National Health and Nutrition Examination Survey (NHANES)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Youth Fitness Survey	Form	New	Available
Feasibility Study to Identify Physical Activity and Oral Health Study and 24 Hour Urine Study and Birth Cert Linkage Study	Form and Instruction	New	Available
NCHS National Health and Nutrition Examination Survey (NHANES) line 1 NHANES questionnaire and examination	Form	New	Available
NHANES 2011-12 Sup Stat B 20100929 clean copy.doc	Supporting Statement B	Uploaded 2010-10-05	Available
Attachment 12b PM informational flyer 2010.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 12a PM self assessment 2010.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 10 2011-12.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 8 2011-12.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 7 Analytic guidelines 2010.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 6 2011-12.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 5 2011-12.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 4 Letters and scripts 2010.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 3 Agencies consulted 2010.doc	Supplementary Document	Uploaded 2010-10-05	Available
Attachment 2b Responces to 60-day FRN 2010.doc	Supplementary Document	Uploaded 2010-10-05	Repair queued
NHANES 2011-12 Sup Stat A 20100929 clean copy.doc	Supporting Statement A	Uploaded 2010-10-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202801	Health Measures at Home Study	Instruction	New
202148	NHANES Pilot Studies 2012	Instruction	New
199004	National Youth Fitness Survey	Form	New
197265	Feasibility Study to Identify Physical Activity and Oral Health Study and 24 Hour Urine Study and Birth Cert Linkage Study	Form and Instruction	New
194865	NCHS National Health and Nutrition Examination Survey (NHANES) line 1 NHANES questionnaire and examination	Form	New

ICR Details

OMB Control No: 0920-0237	ICR Reference No: 201010-0920-007
Status: Historical Active	Previous ICR Reference No: 200901-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health and Nutrition Examination Survey (NHANES)
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: 11/02/2010
	Date Received in OIRA: 10/15/2010
Terms of Clearance: This package is approved so that 2011 data collection can begin on time. However, the ICR must be converted from a generic to a regular package. Since this change will require obtaining a new OMB number and discontinuing the existing number, all future submissions must reference 0920-0214 to facilitate tracking changes to the study (and burden) over time.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	12/31/2011
Responses	22,813	0	22,813
Time Burden (Hours)	49,626	0	49,626
Cost Burden (Dollars)	0	0	0

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Abstract: The National Health and Nutrition Examination Survey (NHANES) is a continuous nationally representative sample of the civilian, non-institutionalized U.S. population. The survey is unique in that it contains interview, laboratory and physical examination segments. The examination component is conducted in mobile examination centers that travel to fifteen survey locations each year. NHANES data have been the cornerstone for numerous national health and nutrition policy and surveillance activities. This request seeks approval for the 2011-2012 survey, which has an Asian oversample added to the survey design.

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Authorizing Statute(s): PL: Pub.L. 101 - 445 103 Name of Law: The National Nutrition Monitoring and Related Reseach Act of 1990
   US Code: 42 USC 242k Name of Law: National Center for Health Statistics
   PL: Pub.L. 104 - 170 301 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:
	75 FR 20599	04/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 44799	07/29/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
NCHS National Health and Nutrition Examination Survey (NHANES) line 1 NHANES questionnaire and examination	none	Questionnaire and MEC Data collection Forms
Feasibility Study to Identify Physical Activity and Oral Health Study and 24 Hour Urine Study and Birth Cert Linkage Study	none, none, none, none	Children and Adolescent Physical Activity - Health Measurement List ,   Birth Certificate Linkage ,   Oral Health Dental Fluorosis Imaging ,   24 Hour Urine Sodium Calibration
Health Measures at Home Study
NHANES Pilot Studies 2012
National Youth Fitness Survey	none	National Youth Fitness 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	22,813	22,813	0	0	0	0
Annual Time Burden (Hours)	49,626	49,626	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $41,200,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 10/15/2010

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