National Health and Nutrition Examination Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HPV PRC Providers	Form	New	Available
HPV PRC Participants	Form	New	Available
Liver Ultrasound Pilot	Form	New	Available
Form 2 NHANES Questionnaire	Form	Unchanged	Available
Combined nonsubs 11_23.docx	Supplementary Document	Uploaded 2015-11-23	Available
Combined nonsubs 110315.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-11-04	Available
Waist Circ v5 nonsubstantive change 29APR2015rev.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-04-29	Available
NHANES_15-16_Sup_Stat_A_102114.docx	Supporting Statement A	Uploaded 2014-10-28	Available
Att 6 ERB Approval 101614.rtf	Supplementary Document	Uploaded 2014-10-22	Available
Att_11_PM_flyer_15-16 100114.doc	Supplementary Document	Uploaded 2014-10-22	Available
Att_9_ROF_15-16 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
Att_7_labs_15-16 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
Att_5b_Child_Assent_15-16 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
Att_5a_MEC_Consent_15-16 100114.pdf	Supplementary Document	Uploaded 2014-10-22	Available
Att_5_Consents_15-16 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
Att_4 _Letters_scripts 15-16 100114.doc	Supplementary Document	Uploaded 2014-10-22	Available
Att_3_Agencies_15-16 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
Att_2b_60_day responses 100114.docx	Supplementary Document	Uploaded 2014-10-22	Repair queued
Att_2a_60-day_15-16 100114.pdf	Supplementary Document	Uploaded 2014-10-22	Available
Att_1_15-16_Laws 100114.docx	Supplementary Document	Uploaded 2014-10-22	Available
NHANES_15-16_Sup_Stat_B_100114.docx	Supporting Statement B	Uploaded 2014-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218880	HPV PRC Providers	Form	New
218879	HPV PRC Participants	Form	New
218863	Liver Ultrasound Pilot	Form	New
213575	NHANES Special Studies	Instruction	Unchanged
213574	NHANES Questionnaire	Form	Unchanged

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 201511-0920-004
Status: Historical Active	Previous ICR Reference No: 201504-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 16DJ
Title: National Health and Nutrition Examination Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/23/2015
	Date Received in OIRA: 11/12/2015
Terms of Clearance: November 23, 2015 version of request approved (clarification made that the request is to test liver ultrasound elastography equipment).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	11/30/2016	11/30/2016
Responses	18,310	0	16,910
Time Burden (Hours)	43,525	0	43,525
Cost Burden (Dollars)	0	0	0

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Abstract: NCHS requests a nonsubstantive change to the National Health and Nutrition Examination Survey (NHANES) (OMB No. 0920-0950, exp. November 30, 2016) to conduct "Special Studies." No additional burden is requested as burden hours for these studies has been approved in advance.

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Authorizing Statute(s): US Code: 21 USC 393 Name of Law: Federal Food, Drug and Cosmetic Act
   US Code: 42 USC 306 Name of Law: PHSA
   PL: Pub.L. 104 - 170 301 Name of Law: Food Quality Protection Act
   PL: Pub.L. 101 - 445 103 Name of Law: National Nutrition Monitoring and Related Research Act of 1990
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 20204	04/11/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 64196	10/28/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Liver Ultrasound Pilot	none	Liver Ultrasound
NHANES Questionnaire	2	NHANES Questionaire -revised
NHANES Special Studies
HPV PRC Participants	none	HPV Participants
HPV PRC Providers	none	HPV PRC Providers

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ICR Summary of Burden

table that charts list of burden

	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	18,310	16,910	0	1,400	0	0
Annual Time Burden (Hours)	43,525	43,525	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $41,200,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/12/2015

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