National Health and Nutrition Examination Survey

Forms and Documents

Document Name	Status
Form 0920-0950 Flexible Consumer Behavior Survey Phone Follow-up Form	Modified
Form 0920-0950 NHANES Questionnaire Form	Modified
Att_5a_Lab_17-18_101816.docx Supplementary Document	2016-11-01
Att_6_ERB Approval 120415.rtf Supplementary Document	2015-12-07
Sup_Stat_B_101416.docx Supporting Statement B	2016-11-01
Sup_Stat_A_101416.docx Supporting Statement A	2016-11-01
Att_11_PM_flyer_15-16 100114.doc Supplementary Document	2015-12-03
Att_5b_labs_15-16 062816.docx Supplementary Document	2016-11-01
Att_7_labs_15-16 112315.docx Supplementary Document	2015-12-03
Att_2a_0920-0950 60-day 062816.pdf Supplementary Document	2016-11-01
Att_1_17-18_Laws 062816.docx Supplementary Document	2016-11-01

IC Document Collections

IC ID	Document Title	Status
219202	Developmental Projects and Special Studies Instruction	Modified
218880	Wearable Device Projects Instruction	Modified
218879	Flexible Consumer Behavior Survey Phone Follow-up Form	Modified
218863	Blood Pressure Methodology Phase 2 Instruction	Modified
213575	Blood Pressure Methodology Study Phase 1 Instruction	Modified
213574	NHANES Questionnaire Form	Modified

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 201611-0920-002
Status: Historical Active	Previous ICR Reference No: 201607-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0950
Title: National Health and Nutrition Examination Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2016
	Date Received in OIRA: 11/09/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	12/31/2017
Responses	27,514	0	22,310
Time Burden (Hours)	79,894	0	46,925
Cost Burden (Dollars)	0	0	0

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Abstract: The National Health and Nutrition Examination Survey (NHANES) is a continuous nationally representative sample of the civilian, non-institutionalized U.S. population. The survey is unique in that it contains interview, laboratory and physical examination segments. The examination component is conducted in mobile examination centers that travel to fifteen survey locations each year. NHANES data have been the cornerstone for numerous national health and nutrition policy and surveillance activities. This request seeks a revised approval for data collection for the 2017-2018 survey.

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

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:
	81 FR 32333	05/23/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78155	11/07/2016
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Blood Pressure Methodology Phase 2
Developmental Projects and Special Studies
NHANES Questionnaire	0920-0950	NHANES Questionnaire and Data Collection Forms 2017-18
Blood Pressure Methodology Study Phase 1
Flexible Consumer Behavior Survey Phone Follow-up	0920-0950	Flexible Consumer Behavior Survey (FCBS)
Wearable Device Projects

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ICR Summary 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	27,514	22,310	0	5,204	0	0
Annual Time Burden (Hours)	79,894	46,925	0	32,969	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This is a revision of a currently approved ICR.

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Annual Cost to Federal Government: $46,200,000

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: 11/09/2016

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