-InterviewerAuthorizationLetter-English.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G6-NSFG-FamilyFactSheet-English.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G6-NSFG-FamilyFactSheet-English.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G5-ConfidentialityBrochure-English.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G5-ConfidentialityBrochure-English.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G4_QandABrochure_English.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G4_QandABrochure_English.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G3-NSFG-ConsentAssentForms-2021.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G3-NSFG-ConsentAssentForms-2021.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G2-NSFG-AdvanceRESPONDENTletter-2021-English.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G2-NSFG-AdvanceRESPONDENTletter-2021-English.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-G1-NSFG-AdvanceHOUSEHOLDletter-2021-English.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-G1-NSFG-AdvanceHOUSEHOLDletter-2021-English.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-F2-2019-RFI-NSFG.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-F2-2019-RFI-NSFG.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-F-NSFG=OutsideConsultation-BSC-10Feb2022.pdf	Supplementary Document	Uploaded 2023-08-07	Available
ATT-F-NSFG=OutsideConsultation-BSC-10Feb2022.pdf	Supplementary Document	Uploaded 2023-08-07	Repair queued
ATT-E13_DASH_2021LetterofSupport.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E13_DASH_2021LetterofSupport.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E12_DRH_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E12_DRH_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E11_DCPC_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E11_DCPC_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E10_DVP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E10_DVP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E9_DSTDP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E9_DSTDP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E8_DHP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E8_DHP_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E7_OWH_2021LetterofSupport_30day.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E7_OWH_2021LetterofSupport_30day.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E6_OPRE_2021LetterofSupport_30day.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E6_OPRE_2021LetterofSupport_30day.docx	Supplementary Document	Uploaded 2021-09-16	Missing upstream
ATT-E5_CB_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E5_CB_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E4_NICHD_2021LetterofSupport.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E4_NICHD_2021LetterofSupport.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E3_OPA_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-E3_OPA_2021LetterofSupport.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-E2_HP2030_NSFGObjectives.docx	Supplementary Document	Uploaded 2023-08-07	Available
ATT-E2_HP2030_NSFGObjectives.docx	Supplementary Document	Uploaded 2023-08-07	Repair queued
ATT-E1_NCHS_PublicAffairsOffice.docx	Supplementary Document	Uploaded 2023-08-07	Available
ATT-E1_NCHS_PublicAffairsOffice.docx	Supplementary Document	Uploaded 2023-08-07	Repair queued
ATT-D4-NSFG-IncentiveExperimentResults-July2023.docx	Supplementary Document	Uploaded 2023-08-07	Available
ATT-D4-NSFG-IncentiveExperimentResults-July2023.docx	Supplementary Document	Uploaded 2023-08-07	Repair queued
ATT-D3-NSFG-LHC-eLHCFeasibilityandUsage2022.docx	Supplementary Document	Uploaded 2023-08-07	Available
ATT-D3-NSFG-LHC-eLHCFeasibilityandUsage2022.docx	Supplementary Document	Uploaded 2023-08-07	Repair queued
ATT-D2-NSFG-Phase4-NRFU-Resultsfrom2022-Q1Q2.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-D2-NSFG-Phase4-NRFU-Resultsfrom2022-Q1Q2.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
ATT-D1-NSFG-PaperScreenerExperimentResultsfrom2022-Q3Q4.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-D1-NSFG-PaperScreenerExperimentResultsfrom2022-Q3Q4.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
ATT-C-NSFG-SensitiveQuestionJustification-2023.docx	Supplementary Document	Uploaded 2023-07-28	Available
ATT-C-NSFG-SensitiveQuestionJustification-2023.docx	Supplementary Document	Uploaded 2023-07-28	Repair queued
ATT-B1_Published 60-Day FRN 4.7.23.pdf	Supplementary Document	Uploaded 2023-07-28	Available
ATT-B1_Published 60-Day FRN 4.7.23.pdf	Supplementary Document	Uploaded 2023-07-28	Repair queued
ATT-A11_DASH_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-A11_DASH_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-A10_NCIPC_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-A10_NCIPC_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-A9_DSTDP_2021AuthLegis.pdf	Supplementary Document	Uploaded 2021-09-16	Available
ATT-A9_DSTDP_2021AuthLegis.pdf	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-A8_OWH_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-A8_OWH_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-A7_DCPC_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Available
ATT-A7_DCPC_2021AuthLegis.docx	Supplementary Document	Uploaded 2021-09-16	Repair queued
ATT-A6_OPRE_2023AuthLegis_30day.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-A6_OPRE_2023AuthLegis_30day.docx	Supplementary Document	Uploaded 2023-08-03	Missing upstream
ATT-A5_PHS301_2023MultAuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-A5_PHS301_2023MultAuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Missing upstream
ATT-A4_CB_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-A4_CB_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
ATT-A3_NICHD_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
ATT-A3_NICHD_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Missing upstream
ATT-A2_OMB_2023AuthLegis.pdf	Supplementary Document	Uploaded 2023-08-03	Available
ATT-A2_OMB_2023AuthLegis.pdf	Supplementary Document	Uploaded 2023-08-03	Repair queued
ATT-A1_NCHS_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Available
ATT-A1_NCHS_2023AuthLegis.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
NSFG_OMB_SSB_25Jul2023_clean.docx	Supporting Statement B	Uploaded 2023-08-25	Repair queued
NSFG_OMB_SSB_25Jul2023_clean.docx	Supporting Statement B	Uploaded 2023-08-25	Available
SSA_Sept 29 2023 update.docx	Supporting Statement A	Uploaded 2023-09-29	Repair queued
SSA_Sept 29 2023 update.docx	Supporting Statement A	Uploaded 2023-09-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216270	Main Interview Verification	Instruction	Unchanged
216268	Interviews Observation Form (Screener Verification)	Form and Instruction	Unchanged	INTERVIEW OBSERVATION FORM
216268	Interviews Observation Form (Screener Verification)	Form and Instruction	Unchanged
216266	Male Questionnaire	Form and Instruction	Modified	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - MALE QUESTIONNAIRE CAPI-LITE
216266	Male Questionnaire	Form and Instruction	Modified	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) MALE QUESTIONNAIRE in CAPI-LITE FORMAT
216266	Male Questionnaire	Form and Instruction	Modified
216265	Female Questionnaire	Form and Instruction	Modified	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - FEMALE QUESTIONNAIRE CAPI-LITE
216265	Female Questionnaire	Form and Instruction	Modified	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) FEMALE QUESTIONNAIRE in CAPI-LITE FORMAT
216265	Female Questionnaire	Form and Instruction	Modified
216263	Household Screener Instrument	Form and Instruction	Unchanged	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOLD SCREENER INSTRUMENT in CAPI-LITE FORMAT
216263	Household Screener Instrument	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0314	ICR Reference No: 202507-0920-018
Status: Active	Previous ICR Reference No: 202404-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0148
Title: [NCHS] National Survey of Family Growth
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	09/30/2026	09/30/2026
Responses	20,400	0	20,400
Time Burden (Hours)	6,584	0	6,584
Cost Burden (Dollars)	0	0	0

