National Health and Nutrition Examination Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NHANES Questionnaire	Form and Instruction	New	Available
NHANES 2013-2014 Sup Stat B 091912 Clean Copy rev 11_27_2012.doc	Supporting Statement B	Uploaded 2012-11-27	Available
Attachment 12 PM informational flyer 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 10 ROF 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 8 Lab 2013-14_090612.docx	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 7 Analytic guidelines 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 6 NHANES 2011-12 ERB approval.doc	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 5b Child Assent Brochure 2013-14.docx	Supplementary Document	Uploaded 2012-10-17	Repair queued
Attachment 5a MEC Consent brochure 2013-14.docx	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 5 Consents 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Available
NHANES 2013-2015 Attachment 4 Letters and scripts 11_27_2012.doc	Supplementary Document	Uploaded 2012-11-27	Available
Attachment 3 Agencies consulted 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Repair queued
Attachment 2b Responses to 60-day FRN 2013-14.doc	Supplementary Document	Uploaded 2012-10-17	Repair queued
Attachment 2a 60-day FRN NHANES 2013-14.pdf	Supplementary Document	Uploaded 2012-10-17	Available
Attachment 1 2013-14 Applicable Laws.doc	Supplementary Document	Uploaded 2012-10-17	Available
NHANES_2013-14_Sup_Stat_A_091912_Clean_Copy_rev_100412[1] Special studies edits only.doc	Supporting Statement A	Uploaded 2012-11-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204607	Special Studies and Pretests	Instruction	New
204606	NHANES Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 201210-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health and Nutrition Examination Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/28/2012
	Date Received in OIRA: 10/25/2012
Terms of Clearance: The protocol for NHANES 2013-2014 are approved. The protocols for additional calendar years must be submitted to OMB as full revisions. CDC may submit protocols/requests to conduct small methodological tests as well as field test of items being considered for subsequent calendar years as nonsubtantive changes. However, special studies, large methodological tests, and pilot tests on separate samples must be submitted as full revisions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2015	36 Months From Approved
Responses	17,911	0	0
Time Burden (Hours)	46,028	0	0
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 new approval for data collection for the 2013-2014 survey.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: PHSA
   PL: Pub.L. 101 - 445 103 Name of Law: National Nutrition Monitoring and Related Research Act of 1990
   PL: Pub.L. 104 - 170 301 Name of Law: Food Quality Protection Act
   US Code: 21 USC 393 Name of Law: Federal Food, Drug and Cosmetic Act
  

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 28600	05/15/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 64808	10/23/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
NHANES Questionnaire	none	NHANES Questionnaire
Special Studies and Pretests

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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	17,911	0	0	17,911	0	0
Annual Time Burden (Hours)	46,028	0	0	46,028	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new ICR.

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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: 10/25/2012

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