National Survey of Children's Health Pretest

Appendix A -NSCH 2015 Pretest - Respondent Contact Materials 042815

National Survey of Children's Health Pretest

OMB: 0607-0984

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Appendix A.
NSCH 2015 Pretest - Respondent Contact Materials
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Advance letter: NSCH 10L(A)*
Initial Screener Mailing Cover Letter for Mail-Only: NSCH-11L(A)*
Initial Screener Mailing Cover Letter for Web Push + Mail: NSCH-11L(B)*
Mail Screener Follow-Up Postcard: 7306-12MP
Web Push + Mail Screener Follow-up Postcard: 7306-12WP
First Nonresponse Follow-up Screener Cover Letter for Mail-Only: NSCH-12L(A)*
First Nonresponse Follow-up Screener Cover Letter for Web Push + Mail: NSCH-12L(B)*
Second Nonresponse (Fed-Ex) Follow-up Screener Cover Letter for Mail-Only: NSCH-13L(A)*
Second Nonresponse (Fed-Ex) Follow-up Screener Cover Letter for Web Push + Mail:
NSCH-13L(B)*
Third Nonresponse Follow-up Screener Cover Letter for Mail-Only: NSCH-14L(A)*
Third Nonresponse Follow-up Screener Cover Letter for Web Push + Mail: NSCH-14L(B)*
Initial Topical Mailing Cover Letter for Mail-Only (for households with one child):
NSCH-21L(A)*
Initial Topical Mailing Cover Letter for Mail-Only (for households with multiple children):
NSCH-21L(B)*
Mail Topical Follow-Up Postcard: 7306-22P
First Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with one
child): NSCH-22L(A)*
First Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with
multiple children): NSCH-22L(B)*
Second Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with one
child): NSCH-23L(A)*
Second Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with
multiple children): NSCH-23L(B)*
Third Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with one
child): NSCH-24L(A)*
Third Nonresponse Follow-up Topical Cover Letter for Mail-Only (for households with
multiple children): NSCH-24L(B)*

*All letters will be translated into Spanish after OMB approval and will become bilingual with
the translated text being placed on the back of each.

Advance letter: NSCH 10L(A)

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-10L(A)
(06-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] Resident:
In a few days, your household will receive an important request from me to complete a U.S.
Census Bureau survey called the National Survey of Children's Health.
We are conducting this survey for the U.S. Department of Health and Human Services and
it is very important that we hear from all of the households we contact, both those with and
without children.
I am writing now just to let you know the request will be mailed to you.
This survey will help us to better understand the health and health care needs of children,
both nationwide and in your state. Your participation ensures that we will have accurate
information on children and households in your state. Because this survey is critical for
assessing children's physical and emotional health and for determining areas of need, we will
be including a small token of appreciation as a way of thanking you for your participation.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau

census. gov

Initial Screener Mailing Cover Letter for Mail-Only: NSCH-11L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
NSCH-11L(A)
(06-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Dear Resident:
The U.S. Census Bureau is conducting the National Survey of Children’s Health, an important national study for the U.S.
Department of Health and Human Services. We need your help. The enclosed survey is the first step in a study that
provides important information used to improve the health of children and families throughout the United States.
Please fill out this survey and mail it back in the postage-paid envelope provided. The questionnaire will help us find
households with children and youths. This information is used later to ask those households about health issues that
may affect their children.
Even if you have no infants or children in your household, it is important that you return this survey so that every type
of household in America is represented. Simply answer the first question on the enclosed form and mail it back. It
usually takes 5 minutes or less to fill out these initial questions and even less if there is no one in your household 0 17 years old.
Your household was randomly selected as part of this voluntary study, and we cannot replace your household with
another one. All information you provide will only be used for statistical purposes and will not be disclosed, or used,
in an identifiable way for any other purpose in accordance with the Privacy Act of 1974 (5 U.S.C. Section 552a) and
System of Records Notice COMMERCE/Census-7. In addition, any information that you provide will be kept
confidential in accordance with the Confidential Information Protection and Statistical Efficiency Act (CIPSEA), 44
U.S.C. 3501. Additional information on these protections can be found on the cover of the questionnaire.
The Census Bureau is conducting this survey under Title 13, U.S.C. Section 8(b) and Title 42 U.S.C. Section
701(a)(2).
This survey and survey forms have been approved by the Office of Management and Budget (OMB) and have been
given the number
. Response to this collection of information is not required unless it displays a valid
approval number from OMB. The eight-digit OMB number appears in the upper right corner of the report form.
The results of this study will help educators, researchers, policymakers, child advocates, and the general public better
understand and respond to the health care needs of children and families.
We greatly appreciate your helping with this important nationwide study, and have enclosed a small token of
appreciation for your participation. Thank you for taking part in this important study on the future of children's health in
America.
If you need assistance or have questions, please call 1-800-845-8241 or email us at [email protected].
Sincerely,

