2015 NHIS Occupational Health Supplement and Cancer Control Supplement

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Document Name Document Type
0920-0222 Attach 3- 2015 NHIS Occ Hlth Screening script.docx Other-WORD
0920-0222 Attach 1- 2015 NHIS Occ Hlth Qnne.docx Other-WORD
Cancer Control - Questionniare 0920-0222 Attach 1- 2015 NHIS Cancer Qnne.docx Form
Cancer Control - screener 0920-0222 Attach 3- 2015 NHIS Cancer Screening script.docx Form
0920-0222 Attach 2- 2015 NHIS Occ Hlth Adv & Flyer.docx 0920-0222 Attach 2- 2015 NHIS Occ Hlth Adv & Flyer IC Document
0920-0222 Attach 2- 2015 NHIS Cancer Adv & Flyers.docx Cancer Control - Flyers IC Document
0920-0222 QDRL 2015 NHIS Occ Hlth Letter.docx 0920-0222 QDRL 2015 NHIS Occ Hlth Letter IC Document
0920-0222 QDRL 2015 NHIS Cancer Letter.docx Cancer Control - Letter to Dr. Schwab IC Document

Information Collection (IC) Details

IC Title:	2015 NHIS Occupational Health Supplement and Cancer Control Supplement	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			0920-0222 Attach 3- 2015 NHIS Occ Hlth Screening script.docx	Yes	Yes	Fillable Fileable
Other-WORD			0920-0222 Attach 1- 2015 NHIS Occ Hlth Qnne.docx	Yes	Yes	Fillable Printable
Form	none	Cancer Control - Questionniare	0920-0222 Attach 1- 2015 NHIS Cancer Qnne.docx	Yes	Yes	Fillable Fileable
Form	none	Cancer Control - screener	0920-0222 Attach 3- 2015 NHIS Cancer Screening script.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Populations	FR Citation: 49 FR 37693

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	70	0	0	0	0	0
Annual IC Time Burden (Hours)	70	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0920-0222 Attach 2- 2015 NHIS Occ Hlth Adv & Flyer	0920-0222 Attach 2- 2015 NHIS Occ Hlth Adv & Flyer.docx	03/03/2014
Cancer Control - Flyers	0920-0222 Attach 2- 2015 NHIS Cancer Adv & Flyers.docx	03/03/2014
0920-0222 QDRL 2015 NHIS Occ Hlth Letter	0920-0222 QDRL 2015 NHIS Occ Hlth Letter.docx	03/03/2014
Cancer Control - Letter to Dr. Schwab	0920-0222 QDRL 2015 NHIS Cancer Letter.docx	03/03/2014

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