National Survey of Family Growth

Forms and Documents

Document Name	Status
NSFG Main Interview Verification Form and Instruction	New
NSFG Screener Verification Form and Instruction	New
NSFG Male Questionnaire Form and Instruction	New
NSFG Female Questionnaire Form and Instruction	New
NSFG 2015 Household Screener Instrument Form and Instruction	New
Form 3 Household Screener Form and Instruction	Removed
Form K Verification form Form and Instruction	Removed
National Survey of Family Growth--Male Interview Form and Instruction	Removed
Female Interview Questionnaire -- Form and Instruction	Removed
ATT C7 NSFG Questionnaire Changes for 2015_Summary.docx Supplementary Document	2015-04-23
ATT M 2015 Nonresponse bias analysis.doc Supplementary Document	2015-04-23
ATT L Interview Observation Form.doc Supplementary Document	2015-04-23
ATT J 2015 Sensitive Question Justification.docx Supplementary Document	2015-04-23
ATT I IRB continuation approval.pdf Supplementary Document	2015-04-23
ATT H5 Respondent Concerns Letters.docx Supplementary Document	2015-04-23
ATT H3 Consent forms.docx Supplementary Document	2015-04-23
ATT H2 Brochures and Letter of Authorization.pdf Supplementary Document	2015-04-23
ATT H1 Household and Respondent Letters.docx Supplementary Document	2015-04-23
ATT G2 2013-2014 NSFG Incentive Experiment.docx Supplementary Document	2015-04-23
ATT G1 Prior Incentive Experiments in the NSFG.doc Supplementary Document	2015-04-23
ATT F2 2006-2010 Publications.docx Supplementary Document	2015-04-23
ATT F1 2002 Publications.docx Supplementary Document	2015-04-23
ATT E5 2014 Advisory workshop.pdf Supplementary Document	2015-04-23
ATT E4 2013 ACA Advisory Workshop.docx Supplementary Document	2015-04-23
ATT E3 Meet with Atl CDC agencies.docx Supplementary Document	2015-04-23
ATT E2 2012 Research Conf.docx Supplementary Document	2015-04-23
ATT E1 BSC report of NSFG.docx Supplementary Document	2015-04-23
ATT D13 OAH Letter of support.pdf Supplementary Document	2015-04-23
ATT D12 DRH Letter of support.docx Supplementary Document	2015-04-23
ATT D11 DBDDD Letter of support.docx Supplementary Document	2015-04-23
ATT D10 DCPC Letter of support.docx Supplementary Document	2015-04-23
ATT D9 DSTDP Letter of support.docx Supplementary Document	2015-04-23
ATT D8 DHAP Letter of support.pdf Supplementary Document	2015-04-23
ATT D7 OPRE Letter of support.docx Supplementary Document	2015-04-23
ATT D6 ASPE Letter of support.doc Supplementary Document	2015-04-23
ATT D5 CB Letter of support.docx Supplementary Document	2015-04-23
ATT D4 NICHD Letter of support.docx Supplementary Document	2015-04-23
ATT D3 OPA Letter of support.pdf Supplementary Document	2015-04-23
ATT D2 HP Fam Plan HIV STD obj.docx Supplementary Document	2015-04-23
ATT D1 NCHS Public Affairs Office.docx Supplementary Document	2015-04-23
ATT B2 Public comment.pdf Supplementary Document	2015-04-23
60 Day FRN.pdf Supplementary Document	2015-04-23
ATT A8 DBDDD Auth Legislation.docx Supplementary Document	2015-04-23
ATT A7 DCPC Auth Legislation.docx Supplementary Document	2015-04-23
ATT A6 OPRE Auth Legislation.docx Supplementary Document	2015-04-23
ATT A5 ASPE DHAP DSTDP DRH Legis.doc Supplementary Document	2015-04-23
ATT A4 CB Auth Legislation.docx Supplementary Document	2015-04-23
ATT A3 NICHD Auth Legislation.docx Supplementary Document	2015-04-23
ATT A2 OPA Auth Legislation.doc Supplementary Document	2015-04-23
ATT A1 NCHS Auth Legislation.docx Supplementary Document	2015-04-23
SSB 041315 rev.docx Supporting Statement B	2015-04-23
SSA 041415 rev JZ.docx Supporting Statement A	2015-04-23

IC Document Collections

IC ID	Document Title	Status
216270	NSFG Main Interview Verification Form and Instruction	New
216268	NSFG Screener Verification Form and Instruction	New
216266	NSFG Male Questionnaire Form and Instruction	New
216265	NSFG Female Questionnaire Form and Instruction	New
216263	NSFG 2015 Household Screener Instrument Form and Instruction	New
188705	Household Screener Form and Instruction	Removed
188703	Verification form Form and Instruction	Removed
188702	National Survey of Family Growth--Male Interview Form and Instruction	Removed
184020	Female Interview Questionnaire -- Form and Instruction	Removed

ICR Details

OMB Control No: 0920-0314	ICR Reference No: 201504-0920-006
Status: Historical Active	Previous ICR Reference No: 201302-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0314
Title: National Survey of Family Growth
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/25/2015
	Date Received in OIRA: 04/24/2015
Terms of Clearance: NCHS must submit a non-substantive change request to OMB within 18 months years to file the results of the crossover study and describe resulting recommendations.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	22,110	0	20,400
Time Burden (Hours)	7,318	0	7,192
Cost Burden (Dollars)	0	0	0

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Abstract: The National Survey of Family Growth (NSFG) provides nationally representative data on factors related to birth and pregnancy rates, sexually transmitted diseases, and family formation including marriage, divorce, and adoption for NCHS and other Department of Health and Human Services (DHHS) programs. The survey is administered in person, in English and Spanish. About 5,000 people are interviewed each year. This Revision will; expand the age range of the NSFG from 15-44 to 15-49, and make revisions to the female and male questionnaires (for fieldwork starting in September 2015).

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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:
	79 FR 65398	11/04/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 22198	04/21/2015
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
NSFG 2015 Household Screener Instrument	None	NSFG 2015 Household Screener Instrument
Female Interview Questionnaire --	None, None	Attachment 2: 2011-2015 National Survey of Family GrowthFEMALE Questionnaire(Mark-Up for Year 3 with red highlights) ,   Attachment 2: 2011-2015 National Survey of Family Growth FEMALE Questionnaire (Mark-Up for Year 3)
NSFG Screener Verification	None	NSFG Verification Questionnaire - Screener
National Survey of Family Growth--Male Interview	None, None	ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire(Mark-Up for Year 3) ,   ATTACHMENT 3:2011-2015 National Survey of Family Growth MALE Questionnaire (Mark-Up for Year 3 with red highlights)
Verification form	K	National Survey of Family Growth, Verification Questionnaires
Household Screener	3	Household Screening Questionnaire
NSFG Female Questionnaire	None	2015 NSFG Female Questionnaire
NSFG Male Questionnaire	None	2015 NSFG Male Questionnaire
NSFG Main Interview Verification	None	NSFG Verification Questionnaire - Main Interview

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ICR Summary 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	22,110	20,400	0	1,710	0	0
Annual Time Burden (Hours)	7,318	7,192	0	126	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: 0920-0314 is a REVISION that contains modifications to the Male and Female Interview Questionnaires.

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Annual Cost to Federal Government: $6,200,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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: 04/24/2015

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