John H. Thompson Director
U.S. Census Bureau
Enclosure

census.gov

Initial Screener Mailing Cover Letter for Web Push + Mail: NSCH-11L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
NSCH-11L(B)
(06-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Dear [enter City here] Resident:
The U.S. Census Bureau is conducting the National Survey of Children’s Health, an important national study for the
U.S. Department of Health and Human Services. We need your help. This survey provides important information that
is used to improve the health of children and families throughout the United States.
Filling out this survey is easy.
1. Go to this website:
2. Enter your user name:
3. Enter your password:

https://respond.census.gov/nsch

If you are unable to complete this survey online, need assistance, or have questions, please call
1-800-845-8241 or email us at [email protected]. We are collecting this information online in order to be able
to report results more quickly and at considerably less cost.
Even if you have no infants or children in your household, it is important that you complete this survey so that every
type of household in America is represented. You will be directed automatically to the questions that apply to your
household. It usually takes no longer than 30 minutes to answer the questions, and less than 5 minutes if there is no
one in your household 0 - 17 years old.
Your household was randomly selected as part of this voluntary study, and we cannot replace your household with
another one. All information you provide will only be used for statistical purposes and will not be disclosed, or used,
in an identifiable way for any other purpose in accordance with the Privacy Act of 1974 (5 U.S.C. Section 552a) and
System of Records Notice COMMERCE/Census-7. In addition, any information that you provide will be kept
confidential in accordance with the Confidential Information Protection and Statistical Efficiency Act (CIPSEA), 44
U.S.C. 3501. Additional information on these protections can be found on the Privacy Act Statement screen within
the online survey.
The Census Bureau is conducting this survey under Title 13, U.S.C. Section 8(b) and Title 42 U.S.C. Section
701(a)(2).
This survey and survey forms have been approved by the Office of Management and Budget (OMB) and have been
given the number
. Response to this collection of information is not required unless it displays a valid
approval number from OMB. The eight-digit OMB number appears in the upper right corner of the report form.
The results of this study will help educators, researchers, policymakers, child advocates, and the general public
better understand and respond to the health care needs of children and families.
We greatly appreciate your helping with this important nationwide study, and have enclosed a small token of
appreciation for your participation. Thank you for taking part in this important study on the future of children's health
in America.
Sincerely,

John H. Thompson Director
U.S. Census Bureau
census.gov

Mail Screener Follow-Up Postcard: 7306-12MP

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-12MP (06-2015)

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-12MP (06-2015)

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Recently, you should have received a questionnaire for a study sponsored by the U.S.
Department of Health and Human Services. If someone in your household has already
returned this survey, w e thank you very much for your help.

If you have not completed and returned your survey, please do so right aw ay. We need to
hear from everyone and your help is very important to us. Your household w as randomly
selected to take part in this survey and cannot be replaced.

