Form 1 Mail Materials

Generic Clearance for Questionnaire Pretesting Research

NSCH 2019 Mail Materials for Cognitive Testing_OMB

NSCH Mail Materials Cognitive Testing

OMB: 0607-0725

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0607-0725 can be found here:

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NSCH11wa_1

Dear (insert City) Resident:

Y our address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

Shape3

Shape4

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at [email protected].

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

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH11wa_ 2

Dear (insert City) Resident:

Your address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Shape6

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

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

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH11wa_ 3

Dear (insert City) Resident:

Your address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

The success of this survey depends on your participation. The results will help your state better understand and respond to the health and healthcare needs of children and families. Results from the National Survey of Children’s Health are used to determine:

School programs for children with learning and developmental conditions
Healthcare programs for mothers and children
Support for families of children with special healthcare needs
State level funding for children’s health programs

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH12wa(SC)_ 1

Dear (insert City) Resident:

R ecently, we requested your participation in the National Survey of Children’s Health. If you have completed the survey 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 information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

Shape13

If there are children 0-17 years old in your household:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

If you are unable to complete the survey online:

Answer the question at the bottom, detach the form and return it in the postage-paid envelope.

If there are NO children 0-17 years old in your household:

Let us know. Answer the question at the bottom of this letter, detach the form, and return it in the postage-paid envelope.

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at [email protected].

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

Steven D. Dillingham, Director

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

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

0 1 2 3 4 or more

Mailing Instructions: 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

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

Shape19 Public reporting burden for this collection of information is estimated to average 1 minute per response. 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.

NSCH12wa(SC)_ 2

Dear (insert City) Resident:

Responding to this survey is easy:

Shape21

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

If there are children 0-17 years old in your household:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

If you are unable to complete the survey online:

Answer the question at the bottom, detach the form and return it in the postage-paid envelope.

If there are NO children 0-17 years old in your household:

Let us know. Answer the question at the bottom of this letter, detach the form, and return it in the postage-paid envelope.

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at [email protected].

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

Steven D. Dillingham, Director

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

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

0 1 2 3 4 or more

Mailing Instructions: 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

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

Shape28 Public reporting burden for this collection of information is estimated to average 1 minute per response. 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.

NSCH12wa(SC)_ 3

Dear (insert City) Resident:

Recently, we requested your participation in the National Survey of Children’s Health. If you have completed the survey 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 information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Shape30 Shape29

Shape31

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

The success of this survey depends on your participation. The results will help your state better understand and respond to the health and health care needs of children and families. Results from the National Survey of Children’s Health are used to determine:

School programs for children with learning and developmental conditions
Healthcare programs for mothers and children
Support for families of children with special healthcare needs
State level funding for children’s health programs

Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at [email protected].

Steven D. Dillingham, Director

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

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

0 1 2 3 4 or more

Mailing Instructions: 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

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

Shape37 Public reporting burden for this collection of information is estimated to average 1 minute per response. 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.

NSCH13_ 1

Dear (insert City) Resident:

R ecently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.

Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

Shape40

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

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

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH13_ 2

Dear (insert City) Resident:

Recently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.

Responding to this survey is easy:

Shape43

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

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

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH13_ 3

Dear (insert City) Resident:

Recently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.

Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID: 54387543

Even if there are no children 0-17 years old in your household, please log in to let us know.

School programs for children with learning and developmental conditions
Healthcare programs for mothers and children
Support for families of children with special healthcare needs
State level funding for children’s health programs

Thank you for your help.

Steven D. Dillingham, Director

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH21b_ 1

D ear Parent or Caregiver:

A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your participation. The final step of this survey is to answer some follow-up questions about your child:

[NAME] [AGE][SEX]

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

This child was selected to ensure the survey results represent every type of child and health situation.

This survey should be filled out by a parent or adult caregiver who lives in this household and who is familiar with this child’s health and healthcare. Please return your completed questionnaire in the postage-paid envelope provided.

The success of this survey depends on your participation. The results will help our nation better understand and respond to the healthcare needs of children and families in your state and across the country.

If you need assistance with the survey or have questions, please call 1–800–845–8241 or email [email protected].

Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director

Enclosure

NSCH21b_ 2

Dear Parent or Caregiver:

[NAME, AGE(or BABY), SEX]

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

This child was selected to ensure the survey results represent every type of child and health situation.

