The NHANES Longitudinal Study – Feasibility Component

Forms and Documents

Document Name	Status
Field Feasibility Test Hospital Records Form Form and Instruction	New
Field Feasibility Test Decedent Proxy Interview Form and Instruction	New
Field Feasibility Test Home Urine Collection Form and Instruction	New
Field Feasibility Test Home Visit Form and Instruction	New
Field FeasibilityTest Registration and Scheduling Form and Instruction	New
Att 4a_Living SP Mails_170407.docx Supplementary Document	2017-04-10
Att 7_ROF_170209.docx Supplementary Document	2017-02-16
Att 6_ERB Approval_170209.docx Supplementary Document	2017-02-16
Att 5_Consents_170209.docx Supplementary Document	2017-02-16
Att 4b_Decedent Proxy Mails_170209.docx Supplementary Document	2017-02-16
Att 4a_Living SP Mails_170407.docx Supplementary Document	2017-04-10
Att 2b_FRN Response_170209.docx Supplementary Document	2017-02-16
Att 2a_60 Day FRN_170209.pdf Supplementary Document	2017-02-16
Att 1_Excerpts of Laws_170209.docx Supplementary Document	2017-02-16
Supporting Statement B_170407.docx Supporting Statement B	2017-04-10
Supporting Statement A_170407.docx Supporting Statement A	2017-04-10

IC Document Collections

IC ID	Document Title	Status
225823	Targeted Methodological Studies for the Field Feasibility Test Other-Overview of Types of Methodological Studies	New
225822	Field Feasibility Test Hospital Records Form Form and Instruction	New
225821	Field Feasibility Test Decedent Proxy Interview Form and Instruction	New
225820	Field Feasibility Test Home Urine Collection Form and Instruction	New
225819	Field Feasibility Test Home Visit Form and Instruction	New
225817	Field FeasibilityTest Registration and Scheduling Form and Instruction	New

ICR Details

OMB Control No: 0920-1176	ICR Reference No: 201702-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16AJE
Title: The NHANES Longitudinal Study – Feasibility Component
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2017
	Date Received in OIRA: 03/02/2017
Terms of Clearance: Approved consistent with the understanding that this is one-time collection designed to field test ability to recontact participants and gauge their willingness to engage in future data collection. Data collected during this test are not designed to be representative; caution must be used in interpreting analyses.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved
Responses	1,891	0	0
Time Burden (Hours)	1,055	0	0
Cost Burden (Dollars)	24,506	0	0

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Abstract: The goal of the study is to assess the response rates of re-contacting, interviewing, and examining previously examined participants in the National Health and Nutrition Examination Surveys (NHANES), using a core module designed for the NHANES Longitudinal Study with a focus on chronic conditions. Findings will be used to assess the feasibility of conducting a full-scale follow-up of previously examined NHANES adult participants. The feasibility study is planned for 2017-2018. The target start date of the full-scale NHANES follow-up is 2020.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act section 306 statistical and epidemiological activities
  

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 32330	05/23/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 12361	03/02/2017
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
Field Feasibility Test Decedent Proxy Interview	N/A	Suggested Scripts and Data Collection Forms for Decedent Proxy Interviews
Field Feasibility Test Hospital Records Form	N/A	Hospitalization Record Return Form
Targeted Methodological Studies for the Field Feasibility Test
Field FeasibilityTest Registration and Scheduling	N/A	Registration Form
Field Feasibility Test Home Visit	N/A	Suggested Scripts and Data Collection Forms for Presumed Living Participants
Field Feasibility Test Home Urine Collection	N/A	Scripts Forms and Instructions for Home Urine Collection

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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	1,891	0	0	1,891	0	0
Annual Time Burden (Hours)	1,055	0	0	1,055	0	0
Annual Cost Burden (Dollars)	24,506	0	0	24,506	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $2,401,050

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/02/2017

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