If you need assistance or have questions, please feel free to contact us at
1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

John H. Thompson
Director, U.S. Census Bureau
7306-12MP (06-2015)

7306-12MP (06-2015)

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

If you need assistance or have questions, please feel free to contact us at
1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

John H. Thompson
Director, U.S. Census Bureau
7306-12MP (06-2015)

7306-12MP (06-2015)

Web Push + Mail Screener Follow-up Postcard: 7306-12WP

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-12WP (06-2015)

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-12WP (06-2015)

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Recently, you should have received instructions for completing an important survey
online sponsored by the U.S. Department of Health and Human Services. If
someone in your household has already completed this survey, w e thank you very
much for your help.

If you have not completed your survey online, please do so right aw ay. We
need to hear from everyone and your help is very important to us. Your
household w as randomly selected to take part in this survey and cannot be replaced.

If you are unable to complete the survey online, need assistance, or have questions,
please feel free to contact us at 1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

7306-12WP (06-2015)

John H. Thompson
Director, U.S. Census Bureau

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

7306-12WP (06-2015)

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

If you are unable to complete the survey online, need assistance, or have questions,
please feel free to contact us at 1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

John H. Thompson
7306-12WP (06-2015)

Director, U.S. Census Bureau

7306-12WP (06-2015)

First Nonresponse Follow-up Screener Cover Letter for Mail-Only:
NSCH-12L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-12L(A)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
About three weeks ago, I wrote to ask for your help with a national survey on children’s health. To the
best of our knowledge, we have not yet received your completed survey.
If you have sent the completed questionnaire to us, please accept our sincere thanks. If you haven’t
had a chance to reply yet, please fill out the enclosed survey and mail it back in the postage-paid
envelope today. It should only take a few minutes.
If you don’t have children living there, we still need your response to ensure that every type of
household in America is represented. If there are no children in your household, you only need to
answer the first question on page 2 of the survey and return the survey to us.
This first-of-its kind national survey is the best way to get a complete picture of our children’s health
and their health care needs. Because households in all 50 states and the District of Columbia have
been selected to participate, this study also will inform us about children’s health and the availability
of health care services in every location. We must make sure that the health care needs of children of
all ages and in every state are met, both now and in the future.
Your household was scientifically selected to represent thousands of other households in your
state. No one can substitute for you. If we don’t receive your response, the picture of American
children’s health will be incomplete.
Raising healthy children concerns all of us. The future of the United States depends upon it. Thank
you so much in advance for taking part in this national effort.
If you have questions or need assistance, please contact us toll-free at 1-800-845-8241 or by email
at [email protected].
Sincerely,

John H. Thompson
Director
U.S. Census Bureau

census. gov

First Nonresponse Follow-up Screener Cover Letter for Web Push + Mail:
NSCH-12L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-12L(B)
(06-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
Recently, I wrote to ask for your help with the National Survey of Children’s Health. To the best of
our knowledge, we have not yet received your completed survey.
If you have already completed the survey online, please accept our sincere thanks.
If you haven’t had a chance to reply yet, please go online and complete the survey as soon as
possible.
1. Go to this website:
https://respond.census.gov/nsch
2. Enter your user name:
3. Enter your password:
If you don’t have children in your household, we still need your response to ensure that every type
of household in America is represented. If there are no children in your household, you will need to
complete no more than four questions.
This first-of-its-kind national survey is our best way to get a complete picture of our children’s
health and their health care needs. Because households in all 50 states and the District of
Columbia have been selected to participate, this study also will inform us about children’s health in
all regions of the country, and the availability of health care services in every location. We have to
make sure that the health care needs of children of all ages in every state are met, both now and in
the future.
Your household was scientifically selected to represent thousands of other households in your
state. No one can substitute for you. If we don’t receive your response, the picture of American
children’s health will be incomplete.
Raising healthy children concerns all of us. The future of the United States depends upon it. Thank
you so much for taking part in this national effort.
If you have questions or need assistance, please contact us toll-free at 1-800-845-8241 or by email
at [email protected].

Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure
census. gov

Second Nonresponse (Fed-Ex) Follow-up Screener Cover Letter for
Mail-Only: NSCH-13L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-13L(A)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
In June, I wrote asking for your help with the National Survey of Children’s Health. As of today, it
appears that we have not yet received your response.
It may be that you did reply, but your questionnaire has not yet reached us. Thank you very much if
you have already sent it.
If you haven’t been able to respond, I encourage you to fill out the enclosed questionnaire today. The
study period is drawing to a close.
Please remember that we need to hear from you whether you have children living in your household
or not. We need to represent all types of households, including those with and without children. It only
takes a few minutes to fill out the questionnaire.
We would not ask for your help in this study if your response was not essential. The information
gathered in this survey is critical to understanding children’s health and their health care needs, both
in your state and across the country. Because your household was scientifically selected from all of
the households in the country, your response represents thousands of households like yours. The
information you provide will only be used for statistical purposes and will not be disclosed or used in
any way that identifies you or members of your household.
If you have any questions or concerns about participating in the National Survey of Children’s Health,
please contact us toll free at 1-800-845-8241, or by email at [email protected].
Thank you again for your consideration of this request for help. This study depends on your
response. We hope to hear from you soon.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure
census. gov

Second Nonresponse (Fed-Ex) Follow-up Screener Cover Letter for
Web Push + Mail: NSCH-13L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-13L(B)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
In June, I wrote asking for your help with the National Survey of Children’s Health. As of today, it
appears that we have not yet received your response.
It may be that you did reply, but your response has not yet been processed. Thank you very much if
you have already submitted it. If you haven’t been able to respond, I hope that you will take the time
to do so today. The study period is drawing to a close.
Please go online and complete the survey as soon as possible.
1. Go to this website:
https://respond.census.gov/nsch
2. Enter your user name:
3. Enter your password:
You may be wondering what questions are being asked in this survey. Enclosed is a paper version
of the survey that may be helpful to you in completing the survey online.
We also realize that some people do not use the Internet, and we very much want to hear from
everyone we have contacted. If you prefer to complete the paper questionnaire, we have enclosed
a prepaid envelope for returning it. The important thing is that we want to hear from you, even if
there are no children living in your household.
We would not ask for your help in this study if your response was not essential. The information
gathered in this survey is critical to understanding children’s health care needs, both in your state
and across the country. Your household was scientifically selected from all of the households in the
country, and your response represents thousands of households like yours. The information you
provide will only be used for statistical purposes and will not be disclosed or used in any way that
identifies you or members of your household.
If you have any questions or concerns about participating in the National Survey of Children’s
Health, please contact us toll free at 1-800-845-8241, or by email at [email protected].
Thank you again for your consideration of this request for help. This study depends on your
response. We hope to hear from you soon.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census.gov

Third Nonresponse Follow-up Screener Cover Letter for Mail-Only:
NSCH-14L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-14L(A)
(08-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]

Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
Since June, we have been in contact with you about the National Survey of Children’s Health,
which the Census Bureau is conducting on behalf of the U.S. Department of Health and Human
Services. I am writing again as this is the last opportunity to participate in this very important
study.
The survey is designed to provide accurate and complete information about the health care needs
of our nation’s children. The information gathered in this study can give the public and our state
and national governments key insights into how the youngest members of our society are doing
and what they need in order to thrive.
If you have responded to our request to participate in the study, please accept our sincere thanks.
Your participation ensures that the information we gather is accurate and complete. If you have
not yet responded, please complete the enclosed questionnaire now and return it in the postagepaid envelope.
Since the study period will soon end, this is the last time I will have the opportunity to write and ask
for your help. I hope that you will complete the questionnaire and mail it back. We want to be sure
that the study accurately reflects the experiences of households like yours.
If you have any hesitation about participating in the study, please contact us toll-free at
1-800-845-8241 or by email us at [email protected] so we may address your concerns.
Thank you for your consideration.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census. gov

