Att 1_ Confidentiality Pledge

Attachment 1: Confidentiality pledge to be cognitively tested

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Information Collection Review Office; 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0222).

Form Approved OMB #0920-0222; Expiration Date: 07/31/2018

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

National Health Interview Survey

Since – 1957

From the Director of the United States National Center for Health Statistics

I’m Charles Rothwell and I head the National Center for Health Statistics (NCHS), part of CDC (the United States Centers for Disease Control and Prevention). In partnership with the U.S. Census Bureau, my agency is conducting a major survey about the nation’s health and we need your help. In the next few days, a Census Bureau interviewer will ask you some questions to see if you are eligible for the National Health Interview Survey. For your protection, the interviewer will show you an official identification card.

Your answers are used only for health research, and to help understand and solve today’s health problems and anticipate future health issues. Quality health information is necessary to make good decisions and sound policies. In this way, taking part in the survey indirectly benefits all Americans.

We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA ,Title 5 of Public Law 107-347). In accordance with CIPSEA every NCHS employee, contractor and agent have taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.  In addition, NCHS complies with the Cybersecurity Enhancement Act of 2015.  This law requires the Federal government to protect its information by using computer security programs to identify cybersecurity risks against federal computer networks.

I hope you will want to take part in the survey–it is your choice. No penalties or loss of benefits will come from refusing.

The length of the interview will depend on the size and health of your family. Most interviews take about an hour, but you can stop at any time and you can choose not to answer any question you do not wish to answer. Health and health care information from other records may be combined with your survey answers. These data also will be kept strictly private. You also may be given the choice to take part in other surveys sponsored by the National Center for Health Statistics.

Please contact the Census Bureau, toll-free, at 1–800–262–4236, press 4, if you have questions about the survey or to schedule an interview. About a week after the interview, some households will be asked a few extra questions for quality purposes.

You can learn more about the survey at our website: http://www.cdc.gov/nchs/nhis.htm I know your time and privacy are valuable so I am very grateful for your help. Thank you for your cooperation.

Sincerely,

Charles J. Rothwell

Director, National Center for Health Statistics

Centers for Disease Control and Prevention

FREQUENTLY ASKED QUESTIONS ABOUT THE

NATIONAL HEALTH INTERVIEW SURVEY (NHIS)

1. HOW WAS I CHOSEN FOR THE SURVEY?

Every month we pick between 5,300 and 5,500 home addresses across the entire United States. We pick addresses using scientific methods so they represent all communities in the U.S.

2. WHY NOT INTERVIEW AT THE HOUSE ACROSS THE STREET? WHY IS MY PARTICIPATION IMPORTANT?

It is important that the people living at the address selected be in the survey. Due to the scientific methods used to pick addresses, we cannot exchange one address for another. If we did that, the survey results would not describe the entire country.

3. I AM NOT SICK – WHY SHOULD I TAKE PART IN A HEALTH SURVEY?

This is a survey of the Nation’s health. We want to know how many people are sick and why they are sick, but it is also important to know how many people are healthy and why they are healthy. Everyone’s answers are important.

4. WHAT ARE YOU GOING TO ASK ME?

The NHIS covers a wide range of topics like doctor visits, medical conditions, health insurance, physical activity, and injuries. We also ask questions that help us better understand the health information you give us. For example, we ask about race, income, and permission to combine your answers with information from other places, like medical records. Most people have no difficulty with any of the questions in the NHIS. However, others find some questions to be sensitive. You do not have to answer any questions you don’t want to.

5. WHAT IS THE CYBERSECURITY ACT OF 2015?

The Cybersecurity Act of 2015 permits monitoring information systems for the purpose of protecting a network from hacking, denial of service attacks and other security vulnerabilities.(1)  The software used for monitoring may scan information that is transiting, stored on, or processed by the system.  If the information triggers a cyber threat indicator, the information may be intercepted and reviewed for cyber threats.  The cyber threat indicator or defensive measure taken to remove the threat may be shared with others only after any information not directly related to a cybersecurity threat has been removed. Sharing of information can occur only after removal of personal information of a specific individual or information that identifies a specific individual. Monitoring under the Cybersecurity Act may be done by a system owner or another entity the system owner allows to monitor its network and operate defensive measures on its behalf.

6. WHO LOOKS OUT FOR THE INTERESTS OF SURVEY PARTICIPANTS?

Every year, the Research Ethics Review Board (ERB) of the National Center for Health Statistics reviews survey content and methods to protect study participants. You may call the ERB if you want to ask about your rights as a participant in this research study. The toll-free number is 1–800–223–8118. Please leave a brief message with your name and phone number. Say you are calling about Protocol # 2015-08. Your call will be returned promptly.

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