Information Collection

NHANES Questionnaire

IC 204606 under ICR 201302-0920-004 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NHANES Questionnaire	Form and Instruction
NHANES Questionnaire Attachment 9 Questionnaire & MEC Forms 2013-14 rev 10-4-12.docx	Form and Instruction

IC Title:

NHANES Questionnaire

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	none	NHANES Questionnaire	Attachment 9 Questionnaire & MEC Forms 2013-14 rev 10-4-12.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probablity Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 15,411

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	15,411	15,411
Annual IC Time Burden (Hours)	38,528	38,528
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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