3 Experimental Treatment B - NonPerforated Mockup 2

Generic Clearance for Questionnaire Pretesting Research

NSCH11wa - Experimental Treatment B_Non-perforated Mockup 2_OMB

NSCH Screener Cognitive Interviews

OMB: 0607-0725

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NSCH11wa – Treatment B – Non-perforated Mockup 2 (NSCH11wa Adapted Version 1)


A Message from the Director, U.S. Census Bureau:

Your address has been selected to participate in the National Survey of Children’s Health (NSCH). This survey collects information that is used to improve the health of children and families throughout the United States. The U.S. Census Bureau conducts this survey on behalf of the U.S. Department of Health and Human Services.

Responding to this survey online is easy:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID:

If there are no children age 0 to 17 in your household, we still want to hear from you. Simply answer the questions on the included card and return it in the postage-paid envelope.

We are conducting this survey online to help us reduce costs and report results quickly. If you are unable to complete the survey online, need assistance, or have questions, please call 1–800–845–8241 or email us at: [email protected].

Your household was randomly selected as part of this voluntary survey. We cannot replace your household with another one. The survey takes less than 5 minutes if there are no children in your household, and on average 33 minutes for households with children.

The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your responses in a way that could identify your household. The U.S. Census Bureau is conducting this survey under the authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number 0607-0990 appears in the bottom left corner of the survey web page. If this number were not displayed we could not conduct this survey.

The success of this survey depends on your participation. The results will help our nation better understand and respond to the health care needs of children and families.



Thank you for your help.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorM Christopher Stringer (CENSUS/DSMD FED)
File Modified0000-00-00
File Created2021-01-20

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