Followback Survey Questionnaire

National Health Interview Survey

OMB: 0920-0214

IC ID: 214142

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Followback Survey Questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None 2015 FollowBack Survey Questionnaire Attachment 3g - 2015 NHIS Followback Questionnaire.pdf None Yes Yes Fillable Fileable

Health Public Health Monitoring

 

12,000 0
   
Individuals or Households
 
   0 %

  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 12,000 0 0 0 0 12,000
Annual IC Time Burden (Hours) 4,000 0 0 0 0 4,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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