Household Forms

7317-100B(L)
(3-2009)

DC

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Dear Current Resident,
We are writing to you to ask for your help with a survey that the U.S. Census Bureau is
conducting for the Centers for Disease Control and Prevention (CDC), called the National
Immunization Survey. You were selected to participate in this survey through a sampling
process. You’ve been chosen to represent thousands of other people with characteristics
similar to yours. We would like to conduct a short telephone interview with you to collect
information on your child(ren)’s immunizations.
We understand that parents or guardians might have some concerns regarding their child’s
immunization records. We guarantee all responses are confidential and will be used only for
statistical purposes. Data from this study will not be linked with you/your child(ren)’s name(s)
or any other identifying information. The interviewers are trained professionals, sworn to
protect the confidentiality of the data.
One of our interviewers will call your household to conduct the interview. If you would like
to schedule a specific time for your interview, please do so by calling 1-888-595-1340.
The back of this letter provides you with information about the study and how the data from
this survey are used. Your participation is voluntary, and we hope that you will participate in
this important study.
Thank you for your cooperation.
Sincerely,

Thomas L. Mesenbourg
Acting Director
U.S. Census Bureau

Anne Schuchat, M.D.
Rear Admiral, United States Public Health Service
Director, National Center for Immunization and
Respiratory Diseases

USCENSUSBUREAU
Helping You Make Informed Decisions

www.census.gov

National Immunization Survey – Evaluation Study
Frequently Asked Questions

How long will this survey take?
It will take approximately 28 minutes to complete the interview.
Why can’t you contact somebody else?
Your household was scientifically selected to participate in this study and represents many
others in your community. Without your help, your community may not be adequately
represented in the results of the survey.
How are the data used?
Although childhood vaccination rates are at an all-time high of approximately 90%, many
children still do not have all of their shots. In response, the Department of Health and
Human Services wants to improve immunization services while lowering the cost of
vaccines. Local, state, and federal health officials need the results of this survey to help
achieve those goals.
Data are collected from households with children between the ages of 19 and 35 months
living in the United States at the time of the interview. These data are used to analyze
vaccination levels among young children in the United States, to identify groups at risk of
vaccine-preventable diseases and to evaluate the effectiveness of programs designed to
increase vaccination coverage.
The results of this survey also help local, state, and federal health officials understand how
to improve health care services for all children. Therefore, some households may be asked
questions about the types of health services their children need or use.
What confidential protection do I have?
This survey is authorized by Title 42, United States Code, Sections 306 & 2102(a)(7) of the
Public Health Service Act and by The National Childhood Vaccine Injury Act of 1986. Legal
authorization for the Census Bureau to conduct the survey is granted by Title 13, United
States Code, Section 8. The information you provide will be treated confidentially, as
specified by law in Section 9 of Title 13. We will not release any information that could
identify you, your child, or the child’s medical history. The information collected will be used
for statistical purposes only. Although your participation is voluntary, we hope that you will
choose to participate in this very important study.
What if I have comments about this survey?
If you have comments about the time estimate or any other aspect of this survey, please
send them to Paperwork Project 0607-####, U.S. Census Bureau, 4600 Silver Hill Road,
AMSD & 3K138, Washington, DC 20233. You may email comments to
[email protected]; use “Paperwork Project 0607-####” as the subject. The approval
number from the Office of Management and Budget (OMB) is 0607-#### and it will expire
on Month/Date/Year. Without this approval from the OMB, the Census Bureau could not
conduct this survey.

7317-100B(L)