Third Nonresponse Follow-up Screener Cover Letter for Web Push +
Mail: NSCH-14L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-14L(B)
(08-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]

Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
Since June, we have been in contact with you about the National Survey of Children’s Health,
which the Census Bureau is conducting on behalf of the U.S. Department of Health and Human
Services. I am writing again as this is the last opportunity to participate in this very important
study.
The survey is designed to provide accurate and complete information about the health care needs
of our nation’s children. The information gathered in this study can give the public and our state
and national governments key insights into how the youngest members of our society are doing
and what they need in order to thrive.
If you have responded to our request to participate in the study, please accept our sincere thanks.
Your participation ensures that the information we gather is accurate and complete. If you have not
responded, please do so now.
To complete the survey online:
1. Go to this website:
https://respond.census.gov/nsch
2. Enter your user name:
3. Enter your password:
If you are not able to complete the questionnaire online, please complete the enclosed questionnaire
and return it in the postage-paid envelope.
If you have any hesitation about participating in the study, please contact us toll-free at
1-800-845-8241 or by email us at [email protected] so we may address your concerns.
Thank you for your consideration.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure
census. gov

Initial Topical Mailing Cover Letter for Mail-Only (for households with
one child): NSCH-21L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
NSCH-21L(A)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]

Dear Resident:
A few weeks ago you responded to my request to help with the National Survey of Children’s Health.
We greatly appreciate your participation and the participation of thousands of other parents and
caregivers from every state who have made the first step of this effort a success.
The second, and final step is to complete a more detailed survey about the child who is a member of
your household.
This voluntary survey has more questions than we asked in the short survey you completed earlier.
Here we will collect more detailed information on the child’s health status, visits to health care
providers, health care costs, and health insurance coverage. The questionnaire should be filled out
by an adult who is familiar with this child’s health and health care. For most households, it should
take less than 30 minutes to complete.
I want to assure you that your responses to this questionnaire are confidential, as explained on the
front page of the survey. The U.S. Census Bureau and the U.S. Department of Health and Human
Services are required by law to protect the confidentiality of every individual’s responses in
accordance with the Confidential Information Protection and Statistical Efficiency Act (CIPSEA), 44
U.S.C. 3501. All information you provide will only be used for statistical purposes and will not be
disclosed, or used, in an identifiable way for any other purpose in accordance with the Privacy Act of
1974 (5 U.S.C. Section 552a) and System of Records Notice COMMERCE/Census-7. The Census
Bureau is conducting this survey under Title 13 U.S.C. Section 8(b) and Title 42 U.S.C. Section
701(a)(2).
This survey and survey forms have been approved by the Office of Management and Budget (OMB)
and have been given the number
. Response to this collection of information is not required
unless it displays a valid approval number from OMB. The eight-digit OMB number appears in the
upper right corner of the report form.
We realize that answering these questions requires some time and effort. We have enclosed a small
token of appreciation as a way to say thank you. Your participation provides critical information on the
health and health care needs of children in your state and ensures that households like yours are
fairly represented.
If you have any questions about the study or need replacement materials please call us toll-free at
1–800-845-8241 or email us at [email protected].
Thank you once again for your help.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census.gov

Initial Topical Mailing Cover Letter for Mail-Only (for households with
multiple children): NSCH-21L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
NSCH-21L(B)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]

