Screener Questionnaire

National Health Interview Survey

OMB: 0920-0214

IC ID: 37725

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Screener Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener Attachment 3 - OMB Statement and Screener.pdf Yes Yes Fillable Fileable

Health Immunization Management

Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population  49 FR 37693

10,000 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10,000 0 -2,000 0 0 12,000
Annual IC Time Burden (Hours) 833 0 -167 0 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy