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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Gender X Marker
Agency IC Tracking Number:
0920-22AY
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
Other-Draft Modified Form with Questions to be Tested
Attachment 1 - Passport Application Form.docx
Yes
Yes
Fillable Printable
Form and Instruction
n/a
Screening Questions for Potential Respondents
Attachment 3 - Screener.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Informed Consent
Attachment 4v2 - Informed Consent.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Respondent Data Collection Sheet
Attachment 5- Respondent Data Collection Sheet.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:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
150
0
150
0
0
0
Annual IC Time Burden (Hours)
129
0
129
0
0
0
Annual IC Cost Burden (Dollars)
1,074
0
1,074
0
0
0
Documents for IC
Title
Document
Date Uploaded
Project Description and Justification (10-day letter)
Gender X 10-day-letter-111821 Clean SK.docx
11/18/2021
Recruitment Advertisement
Attachment 2- Non-Specific Advertisement.docx
11/18/2021
Data Retention Policy
Attachment 6-Data Retention Policy_ 102121.docx
11/18/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.