Dear Resident:
A few weeks ago you responded to my request to help with the National Survey of Children’s Health. We greatly appreciate your
participation and the participation of thousands of other parents and caregivers from every state who have made the first step of
this effort a success.
The second and final step is to complete a more detailed survey about one child who is a member of your household. Since
there is more than one child in your household, the one about whom we would like you to answer questions is:
[Insert name of child here]
We have selected only one child per household in order to minimize the amount of time needed to complete the questions. This
child has been selected at random to make sure that we are able to represent every type of child and the full range of health
situations across the country. It is important that you answer the questions about this selected child.
This voluntary survey has more questions than we asked in the short survey you completed earlier. For most households, it will
take less than 30 minutes to complete. Here we will collect more detailed information on the selected child’s health status, visits
to health care providers, health care costs, and health insurance coverage. The questionnaire should be filled out by an adult who
is familiar with this child’s health and health care.
I want to assure you that your responses to this questionnaire are confidential, as explained on the front page of the survey. The
U.S. Census Bureau and the U.S. Department of Health and Human Services are required by law to protect the confidentiality of
every individual’s responses in accordance with the Confidential Information Protection and Statistical Efficiency Act (CIPSEA),
44 U.S.C. 3501 note. All information you provide will only be used for statistical purposes and will not be disclosed, or used, in an
identifiable way for any other purpose in accordance with the Privacy Act of 1974 (5 U.S.C. Section 552a) and System of Records
Notice COMMERCE/Census-7. The Census Bureau is conducting this survey under Title 13 U.S.C. Section 8(b) and Title 42
Section 701(a)(2).

This survey and survey forms have been approved by the Office of Management and Budget (OMB) and have been
given the number
. Response to this collection of information is not required unless it displays a valid
approval number from OMB. The eight-digit OMB number appears in the upper right corner of the report form.
We realize that answering these questions requires some time and effort. We have enclosed a small token of appreciation as a
way to say thank you. Your participation provides critical information on the health and health care needs of children in your state
and ensures that households like yours are accurately represented.
If you have any questions about the study or need replacement materials, please call us toll-free at
1-800-845-8241 or email us at [email protected].
Thank you once again for your help.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census.gov

Mail Topical Follow-Up Postcard: 7306-22P

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-22P (07-2015)

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

US DEPA R TME NT OF COMMER C E
Econo m ic s and Statistic s Adminis tr atio n
US Census Burea u
1201 E 10TH Street
Jeffersonville IN 47132-0001

OFFICIAL BUSINESS
Penalty for Private Use $300

7306-22P (07-2015)

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. Census Bureau
Permit No. G-58

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

Recently, you should have received a follow-up questionnaire for a study sponsored by
the U.S. Department of Health and Human Services. This follow-up questionnaire is the
second and final step for you toparticipate in this important study. If someone in your
household has already returned this survey,we thank you very much for your help.

If you have not completed and returned your survey, please do so right away. We need
to hear from everyone and your response is very important to us.

If you need assistance or have any questions, please feel free to contact us at
1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

7306-22P (07-2015)

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

7306-22P (07-2015)

UNITED STAT E S DEP AR T M E N T OF COMME R C E
Econo m i c s and Stati s ti c s Ad mi ni s tr a ti o n
U.S. Cens u s Burea u
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

If you have not completed and returned your survey, please do so right away. We need
to hear from everyone and your response is very important to us.

If you need assistance or have any questions, please feel free to contact us at
1–800–845–8241.

Sincerely,

John H. Thompson
Director, U.S. Census Bureau

7306-22P (07-2015)

John H. Thompson
Director, U.S. Census Bureau

7306-22P (07-2015)

First Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with one child): NSCH-22L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-22L(A)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
Thank you again for helping us complete the first part of the National Survey of Children’s Health –
one of our nation’s most important surveys for understanding the health and health care needs of
America’s children.
About three weeks ago, we mailed you the second and final part of this study. If you have already
completed this follow-up survey, many thanks. We greatly appreciate your taking the time to
respond.
If you haven’t had the chance to complete the questionnaire, please do so very soon. For most
households, it should only take 30 minutes or less to complete this survey.
Your response, combined with the responses of other families, will provide the information
necessary to determine the health status of our children and plan for their health care needs in
each state and across our country. This first-of-its-kind study is the best way we have to gather this
critical information.
Your participation ensures that households like yours are accurately represented in the information
produced by the survey.
I want to assure you that your responses to this questionnaire are confidential. The laws that
protect your responses can be found on the front page of the survey. The U.S. Census Bureau
and the U.S. Department of Health and Human Services are required by law to protect the
confidentiality of every individual’s responses.
Thank you very much for taking part in this important study. If you have questions or need
assistance, please contact us toll-free at 1-800-845-8241 or by email
at [email protected].
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census. gov

First Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with multiple children): NSCH-22L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-22L(B)
(07-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
Thank you again for helping us complete the first part of the National Survey of Children’s Health –
one of our nation’s most important surveys for understanding the health and health care needs of
America’s children.
About three weeks ago, we mailed you the second and final part of this study. If you have already
completed this follow-up survey, many thanks. We greatly appreciate your taking the time to
respond.
If you haven’t had the chance to complete the questionnaire, please do so very soon. For most
households, it should take 30 minutes or less to complete this survey.
Your response, combined with the responses of other families, will provide the information
necessary to determine the health status of our children and plan for their health care needs in
each state and across our country. This first-of-its-kind study is the best way we have to gather this
critical information.
Please complete the survey for the child listed below. This child was selected at random based on
the earlier questionnaire that your household completed.
[Insert child’s name here]
Your participation ensures that households like yours are accurately represented in the information
produced by the survey.
I want to assure you that your responses to this questionnaire are confidential. The laws that
protect your responses can be found on the front page of the survey. The U.S. Census Bureau and
the U.S. Department of Health and Human Services are required by law to protect the
confidentiality of every individual’s responses.
Thank you very much in advance for taking part in this important study. If you have questions or
need assistance, please contact us toll-free at 1-800-845-8241 or by email
at [email protected].
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure
census. gov

Second Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with one child): NSCH-23L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-23L(A)
(08-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
I wrote last month requesting your assistance in completing the final part of the National Survey of
Children’s Health, which we are conducting for the U.S. Department of Health and Human Services.
To the best of our knowledge, we have not yet received your response. It may be that you did return the
completed questionnaire, but our communications have crossed in the mail. If you did respond, thank
you very much for doing so.
If you haven’t been able to complete the questionnaire yet, I hope you can fill it out and return it today.
The time for the study is running out, and we want to be sure that your response is included. For most
households, it should take about 30 minutes or less to complete the questionnaire.
Feel free to contact us toll-free at 1-800-845-8241 or by email at [email protected] if you
have any questions or need any assistance in completing this survey.
The information collected in this study will be used to help today’s children grow into tomorrow’s healthy
adults. We ask for your help because this survey is the only way we have to gather this important
information. And because your household was selected to represent thousands of others, your
response is even more important.
I want to assure you that your responses to this questionnaire are confidential as explained on the front
page of the survey. The U.S. Census Bureau and the U.S. Department of Health and Human Services
are required by law to protect the confidentiality of every individual’s responses.
Thank you very much for your kind consideration of this request.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census. gov

Second Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with multiple children): NSCH-23L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-23L(B)
(08-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
I wrote last month requesting your assistance in completing the final part of the National Survey of
Children’s Health, which we are conducting for the U.S. Department of Health and Human Services.
To the best of our knowledge, we have not yet received your response. It may be that you returned the
completed questionnaire and our communications have crossed in the mail. If you did respond, thank you
very much for doing so.
If you haven’t been able to complete the questionnaire yet, I hope you can fill it out and return it today. The
time for the study is running out, and we want to be sure that your response is included. It should take about
30 minutes or less to complete the questionnaire.
The information collected in this study will be used to help today’s children grow into tomorrow’s healthy
adults. We ask for your help because this survey is the only way we have to gather this important
information. And because your household was selected to represent thousands of others, your response is
even more important.
In order to reduce the time it takes to complete the survey, we have selected one child from your household
to focus on in the questionnaire. Please fill out the survey for
[Insert child’s name here]
Please feel free to contact us toll-free at 1-800-845-8241 or by email at [email protected] if you
have any questions or need any assistance in completing this survey.
I want to assure you that your responses to this questionnaire are confidential. The laws that protect your
responses can be found on the front page of the survey. The U.S. Census Bureau and the U.S.
Department of Health and Human Services are required by law to protect the confidentiality of every
individual’s responses. .
Thank you very much for your consideration and participation.
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure
census. gov

