NHANES Special Studies

National Health and Nutrition Examination Survey

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			Att_10_Spec_Studies 15-16 110915.docx	No		Paper Only
Form and Instruction	none	ABPM Screener	ATT1b_ ABPM Screener 071416.docx	Yes	Yes	Fillable Fileable
Form	none	Pre-ABPM Form	ATT1d_ Pre ABPM Form 071416.docx	Yes	Yes	Fillable Fileable
Form	none	ABPM Diary Form	ATT1f_ ABPM Study Diary 062816.docx	Yes	Yes	Fillable Fileable
Form	none	ABPM Post- ABPM Form	ATT1g_ Post ABPM Form 062816.docx	Yes	Yes	Fillable Fileable
Form	none	Multi-mode Screener	ATT2b_ Multi-Mode Screener 060316.docx	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 %

	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

Title	Document	Date Uploaded
ABPM Description	ATT1a_ ABPM 071416.docx	07/20/2016
ABPM Consent	ATT1c_ ABPM Consent 071416.docx	07/20/2016
ABPM Info Sheet	ATT1e_ ABPM Info Sheet 071416.docx	07/20/2016
ABPM Report of Findings	ATT1h_ ABPM ROF 071416.docx	07/20/2016
Multi-mode screening description	ATT2a_ Multi-Mode Screener 070716.docx	07/20/2016
Advance Letter	ATT2c_ MM Advance Letter 070716.docx	07/20/2016
Postcard Reminder	Att2d_ MM WebScreener Postcard 070716.docx	07/20/2016
Second Letter	Att2e MM Second Letter 070716.docx	07/20/2016
Screener Screenshots	Att2f_MM Screenshots 070716.docx	07/20/2016
Consent Changes	ATT3a Consents Changes 060316.docx	07/20/2016
Revised Consents	ATT3b Revised Consents 060316.docx	07/20/2016

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