8 NonPerforated Mockup 1

Generic Clearance for Questionnaire Pretesting Research

NSCH12wa - Non-perforated Mockup 1_OMB

NSCH Screener Cognitive Interviews

OMB: 0607-0725

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NSCH12wa Non-Perforated Mockup 1 (NSCH12wa Adapted Version 1)


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

Recently we requested your participation in the National Survey of Children’s Health (NSCH). If you have completed the NSCH prior to receiving this mailing, please accept our thanks. If you have not yet responded, we encourage you to complete the survey online. This survey collects important information used to improve the health of children and families throughout the United States.



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 question on the included card and return it in the postage-paid envelope.


If you need assistance or have questions, please call
1–800–845–8241 or email us at: [email protected]

The survey takes less than 5 minutes to respond if there are no children in your household, and on average 33 minutes for households with children.

The information gathered in this survey is critical to understanding children’s health care needs, both in your state and across the country. Your household was scientifically selected from all of the households in the country and your response represents thousands of other households. The U.S. Census Bureau is not permitted to publicly release your responses in a way that could identify your household. By law, the Census Bureau can only use your responses for statistical research.

Your response is vital to the success of this survey. Thank you again for your participation. We hope to hear from you soon.



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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