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	Modified	Available
Form Not assigned NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Repair queued
Form Not Assigned Child Influenza Immunization	Form and Instruction	Modified	Repair queued
Form Not Assigned Child Mental Health Services	Form and Instruction	Modified	Available
Form Not Assigned Child Mental Health Brief Questionnaire	Form and Instruction	Modified	Available
Form Not Assigned Child Identification	Form and Instruction	Modified	Available
Form Not Assigned Child Access to Health Care and Utilization	Form and Instruction	Modified	Available
Form Not Assigned Child Health Status and Limitations	Form and Instruction	Modified	Available
Form Not Assigned Adult AIDS Knowledge and Attitudes	Form and Instruction	Modified	Available
Form Not Assigned Adult Access to Health Care and Utilization	Form and Instruction	Modified	Available
Form Not Assigned Adult Conditions	Form and Instruction	Modified	Available
Form Not Assigned Adult Socio-Demographic	Form and Instruction	Modified	Available
Form Not Assigned Adult Health Status and Limitations	Form and Instruction	Modified	Available
Form Not Assigned Adult Health Behaviors	Form and Instruction	Modified	Available
Form Not Assigned Adult Identification	Form and Instruction	Modified	Available
Form Not Assigned Recontact	Form and Instruction	Modified	Available
Form Not Assigned Family Income	Form and Instruction	Modified	Available
Form Not Assigned Family Socio-Demographic	Form and Instruction	Modified	Available
Form Not Assigned Family Health Insurance	Form and Instruction	Modified	Available
Form Not Assigned Family Access to Health Care and Utilization	Form and Instruction	Modified	Available
Form Not Assigned Family Health Status and Limitations	Form and Instruction	Modified	Available
Form Not Assigned Family Identification	Form and Instruction	Modified	Available
Form Not Assigned Family Injury and Poisoning	Form and Instruction	Modified	Available
Form None Assigned Screener Survey	Form and Instruction	Modified	Available
Form None Assigned Screener Questionnaire	Form and Instruction	Modified	Available
Form Not Assigned Reinterview Survey	Form and Instruction	Modified	Available
Form Not assigned NIS 2008 Teen Immunization Questionnaire	Form and Instruction	New	Available
Form CDC 64.122 National Immunization Survey - Teen	Form	New	Available
Form CDC 64.122 National Immunization Survey	Form	New	Available
Attachment4 CoverUpdated.doc	Supplementary Document	Uploaded 2008-09-22	Available
Attachment3 CoverUpdated.doc	Supplementary Document	Uploaded 2008-09-22	Available
Attachment2 Cover.doc	Supplementary Document	Uploaded 2008-08-07	Available
Attachment5 Provider Record Check Letters Updated.doc	Supplementary Document	Uploaded 2008-09-22	Available
NHIS 83 C 2008 4th qtr Supplement Questions REV 080108.doc	Supplementary Document	Uploaded 2008-08-07	Available
Attachment1 Questions for 2008-2009 NHIS Updated.doc	Supplementary Document	Uploaded 2008-09-22	Available
NHIS 2008-9 Permission to Contact his2apt.pdf	Supplementary Document	Uploaded 2008-07-15	Available
NHIS 2008-9 Justification for Change 071508.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-07-15	Available
Attachment4 Cover.doc	Supplementary Document	Uploaded 2008-08-07	Available
Attachment3 Cover.doc	Supplementary Document	Uploaded 2008-08-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45692	NHIS 2007 Child Topical Module	Form and Instruction	Modified	Child Topical Module
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	NHIS 2007 Child Core Questionnaire
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Influenza Immunization
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Mental Health Services
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Mental Health Brief Questionnaire
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Identification
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Access to Health Care and Utilization
45691	NHIS 2007 Child Core Questionnaire	Form and Instruction	Modified	Child Health Status and Limitations
45690	NHIS 2007 Adult Topical Module	Instruction	Modified
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult AIDS Knowledge and Attitudes
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Access to Health Care and Utilization
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Conditions
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Socio-Demographic
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Health Status and Limitations
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Health Behaviors
45689	NHIS 2007 Adult Core Questionnaire	Form and Instruction	Modified	Adult Identification
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Recontact
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Income
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Socio-Demographic
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Health Insurance
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Access to Health Care and Utilization
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Health Status and Limitations
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Identification
45688	NHIS 2007 Family Core Questionnaire	Form and Instruction	Modified	Family Injury and Poisoning
45687	NHIS 2007 Screener Questionnaire	Form and Instruction	Modified	Screener Survey
45687	NHIS 2007 Screener Questionnaire	Form and Instruction	Modified	Screener Questionnaire
37725	NHIS 2007 Reinterview Survey	Form and Instruction	Modified	Reinterview Survey
186085	NIS 2008 Teen Immunization Questionnaire	Form and Instruction	New	NIS 2008 Teen Immunization Questionnaire
186085	NIS 2008 Teen Immunization Questionnaire	Form	New	National Immunization Survey - Teen
186084	NIS 2008 Child Immunization Questionnaire	Form	New	National Immunization Survey

ICR Details

OMB Control No: 0920-0214	ICR Reference No: 200808-0920-005
Status: Historical Active	Previous ICR Reference No: 200711-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health Interview Survey 2007-2009
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/22/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/12/2008
Terms of Clearance: Prior terms of clearance continue. We would be interested in seeing the results of the comparative analysis between the two vaccine study approaches when it is available.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	12/31/2009	12/31/2009
Responses	119,600	0	147,250
Time Burden (Hours)	28,017	0	38,271
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for changes to the 2008-2009 National Health Interview Survey (NHIS), beginning fourth quarter 2008. 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. Changes requested involve a topical module on immunizations and collection of information on disability and secondary conditions.

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

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: 9

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	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
NHIS 2007 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 ,   NHIS 2007 Child Core Questionnaire
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	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
NHIS 2007 Reinterview Survey	Not Assigned	Reinterview Survey
NHIS 2007 Screener Questionnaire	None Assigned, None Assigned	Screener Questionnaire ,   Screener Survey
NIS 2008 Child Immunization Questionnaire	CDC 64.122	National Immunization Survey
NIS 2008 Teen Immunization Questionnaire	CDC 64.122, Not assigned	National Immunization Survey - Teen ,   NIS 2008 Teen Immunization Questionnaire

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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	119,600	147,250	0	-27,650	0	0
Annual Time Burden (Hours)	28,017	38,271	0	-10,254	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: This no-material/nonsubstantive change request will decrease the number of respondents due to budget cuts. Changes in the forms and fine tuning of the average burden response result in a decrease of burden hours.

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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: 08/12/2008

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