National Health and Nutrition Examination Survey (NHANES)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NHANES 2011-2012 Ext Sup Stat B .doc	Supporting Statement B	Uploaded 2012-09-11	Available
NHANES Ext 2012 Attachment 13b NYFS Supporting Statement B.doc	Supplementary Document	Uploaded 2012-09-11	Available
NHANES Ext 2012 Attachment 13a NYFS Supporting Statement A (Autosaved).doc	Supplementary Document	Uploaded 2012-09-11	Available
NHANES Ext 2012 Att 13d NYFS 2012 Questionnaire.docx	Supplementary Document	Uploaded 2012-09-11	Available
NHANES Ext 2012 Att 13c NYFS 2012 Protocol.docx	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 12b PM informational flyer.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 12a PM self assessment.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 11 Special Studies Pretests.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 10 Report of Findings.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 9 Questionnaires & MEC Forms.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 8 Lab Component.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 7 Analytic guidelines.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 6 NHANES 2011-12 ERB approval.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 5 Consent Documents.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4f-Advance Letter (Korean).doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4e-Advance Letter (Vietnamese).doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4d-Advance Letter (Chinese-Traditional).doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4c-Advance Letter (Chinese-Simplified).doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4b - Advance Letter (Spanish).docx	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 4 Letters and scripts.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 3 Agencies consulted.doc	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 2b - NHANES FR public comments.docx	Supplementary Document	Uploaded 2012-09-11	Repair queued
Attachment 2a - NHANES FR notice extension.pdf	Supplementary Document	Uploaded 2012-09-11	Available
Attachment 1 Applicable Laws.doc	Supplementary Document	Uploaded 2012-09-11	Available
NHANES 2011-2012 Ext Sup St A .doc	Supporting Statement A	Uploaded 2012-09-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form

ICR Details

OMB Control No: 0920-0237	ICR Reference No: 201209-0920-005
Status: Historical Active	Previous ICR Reference No: 201010-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health and Nutrition Examination Survey (NHANES)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2012
	Date Received in OIRA: 09/13/2012
Terms of Clearance: This package is only being extended to complete the current cycle of data collection. NCHS is in the process of converting this ICR 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	10/31/2013	9 Months From Approved	11/30/2012
Responses	5,887	0	22,813
Time Burden (Hours)	13,277	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:
	77 FR 33463	06/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 55478	09/10/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 0

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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	5,887	22,813	0	-16,926	0	0
Annual Time Burden (Hours)	13,277	49,626	0	-36,349	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The request is for an extension to the currently approved data collection. The number of respondents and burden hours have been decreased due to the programs request to only collect one-quarter of the year's data. As per previous discussion with OMB a separate/new request will be submitted to support data collection beyond 2012-2013.

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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: 09/13/2012

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