View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Fertility Knowledge Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	1				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	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	4,000	0	4,000	0	0	0
Annual IC Time Burden (Hours)	1,333	0	1,333	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Adult invitation		02/22/2019
Parent invitation		02/22/2019
Adult consent		02/22/2019
Parent permission		02/22/2019
Minor agreement		02/22/2019
Reminder		02/22/2019
Bill of rights		02/22/2019
Privacy statement		02/22/2019
Privacy committment		02/22/2019

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

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