If you need assistance with the survey or have questions, please call 1–800–845–8241 or email [email protected].

Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director

Enclosure

NSCH21b_ 3

Dear Parent or Caregiver:

[NAME, AGE(or BABY), SEX]

This child was selected to ensure the survey results represent every type of child and health situation.

School programs for children with learning and developmental conditions
Healthcare programs for mothers and children
Support for families of children with special healthcare needs
State level funding for children’s health programs

If you need assistance with the survey or have questions, please call 1–800–845–8241 or email [email protected].

Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director

Enclosure

NSCH22B_1

Dear Parent or Caregiver:

We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

This child was selected to ensure the survey results represent every type of child and health situation.

The information collected in this survey will help your state better understand and respond to the health care needs of children and families. We ask for your response because this survey is the only way we have to gather this important information. Your household was scientifically selected from all of the households in the country and will represent thousands of other households.

Thank you for your help.

Steven D. Dillingham, Director

Enclosure

NSCH22B_ 2

Dear Parent or Caregiver:

We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:

Results from the National Survey of Children’s Health are used to determine:

School programs

for children with learning and developmental conditions

Healthcare programs for mothers and children

Support for families of children with special healthcare needs

State level funding for children’s health programs

This child was selected to ensure the survey results represent every type of child and health situation.

Thank you for your help.

Steven D. Dillingham, Director

Enclosure

NSCH22B_ 3

Dear Parent or Caregiver:

We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:

This child was selected to ensure the survey results represent every type of child and health situation.

Results from the National Survey of Children’s Health are used to determine:

School programs for children with learning and developmental conditions
Healthcare programs for mothers and children
Support for families of children with special healthcare needs
State level funding for children’s health programs

Thank you for your help.

Steven D. Dillingham, Director

Enclosure

FAQ

Frequently Asked Questions

How was I chosen for the survey?

Your address was randomly selected to be part of this voluntary survey from all of the addresses in the United States. We do not know who lives at each address. Everyone has a chance to be picked. This process ensures that the addresses selected represent everyone in the United States.

Can you replace my address with another one?

You are important! No other household is the same as yours. We cannot swap one address for another. If we did that, the survey results would not accurately describe your state or the entire country.

What are you going to ask me?

The survey asks questions about children’s physical and emotional health. It also asks about factors that may influence children’s well-being, including medical care, family interactions, parental health, school experiences, and neighborhoods.

How long will it take?

The survey takes less than 5 minutes if there are no children in your household. For households with children, it takes 33 minutes on average.

Who authorizes this survey?

The Census Bureau is conducting this survey on behalf of the U.S. Department of Health and Human Services under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). 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 right corner of this page, the bottom left corner of the survey web page, and the upper left corner of the paper questionnaire. If this number were not displayed, we could not conduct this survey.

What laws protect my privacy?

Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Under the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

No hablo Ingles. Ques es esto?

La Oficina del Censo de los EE. UU. está llevando a cabo la Encuesta Nacional de Salud de los Niños, una importante investigación nacional de los EE. UU. Necesitamos su ayuda. Esta encuesta proporciona información importante que se utiliza para mejorar la salud de los niños y familias en todos los Estados Unidos. Es muy fácil completar esta encuesta. Si necesita una encuesta Español, llame gratuitamente a este número 1–800–845–8241 o envíenos un correo electrónico a [email protected].

N SCH-PCW_ 1

Dear (insert City) Resident:

Recently, we sent you a letter requesting your participation in the National Survey of Children’s Health. If you have already responded to the survey, please accept our sincere thanks. If you have not yet completed your survey, please do so right away.

Shape56 Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID:

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].

Thank you for your help.

Steven D. Dillingham, Director

N SCH-PCW_ 2

Dear (insert City) Resident:

Shape57 Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID:

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].

Thank you for your help.

Steven D. Dillingham, Director

N SCH-PCW_ 3

Dear (insert City) Resident:

Responding to this survey is easy:

Go to: https://respond.census.gov/nsch
Enter your Login ID:

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].

Thank you for your help.

Steven D. Dillingham, Director

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Rachel E Sloan (CENSUS/DSMD FED)
File Modified	0000-00-00
File Created	2021-01-15