Household Screener Instrument

[NCHS] National Survey of Family Growth

Documents and Forms

Document Name Document Type
Form 0920-0314 Household Screener Instrument Form and Instruction
Form 0920-0314 Household Screener Instrument Form and Instruction
0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOL ATT-H-NSFG-Y3-2024-screener-capilite.docx Form and Instruction
0920-0314 NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOL ATT-H-NSFG-Y3-2024-screener-capilite.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Household Screener Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	0920-0314	NATIONAL SURVEY OF FAMILY GROWTH, YEAR 3 (2024) HOUSEHOLD SCREENER INSTRUMENT in CAPI-LITE FORMAT	ATT-H-NSFG-Y3-2024-screener-capilite.docx		Yes	Yes	Fillable Fileable

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: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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