Information Collection

NHANES Special Studies

IC 213575 under ICR 201607-0920-008 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ABPM Screener NHANES Special Studies	Form and Instruction
Pre-ABPM Form NHANES Special Studies	Form
ABPM Diary Form NHANES Special Studies	Form
ABPM Post- ABPM Form NHANES Special Studies	Form
Multi-mode Screener NHANES Special Studies	Form
Att_10_Spec_Studies 15-16 110915.docx	Other-Other
ABPM Screener ATT1b_ ABPM Screener 071416.docx	Form and Instruction
Pre-ABPM Form ATT1d_ Pre ABPM Form 071416.docx	Form
ABPM Diary Form ATT1f_ ABPM Study Diary 062816.docx	Form
ABPM Post- ABPM Form ATT1g_ Post ABPM Form 062816.docx	Form
Multi-mode Screener ATT2b_ Multi-Mode Screener 060316.docx	Form
ATT1a_ ABPM 071416.docx ABPM Description	IC Document
ATT1c_ ABPM Consent 071416.docx ABPM Consent	IC Document
ATT1e_ ABPM Info Sheet 071416.docx ABPM Info Sheet	IC Document
ATT1h_ ABPM ROF 071416.docx ABPM Report of Findings	IC Document
ATT2a_ Multi-Mode Screener 070716.docx Multi-mode screening description	IC Document
ATT2c_ MM Advance Letter 070716.docx Advance Letter	IC Document
Att2d_ MM WebScreener Postcard 070716.docx Postcard Reminder	IC Document
Att2e MM Second Letter 070716.docx Second Letter	IC Document
Att2f_MM Screenshots 070716.docx Screener Screenshots	IC Document
ATT3a Consents Changes 060316.docx Consent Changes	IC Document
ATT3b Revised Consents 060316.docx Revised Consents	IC Document

IC Title:

NHANES Special Studies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other		No		Paper Only
Form and Instruction	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ABPM Description		07/20/2016
ABPM Consent		07/20/2016
ABPM Info Sheet		07/20/2016
ABPM Report of Findings		07/20/2016
Multi-mode screening description		07/20/2016
Advance Letter		07/20/2016
Postcard Reminder		07/20/2016
Second Letter		07/20/2016
Screener Screenshots		07/20/2016
Consent Changes		07/20/2016
Revised Consents		07/20/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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