Information Collection Request

National Health Interview Survey

ICR 201312-0920-006 · OMB 0920-0214 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Sexual Identity Module--Line 7 Form Removed Available
Supplements (adult family member) Form Modified Available
Child / Teen Record Check (medical provider) Form Modified Available
Screener Questionnaire Form Modified Available
Reinterview Survey Form Modified Available
Native Hawaiian / Pacific Islander Survey (adult family member) Form Modified Available
NHCIS Multi-mode Study (adult family member) Form Modified Available
NHIS_2014-2016_Supporting Statement_B_12-1-13.doc Supporting Statement B Uploaded 2013-12-19 Available
Attachment 7b NHCIS Letters.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 7a - Flowchart.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 7 Incentive Experimentation.doc Supplementary Document Uploaded 2013-12-19 Available
Attachment 6 - Incentive Experimentation.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 5c - Research Ethics Review Board Approval.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 5a - Advance Letters.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 4a Consultants for 1997 Redesign.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 3h - Flashcard Booklet.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 2 - 60 day FR Notice for 2014-6 NHIS rev.pdf Supplementary Document Uploaded 2013-12-19 Available
Attachment 1 Legislative Mandate.pdf Supplementary Document Uploaded 2013-12-19 Available
NHIS_2014-2016_Supporting Atatement A 12-18-13.doc Supporting Statement A Uploaded 2013-12-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
45692 Sexual Identity Module--Line 7 Form Removed
45691 Supplements (adult family member) Form Modified
45690 Child / Teen Record Check (medical provider) Form Modified
45689 Child Core (adult family member) Other-Questionaire Modified
45688 Adult Core (sample adult) Other-Questionaire Modified
45687 Family Core (adult family member) Other-Questionaire Modified
37725 Screener Questionnaire Form Modified
205038 Reinterview Survey Form Modified
186085 Native Hawaiian / Pacific Islander Survey (adult family member) Form Modified
186084 NHCIS Multi-mode Study (adult family member) Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2016 03/31/2016 03/31/2016
179,000 0 257,000
45,500 0 57,099
0 0 0





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 179,000 257,000 0 -78,000 0 0
Annual Time Burden (Hours) 45,500 57,099 0 -11,599 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No