View Information Collection (IC)

View Information Collection (IC)

IC Title:	RANDS NSFG	Agency IC Tracking Number:	0920-0222-21GD

IC Status: New

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	0920-0222	RANDS NSFG Web Questionnaire	Att 1 - Questionnaire and Intro Script.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 2,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	2,200	0	2,200	0	0	0
Annual IC Time Burden (Hours)	734	0	734	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3_ NCHS Non-Disclosure Affidavit for NORC	Att 3 - NCHS Non-Disclosure Affidavit for NORC Organization Staff working on RANDS.docx	06/22/2021
Att 2_NORC CIPESA Protection Plan	Att 2 - NORC CIPESA Protection Plan.docx	06/22/2021
10-day Letter _RANDS NSFG	OMB 10-day Letter_RANDS_NSFG_06 22 2021.docx	06/22/2021

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