Information Collection

NHANES Questionnaire

IC 204606 under ICR 201308-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.