Third Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with one child): NSCH-24L(A)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-24L(A)
(09-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
During the past few months, we have contacted you seeking your participation in completing the final
part of the National Survey of Children’s Health. The U.S. Census Bureau is conducting this important
national survey on behalf of the U.S. Department of Health and Human Services.
As you might recall, the survey is designed to provide accurate and complete information about the
health and health services needs of our nation’s children. The information gathered in the study gives
the public and our state and national governments key insights into how the youngest members of our
society are doing, and what they need in order to thrive.
If you have responded to our request to participate in the second and final part of the survey, please
accept our sincere thanks. Your participation ensures that the information we gather is accurate and
complete. If you have not been able to participate thus far, I’d like to ask you to do so now. We have
enclosed another copy of this survey for your convenience.
Since the study period will soon end, this is the last time I will be able to write to ask for your help. I
hope that you will complete the questionnaire and mail it back. We want to be sure that the study
accurately reflects the experience of households like yours.
Hundreds of families have already returned their surveys. We would greatly appreciate it if you could
respond soon so that families like yours are accurately represented.
We know there are many competing demands for your time and we appreciate your thoughtful
consideration of this request. It should take 30 minutes or less to complete the survey. Once you have
completed it, please enclose it in the postage-paid envelope and mail it as soon as possible.
Finally, thank you for your kind consideration of this request. If you have questions or need assistance,
please contact us toll-free at 1-800-845-8241 or by email at [email protected].
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census. gov

Third Nonresponse Follow-up Topical Cover Letter for Mail-Only (for
households with multiple children): NSCH-24L(B)*

UNITED STATES DEPARTMENT OF COMMERCE
Econ om ics and Statistics Adm inistr atio n
NSCH-24L(B)
(09-2015)

U.S. Census Bureau
Washington, DC 20233-0001
OFFICE OF THE DIRECTOR

[Insert Date Here]
Resident(s) at:
[Insert Street Address Here]
[Insert City, State, and Zip Here]
Dear [enter City here] resident:
During the past few months, we have contacted you seeking your participation in completing the final
part of the National Survey of Children’s Health. The U.S. Census Bureau is conducting this important
national study on behalf of the U.S. Department of Health and Human Services.
As you might recall, the survey is designed to provide accurate and complete information about the
health and health care needs of our nation’s children. The information gathered in the study gives the
public and our state and national governments key insights into how the youngest members of our
society are doing and what they need in order to thrive.
If you have responded to our request to participate in this second and final part of the survey, please
accept our sincere thanks. Your participation ensures that the information we gather is accurate and
complete. If you have not been able to participate thus far, I’d like to ask you to do so now. We have
enclosed another copy of this second survey for your convenience.
Since the study period will soon end, this is the last time I will be able to write to ask for your help. I
hope that you will complete the questionnaire and mail it back. We want to be sure that the study
accurately reflects the experience of households like yours.
Please complete the survey for
[Insert child’s name here]
Since you have more than one child in your household, we have randomly selected one child to reduce
the time it takes to fill out the questionnaire.
Hundreds of families have already returned their surveys. We would greatly appreciate it if you could
respond soon so that families like yours are accurately represented.
We know there are many competing demands for your time and we appreciate your thoughtful
consideration of this request. It should take 30 minutes or less to complete the survey. Once you have
completed it, please enclose it in the postage-paid envelope and mail it as soon as possible.
Finally, thank you for your kind consideration of this request. If you have questions or need assistance,
please contact us toll-free at 1-800-845-8241 or by email at [email protected].
Sincerely,

John H. Thompson
Director
U.S. Census Bureau
Enclosure

census. gov

File Type	application/pdf
Author	Leah Nicole Meyer
File Modified	2015-04-29
File Created	2015-04-13