Appenxdix C

NSCH_OMB_AppendixC.docx

National Survey of Children's Health

Appenxdix C

OMB: 0607-0990

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Appendix C


Sample letters and postcards


Initial Web invite - incentive


Dear Resident:


The U.S. Census Bureau is conducting the National Survey of Children’s Health, an important national study for the U.S. Department of Health and Human Services. We need your help. This survey provides information that is used to improve the health of children and families throughout the United States.


Filling out this survey online is easy:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey


If you are unable to complete this survey online, need assistance, or have questions,

please call toll-free at 1–800–845–8241 or email us at: [email protected] We are collecting this information online in order to be able to report results more quickly and at considerably less cost.


Even if you have no infants or children in your household, it is important that you complete this survey so that every type of household in America is represented. Your household was randomly selected as part of this voluntary study, and we cannot replace your household with another one. You will be directed automatically to the questions that apply to your household. It usually takes less than 5 minutes if there is no one in your household 0 – 17 years old, and no longer than 30 minutes to answer the questions for households with children.


The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your responses in a way that could identify this household. The U.S. Census Bureau is conducting this survey under the authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.


This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number 0607-0990 confirms this approval and appears in the bottom left corner of the survey web page. If this number were not displayed we could not conduct this survey.


We greatly appreciate your help with this study, and have enclosed a small token of appreciation for your participation. The results of this study will help educators, researchers, policymakers, child advocates, and the general public better understand and respond to the health care needs of children and families.


Initial mixed-mode invite - incentive


Dear Resident:


The U.S. Census Bureau is conducting the National Survey of Children’s Health, an important national study for the U.S. Department of Health and Human Services. We need your help. This survey provides information that is used to improve the health of children and families throughout the United States.


Filling out this survey online is easy:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey


If you are unable to complete the survey online, we have enclosed a paper questionnaire that will help us find households with children. The information is used later to ask those households about health issues that may affect children within their household. The data provided will help to improve the health of children and families throughout the United States. If you decide to complete the paper questionnaire instead of the online survey, mail it back in the postage-paid envelope provided.


If you are having difficulty completing this survey online, need assistance, or have questions,

please call toll-free at 1–800–845–8241 or email us at: [email protected]


Even if you have no infants or children in your household, it is important that you complete this survey so that every type of household in America is represented. Your household was randomly selected as part of this voluntary study, and we cannot replace your household with another one. It usually takes less than 5 minutes if there is no one in your household 0 – 17 years old, and no longer than 30 minutes to answer the questions for households with children.


The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your responses in a way that could identify this household. The U.S. Census Bureau is conducting this survey under the authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.


This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number 0607-0990 confirms this approval and appears in the bottom left corner of the survey web page or in the upper right corner of the paper questionnaire. If this number were not displayed we could not conduct this survey.


We greatly appreciate your help with this study, and have enclosed a small token of appreciation for your participation. The results of this study will help educators, researchers, policymakers, child advocates, and the general public better understand and respond to the health care needs of children and families.




Web follow-up - pressure sealed postcard

Dear Resident:


Recently we mailed you a letter inviting you to participate in the National Survey of Children’s Health, an important national study administered by the U.S. Census Bureau on behalf of the U.S. Department of Health and Human Services. If someone in your household has already completed the survey, we thank you very much for your help.


If you have not completed your survey, please do so right away.


Filling out this survey online is easy:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey



If you are having difficulty completing this survey online, need assistance, or have questions, please call toll-free at 1–800–845–8241 or email us at: [email protected]

Mixed-mode follow-up - pressure sealed postcard

Dear Resident:


Recently we mailed you a letter inviting you to participate in the National Survey of Children’s Health, an important national study administered by the U.S. Census Bureau on behalf of the U.S. Department of Health and Human Services. If someone in your household has already completed the survey, we thank you very much for your help.


If you have not completed your survey online or filled out the paper questionnaire and mailed it back in the postage-paid envelope provided, please do so right away.


Filling out this survey online is easy:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey



If you are having difficulty completing this survey online, misplaced your paper questionnaire, need assistance, or have questions, please call toll-free at 1–800–845–8241 or email us at: [email protected]

Web follow-up letter


Dear Resident:


Recently we requested your participation in the National Survey of Children’s Health (NSCH). If you have completed the NSCH prior to receiving this mailing, please accept our thanks. This survey provides important information used to improve the health of children and families throughout the United States.


Filling out this survey online is easy:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey


Even if you have no infants or children in your household, it is important that you complete this survey so that every type of household in America is represented It usually takes less than 5 minutes if there is no one in your household 0 – 17 years old, and no longer than 30 minutes to answer the questions for households with children.


We ask for your help in this study because your response is essential. The information gathered in this survey is critical to understanding children’s health care needs, both in your state and across the country. Your household was scientifically selected from all of the households in the country, and your response represents thousands of households like yours. By law, the Census Bureau can only use your responses for statistical research and they will not be disclosed or used in any way that identifies you or members of your household.


If you would prefer a paper version of the survey, need assistance or have questions, please call toll-free at 1–800–845–8241 or email us at: [email protected]


Thank you again for your consideration of this request for help. This study depends on your response. We

hope to hear from you soon.



Paper screener follow-up letter


Dear Resident:


Recently we requested your participation in the National Survey of Children’s Health (NSCH). If you have completed the NSCH prior to receiving this mailing, please accept our thanks. The enclosed survey is the first step in a study that provides important information used to improve the health of children and families throughout the United States.


Please fill out this survey and mail it back in the postage-paid envelope provided. The questionnaire will

help us find households with children. This information is used later to ask those households

about health issues that may affect these children.


The ability to complete this survey online is also still available:


1. Type the following web address in your internet browser: https://respond.census.gov/nsch


2. Enter the following information on the opening screen:

Login ID: #### - ####


3. Click “Sign In” to begin the survey


Even if you have no infants or children in your household, it is important that you complete this survey so that every type of household in America is represented It usually takes less than 5 minutes if there is no one in your household 0 – 17 years old, and no longer than 30 minutes to answer the questions for households with children.


We ask for your help in this study because your response is essential. The information gathered in this survey is critical to understanding children’s health care needs, both in your state and across the country. Your household was scientifically selected from all of the households in the country, and your response represents thousands of households like yours. By law, the Census Bureau can only use your responses for statistical research and they will not be disclosed or used in any way that identifies you or members of your household.


If you need assistance or have questions, please call toll-free at 1–800–845–8241 or email us at: [email protected]


Thank you again for your consideration of this request for help. This study depends on your response. We

hope to hear from you soon.




Paper Topical letter

Dear Resident:

A few weeks ago you responded to my request to help with the National Survey of Children’s Health. We greatly appreciate your participation and the participation of thousands of other parents and caregivers from every state who have made the first step of this effort a success.


The second, and final step is to complete a more detailed survey about the child who is a member of your household.


This voluntary survey will collect more detailed information on the child’s health status, visits to health care providers, health care costs, and health insurance coverage. The questionnaire should be filled out by an adult who is familiar with this child’s health and health care. For most households, it should take less than 30 minutes to complete.


The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your responses in a way that could identify you, this child or this household. The U.S. Census Bureau is conducting this survey under the authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.


This collection has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number 0607-0990 confirms this approval and appears in the upper right corner of the paper questionnaire. If this number were not displayed we could not conduct this survey.

Your participation provides critical information on the health and health care needs of children in your state and ensures that households like yours are fairly represented.


If you have any questions about the study or need a replacement questionnaire, please call toll-free at 1–800–845–8241 or email us at: [email protected]



Thank you once again for your help.




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AuthorElizabeth Sinclair
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