National Health and Nutrition Examination Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HPV PRC Providers	Form	Unchanged	Available
HPV PRC Participants	Form	Unchanged	Available
Liver Ultrasound Pilot	Form	Unchanged	Available
NHANES Questionnaire	Form	Unchanged	Repair queued
Combined Nonsubs 071416.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-07-20	Available
Att_6_ERB Approval 120415.rtf	Supplementary Document	Uploaded 2015-12-07	Available
Sup_Stat_B_112315.docx	Supporting Statement B	Uploaded 2015-12-07	Available
NHANES_15-16_Sup_Stat_A_011416.docx	Supporting Statement A	Uploaded 2016-01-14	Available
Att_11_PM_flyer_15-16 100114.doc	Supplementary Document	Uploaded 2015-12-03	Available
Att_9_ROF_15-16 100114.docx	Supplementary Document	Uploaded 2015-12-03	Available
Att_7_labs_15-16 112315.docx	Supplementary Document	Uploaded 2015-12-03	Available
Att_5b_Child_Assent_15-16 100114.docx	Supplementary Document	Uploaded 2015-12-03	Available
Att_5a_MEC_Consent_15-16 100114 (1).pdf	Supplementary Document	Uploaded 2015-12-03	Available
Att_5_Consents_15-16 100114.docx	Supplementary Document	Uploaded 2015-12-03	Repair queued
Att_4 _Letters_scripts 15-16 100114.doc	Supplementary Document	Uploaded 2015-12-03	Available
Att_3_Agencies_15-16 100114.docx	Supplementary Document	Uploaded 2015-12-03	Repair queued
Att_2b_60_day response 102015.docx	Supplementary Document	Uploaded 2015-12-03	Available
Att_2a_60-day_15-16 100114.pdf	Supplementary Document	Uploaded 2015-12-03	Available
Att_1_15-16_Laws 100114.docx	Supplementary Document	Uploaded 2015-12-03	Available
Combined nonsubs 11_23.docx	Supplementary Document	Uploaded 2015-11-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219202	NHANES Waist Circumference Study	Instruction	Unchanged
218880	HPV PRC Providers	Form	Unchanged
218879	HPV PRC Participants	Form	Unchanged
218863	Liver Ultrasound Pilot	Form	Unchanged
213575	NHANES Special Studies	Other-Other	Modified
213574	NHANES Questionnaire	Form	Unchanged

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 201607-0920-008
Status: Historical Active	Previous ICR Reference No: 201512-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health and Nutrition Examination Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/22/2016
	Date Received in OIRA: 07/21/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	22,310	0	22,310
Time Burden (Hours)	46,925	0	46,925
Cost Burden (Dollars)	0	0	0

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Abstract: The change request is to conduct NHANES Special Studies; there is no additional burden. This revision request is to a) add the collection of waist circumference data on 3000 people who are participating in NHANES during 2016, b) extend the expiration date to the end of 2017 in order to allow completion of the 2015-2016 data collection and continue conducting special studies that allow refinement in NHANES methods, add additional hours for these special studies.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: PHSA
   PL: Pub.L. 104 - 170 301 Name of Law: Food Quality Protection Act
   PL: Pub.L. 110 - 234 4403 Name of Law: Food, Conservation, and Energy Act of 2008
   US Code: 21 USC 393 Name of Law: Federal Food, Drug and Cosmetic Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 53799	09/08/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 76992	12/11/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
NHANES Waist Circumference Study
Liver Ultrasound Pilot	none	Liver Ultrasound
NHANES Questionnaire	none	NHAMES Questionnaire
NHANES Special Studies	none, none, none, none, none	ABPM Screener ,   Pre-ABPM Form ,   ABPM Diary Form ,   ABPM Post- ABPM Form ,   Multi-mode Screener
HPV PRC Participants	none	HPV Participants
HPV PRC Providers	none	HPV PRC Providers

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	22,310	22,310	0	0	0	0
Annual Time Burden (Hours)	46,925	46,925	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $41,200,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/21/2016

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