11 Perforated Mockup 2

NSCH12wa – Perforated Mockup 2 (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 questions at the bottom of this letter, detach the form 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.

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