National Health Interview Survey 2007-2009

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Not Assigned Child Topical Module	Form and Instruction	New	Available
Form Not Assigned Child Influenza Immunization	Form and Instruction	New	Available
Form Not Assigned Child Mental Health Services	Form and Instruction	New	Available
Form Not Assigned Child Mental Health Brief Questionnaire	Form and Instruction	New	Available
Form Not Assigned Child Identification	Form and Instruction	New	Available
Form Not Assigned Child Access to Health Care and Utilization	Form and Instruction	New	Available
Form Not Assigned Child Health Status and Limitations	Form and Instruction	New	Available
Form Not Assigned Child Identification	Form and Instruction	New	Available
Form Not Assigned Adult Topical Module	Form and Instruction	New	Available
Form Not Assigned Adult Topical Module	Form and Instruction	New	Available
Form Not Assigned Adult AIDS Knowledge and Attitudes	Form and Instruction	New	Available
Form Not Assigned Adult Access to Health Care and Utilization	Form and Instruction	New	Available
Form Not Assigned Adult Conditions	Form and Instruction	New	Available
Form Not Assigned Adult Socio-Demographic	Form and Instruction	New	Available
Form Not Assigned Adult Health Status and Limitations	Form and Instruction	New	Available
Form Not Assigned Adult Health Behaviors	Form and Instruction	New	Available
Form Not Assigned Adult Identification	Form and Instruction	New	Available
Form Not Assigned Adult Identification	Form and Instruction	New	Available
Form Not Assigned Recontact	Form and Instruction	New	Available
Form Not Assigned Family Income	Form and Instruction	New	Repair queued
Form Not Assigned Family Socio-Demographic	Form and Instruction	New	Repair queued
Form Not Assigned Family Health Insurance	Form and Instruction	New	Available
Form Not Assigned Family Access to Health Care and Utilization	Form and Instruction	New	Available
Form Not Assigned Family Injury and Poisoning	Form and Instruction	New	Available
Form Not Assigned Family Health Status and Limitations	Form and Instruction	New	Available
Form Not Assigned Family Identification	Form and Instruction	New	Available
Form Not Assigned Family Health Insurance	Form and Instruction	New	Available
Form Not Assigned Family Identification	Form and Instruction	New	Available
Form None Assigned Screener Survey	Form and Instruction	New	Available
Form None Assigned Screener Questionnaire	Form and Instruction	New	Repair queued
Form Not Assigned Reinterview Survey	Form and Instruction	Modified	Available
Form Not Assigned Reinterview Survey	Form and Instruction	Modified	Available
Attachment8.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment7c.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment7b.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment7a.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment6Updated.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment5aUpdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
ThankYou.pdf	Supplementary Document	Uploaded 2006-12-15	Available
NHIS FR notice.pdf	Supplementary Document	Uploaded 2006-12-15	Available
Attachment5c.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment5b.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment3.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment 2f.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment 2d.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment 2c.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attach2bUpdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment 2eUpdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
Attachment 1.doc	Supplementary Document	Uploaded 2006-12-15	Available
5-FHIupdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
1-FIDupdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
1-CIDupdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
1-AIDupdated.doc	Supplementary Document	Uploaded 2006-12-15	Available
Supporting Statement B.doc	Supporting Statement B	Uploaded 2006-10-11	Available
30-Day FRN 0920-0214 Published 9-22-2006.htm	Supplementary Document	Uploaded 2006-10-11	Available
60-Day FRN 0920-0214 Published 6-23-2006.htm	Supplementary Document	Uploaded 2006-10-11	Available
SSv8NHISupdated.doc	Supporting Statement A	Uploaded 2006-12-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45692	NHIS 2007 Child Topical Module	Form and Instruction	New	Child Topical Module
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Influenza Immunization
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Mental Health Services
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Mental Health Brief Questionnaire
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Identification
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Access to Health Care and Utilization
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Health Status and Limitations
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	New	Child Identification
45690	NHIS 2007 Adult Topical Module	Form and Instruction	New	Adult Topical Module
45690	NHIS 2007 Adult Topical Module	Form and Instruction	New	Adult Topical Module
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult AIDS Knowledge and Attitudes
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Access to Health Care and Utilization
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Conditions
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Socio-Demographic
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Health Status and Limitations
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Health Behaviors
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Identification
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	New	Adult Identification
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Recontact
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Income
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Socio-Demographic
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Health Insurance
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Access to Health Care and Utilization
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Injury and Poisoning
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Health Status and Limitations
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Identification
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Health Insurance
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	New	Family Identification
45687	NHIS 2007 Screener Questionnaire	Form and Instruction	New	Screener Survey
45687	NHIS 2007 Screener Questionnaire	Form and Instruction	New	Screener Questionnaire
37725	NHIS 2007 Reinterview Survey	Form and Instruction	Modified	Reinterview Survey
37725	NHIS 2007 Reinterview Survey	Form and Instruction	Modified	Reinterview Survey

