View Information Collection (IC)
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ICR
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:
Modified
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
Fertility Knowledge Survey
Attach_B_FertilityKnowledgeSurvey_Version20_8-13-19_PRA_Final_Clean.pdf
No
Printable Only
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 %
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
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
Attachment A Title X Legislation
Attach_A_TitleXLeg_May2019.pdf
10/03/2019
Attachment C OMB FRN 60 and 30 day
Attach_C_OMB_FRN_60D&30D_All.pdf
10/03/2019
Attachment D IRB Approval
Attach_D_IRB_All_Sep2019.pdf
10/03/2019
Attachment E Email Invitation
Attach_E_OMB_Invitation_AdultKP&AllYP_May2019_R_Aug2019_Clean.pdf
10/03/2019
Attachment F Consent Form
Attach_F_OMB_Consent_Adult_Revised_May2019_R_Aug2019_Clean.pdf
10/03/2019
Attachment G Email Reminder
Attach_G_OMB_Reminder_All_May2019_R_Aug2019.pdf
10/03/2019
Attachment H Bill of Rights
Attach_H_OMB_BillofRights_TheDeal_May2019_R_Aug2019.pdf
10/03/2019
Attachment I Member Privacy Policy
Attach_I_OMB_KPMemberPrivacyStatement_May2019_R_Aug2019.pdf
10/03/2019
Attachment J Ipsos Privacy Commitment
Attach_J_OMB_IpsosPrivacyCommitment_May2019__Aug2019.pdf
10/03/2019
Attachment K CoC
Attach_K_CoC_All_May2019_R_Aug2019.pdf
10/03/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.