Information Collection

Reinterview Survey--Line 9

IC 186085 under ICR 201209-0920-004 · OMB 0920-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3h Reinterview Survey--Line 9	Form and Instruction
3h 2011 NHIS Reinterview Instrument Screens Attachment 3h Reinterview Survey.pdf	Form and Instruction
Attachment4 Cover.doc Cover sheet for NIS Teen Questionnaire	IC Document

IC Title:

Reinterview Survey--Line 9

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3h	2011 NHIS Reinterview Instrument Screens	Attachment 3h Reinterview Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover sheet for NIS Teen Questionnaire	Attachment4 Cover.doc	08/07/2008

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