5 Experimental Treatment B - Perforated Mockup 2

NSCH11wa – Treatment B – 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 at the bottom of this letter, detach the form 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.

Please detach the form below on the perforated line and return it in the postage-paid envelope

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1. Are there any children 0-17 years old that usually live or stay at this address?

• Yes

• No  SKIP to Mailing Instructions

2. How many children 0-17 years old usually live or stay at this address?

• 1

• 2

• 3

• 4 or more

Mailing Instructions: Thank you. Place this card in the postage-paid envelope provided.

If the envelope has been misplaced, please mail this card to:

U.S. Census Bureau

ATTN: DCB 60-A

1201 E. 10th Street

Jeffersonville, IN 47132-0001

Public reporting burden for this collection of information is estimated to average 1 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to [email protected]; use "Paperwork Project 0607-0990" as the subject.

You may also call 1-800-845-8241 to request a replacement envelope.

OMB No. 0607-0990: Approval Expires 05/31/2019