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Abstract: National Survey of Family Growth (NSFG) collects and disseminate “statistics on family formation, growth, and dissolution.” The NSFG supplements and complements the data from birth and fetal death certificates by monitoring factors (such as sexual activity, contraception, marriage and cohabitation, and infertility) that affect birth and pregnancy rates. The NSFG provides nationally representative data on factors related to fertility, family formation, and reproductive health for NCHS and its cosponsors within DHHS. Throughout its history, NSFG has been administered in person, in English and Spanish, with a self-administered portion added in more recent survey periods. Under the plan laid out in this clearance request, NSFG builds on its past survey design and procedures and incorporates online administration into a multi-phase, multi-mode design. This design calls for about 5,000 people aged 15-49 to be interviewed each year, however higher yields are sought in Year 3 and beyond to compensate for the underproduction seen in the first 2 years of data collection due to the COVID-19 pandemic and associated labor market challenges. This Non-Substantive Change Request is submitted is for a set of survey instrument changes for implementation starting in January 2026 (Year 5). These survey changes consist primarily of question deletions and are proposed to reduce respondent burden and lessen the overall sensitivity of the survey content. No new content areas are proposed. There is no change to the data collection instruments or burden to respondents associated with this collection.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act 242k
  

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:
	88 FR 20887	04/07/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 56826	08/21/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Female Questionnaire	0920-0314, 0920-0314	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) FEMALE QUESTIONNAIRE in CAPI-LITE FORMAT ,   NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - FEMALE QUESTIONNAIRE CAPI-LITE
Household Screener Instrument	0920-0314	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOLD SCREENER INSTRUMENT in CAPI-LITE FORMAT
Interviews Observation Form (Screener Verification)	0920-0314	INTERVIEW OBSERVATION FORM
Main Interview Verification
Male Questionnaire	0920-0314, 0920-0314	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) MALE QUESTIONNAIRE in CAPI-LITE FORMAT ,   NATIONAL SURVEY OF FAMILY GROWTH, YEAR 5 (2026) - MALE QUESTIONNAIRE CAPI-LITE

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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	20,400	20,400	0	0	0	0
Annual Time Burden (Hours)	6,584	6,584	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $6,571,728

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.     Yes

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? No

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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: 07/28/2025

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