Information Collection

National Survey of Children's Health

IC 220525 under ICR 201603-0607-002 · OMB 0607-0990.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0990 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NSCH-T1 National Survey of Children's Health	Form and Instruction
NSCH-S1 NSCH Screener - English NSCH_S1_FINAL.pdf	Form and Instruction
NSCH-PS-S1 NSCH Screener - Spanish NSCH_PS-S1 FINAL.pdf	Form and Instruction
NSCH-PS-T1 NSCH Topical 1 (0-5) - Spanish NSCH_PS-T1 FINAL.pdf	Form and Instruction
NSCH-PS-T2 NSCH Topical 2 (6-11) - Spanish NSCH_PS-T2 FINAL.pdf	Form and Instruction
NSCH-PS-T3 NSCH Topical 3 (12-17) - Spanish NSCH_PS-T3 FINAL.pdf	Form and Instruction
NSCH-T1 NSCH Topical 1 (0-5) - English NSCH_T1_FINAL.pdf	Form and Instruction
NSCH-T2 NSCH Topical 2 (6-11) - English NSCH_T2_FINAL.pdf	Form and Instruction
NSCH-T3 NSCH Topical 3 (12-17) - English NSCH_T3_FINAL.pdf	Form and Instruction

IC Title:

National Survey of Children's Health

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NSCH-T1	NSCH Topical 1 (0-5) - English	NSCH_T1_FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-S1	NSCH Screener - English	NSCH_S1_FINAL.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	NSCH-T3	NSCH Topical 3 (12-17) - English	NSCH_T3_FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-T2	NSCH Topical 2 (6-11) - English	NSCH_T2_FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-PS-S1	NSCH Screener - Spanish	NSCH_PS-S1 FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-PS-T1	NSCH Topical 1 (0-5) - Spanish	NSCH_PS-T1 FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-PS-T2	NSCH Topical 2 (6-11) - Spanish	NSCH_PS-T2 FINAL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NSCH-PS-T3	NSCH Topical 3 (12-17) - Spanish	NSCH_PS-T3 FINAL.pdf	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title: SORN Census 3

FR Citation: 77 FR 18205

Number of Respondents: 266,906

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 45 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	266,906	266,906
Annual IC Time Burden (Hours)	54,117	54,117
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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