ICR Details

OMB Control No: 0920-0214	ICR Reference No: 200610-0920-005
Status: Historical Active	Previous ICR Reference No: 200601-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health Interview Survey 2007-2009
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2006
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/16/2006
Terms of Clearance: Please adopt a consistent method of calculating burden for this study from year to year. In the past NCHS have flipped back and forth between calculating burden as number of participants and as number of responses. Even though the overall burden has not changed significantly over last ten years, the change in method of calculating from year to year implies significant burden changes.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	12/31/2007
Responses	147,250	0	43,417
Time Burden (Hours)	38,271	0	36,821
Cost Burden (Dollars)	0	0	0

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Abstract: The annual National Health Interview Survey (NHIS) is a major source of general statistics on the health of the U.S. population and has been in the field every year since 1957. This household-based survey collects demographic and health-related information on a nationally representative sample of households throughout the country. The NHIS has long been used by government, university, and private researchers to evaluate both general health and specific issues, such as cancer, diabetes, and access to health care. It is a leading source of data for the Congressionally-mandated "Health US" and related publications, as well as the single most important source of statistics to track progress toward the National Health Promotion and Disease Prevention Objectives, "Healthy People 2010." In accordance with the 1995 initiative to increase the integration of surveys within the Department of Health and Human Services, respondents to the NHIS serve as the sampling frame for the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality.

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Authorizing Statute(s): PL: Pub.L. 104 - 170 136 Name of Law: The Food Quality Protection Act of 1996
   PL: Pub.L. 101 - 445 301 Name of Law: The National Nutrition Monitoring and Related Research Act of 1990
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 36096	06/23/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 55476	09/22/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
NHIS 2007 Adult Core Questionnaire	Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned	Adult Identification ,   Adult Health Behaviors ,   Adult Health Status and Limitations ,   Adult Socio-Demographic ,   Adult Conditions ,   Adult Access to Health Care and Utilization ,   Adult AIDS Knowledge and Attitudes ,   Adult Identification
NHIS 2007 Adult Topical Module	Not Assigned, Not Assigned	Adult Topical Module ,   Adult Topical Module
NHIS 2007 Child Core Questionnaire	Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned	Child Health Status and Limitations ,   Child Access to Health Care and Utilization ,   Child Identification ,   Child Mental Health Brief Questionnaire ,   Child Mental Health Services ,   Child Influenza Immunization ,   Child Identification
NHIS 2007 Child Topical Module	Not Assigned	Child Topical Module
NHIS 2007 Family Core Questionnaire	Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned, Not Assigned	Family Identification ,   Family Health Status and Limitations ,   Family Injury and Poisoning ,   Family Access to Health Care and Utilization ,   Family Health Insurance ,   Family Socio-Demographic ,   Family Income ,   Recontact ,   Family Identification ,   Family Health Insurance
NHIS 2007 Reinterview Survey	Not Assigned, Not Assigned	Reinterview Survey ,   Reinterview Survey
NHIS 2007 Screener Questionnaire	None Assigned, None Assigned	Screener Questionnaire ,   Screener Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	147,250	43,417	0	103,833	0	0
Annual Time Burden (Hours)	38,271	36,821	0	1,450	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: An increase of burden hours is due to an increase of questionnaires. There was a small change in the specific data items requested on the forms.

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Annual Cost to Federal Government: $28,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/12/2006

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