Information Collection Request

National Health Interview Survey

ICR 201412-0920-004 · OMB 0920-0214 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Supplements (adult family member) Form Removed Available
Child / Teen Record Check (medical provider) Form Removed Repair queued
Screener Questionnaire Form Removed Repair queued
Followback Survey Questionnaire Form and Instruction New Repair queued
Reinterview Survey Form and Instruction New Repair queued
New Supplements and Core Changes Form and Instruction New Repair queued
Sample Child Core Questionnaire Form and Instruction New Repair queued
Sample Adult Core Questionnaire Form and Instruction New Available
Family Core Questionnaire Form and Instruction New Repair queued
OMB Statement and Screener Form and Instruction New Repair queued
Reinterview Survey Form Removed Repair queued
Native Hawaiian / Pacific Islander Survey (adult family member) Form Removed Available
NHCIS Multi-mode Study (adult family member) Form Removed Repair queued
Attachment 5b - ERB Approval.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 5a - Advance Letters.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 4 - Consultants for 1997 Redesign.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 3j - Core and Supplement Changes Summary Table.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 3i - 2015 NHIS Removal of Health Care Reform Questions.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 3h - 2015 Followback Survey Description.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 3e - 2015 NHIS Flashcards.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 2b - 60-Day FRN Public Comments and Response.pdf Supplementary Document Uploaded 2014-12-04 Available
Attachment 2a - 60-day FRN.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
Attachment 1 - Legislative Mandates.pdf Supplementary Document Uploaded 2014-12-04 Repair queued
2015 NHIS_2015-2017_SS_B 122314.doc Supporting Statement B Uploaded 2014-12-27 Available
2015 NHIS_2014-2016_SS_A 122314.doc Supporting Statement A Uploaded 2014-12-27 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
45691 Supplements (adult family member) Form Removed
45690 Child / Teen Record Check (medical provider) Form Removed
45689 Child Core (adult family member) Other-Questionaire Removed
45688 Adult Core (sample adult) Other-Questionaire Removed
45687 Family Core (adult family member) Other-Questionaire Removed
37725 Screener Questionnaire Form Removed
214142 Followback Survey Questionnaire Form and Instruction New
214116 Reinterview Survey Form and Instruction New
214115 New Supplements and Core Changes Form and Instruction New
214114 Sample Child Core Questionnaire Form and Instruction New
214113 Sample Adult Core Questionnaire Form and Instruction New
214112 Family Core Questionnaire Form and Instruction New
214111 OMB Statement and Screener Form and Instruction New
205038 Reinterview Survey Form Removed
186085 Native Hawaiian / Pacific Islander Survey (adult family member) Form Removed
186084 NHCIS Multi-mode Study (adult family member) Form Removed
ICR Details
0920-0214 201412-0920-004
Historical Active 201407-0920-017
HHS/CDC 21178
National Health Interview Survey
Revision of a currently approved collection   No
Regular
Approved without change 01/01/2015
Retrieve Notice of Action (NOA) 12/16/2014
CDC/NCHS may use the non-substantive change mechanism to modify existing questions, including those designed to add depth/additional detail and cycle in and out supplemental modules that have been used in the past years (with modest updates). A non-substantive change request is required before fielding the proposed incentive experiment. If new supplemental modules, new questionnaire instruments, or modifications to the sample are anticipated, a full revision of the ICR package must be submitted to OMB.
  Inventory as of this Action Requested Previously Approved
12/31/2017 36 Months From Approved 12/31/2016
167,000 0 179,000
48,833 0 45,500
0 0 0

The NHIS is conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), to comply with the NCHS mandate under 42 USC 242k to collect, on an annual basis, statistically valid data on the amount, distribution, and effects of illness and disability in the population and on the utilization of health care services for such conditions. NHIS data are used widely throughout the Department of Health and Human Services (DHHS) to monitor trends in illness and disability and to track progress toward achieving many of the Healthy People objectives for the nation. This revision request is to conduct the National Health Interview Survey for 2015-2017; to continue the increase in the previous two year's sample size; to introduce a program to improve response rates using promotional materials, additional interviewer training, and incentives; to conduct a follow-back survey of sample adult respondents from an earlier NHIS; and to modify selected sections of the 2015, 2016, and 2017 surveys through a nonsubstantive change clearance request.

US Code: 42 USC 242 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  79 FR 52343 09/03/2014
79 FR 71432 12/02/2014
No

  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 167,000 179,000 0 -12,000 0 0
Annual Time Burden (Hours) 48,833 45,500 0 3,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Changes or adjustments in this Revision are the result of modifications to selected sections of the National Health Interview Survey (NHIS)

$42,000,000
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/16/2014