National Health and Nutrition Examination Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Forms for the Balance Vestibular Visual Function Pilot Study	Form and Instruction	Modified	Repair queued
Form 0920-0950 Flexible Consumer Behavior Survey (FCBS)	Form	Unchanged	Available
Form 0920-0950 NHANES Questionnaire and Data Collection Forms 2017-18	Form	Unchanged	Available
Justification - Developmental Projects 083117.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-08-31	Available
Att_5a_Lab_17-18_101816.docx	Supplementary Document	Uploaded 2016-11-01	Available
Att_6_ERB Approval 120415.rtf	Supplementary Document	Uploaded 2015-12-07	Available
Sup_Stat_B_101416.docx	Supporting Statement B	Uploaded 2016-11-01	Available
Sup_Stat_A_101416.docx	Supporting Statement A	Uploaded 2016-11-01	Available
Att_11_PM_flyer_15-16 100114.doc	Supplementary Document	Uploaded 2015-12-03	Available
Att_5b_labs_15-16 062816.docx	Supplementary Document	Uploaded 2016-11-01	Available
Att_7_labs_15-16 112315.docx	Supplementary Document	Uploaded 2015-12-03	Available
Att_2a_0920-0950 60-day 062816.pdf	Supplementary Document	Uploaded 2016-11-01	Available
Att_1_17-18_Laws 062816.docx	Supplementary Document	Uploaded 2016-11-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219202	Developmental Projects and Special Studies	Form and Instruction	Modified	Forms for the Balance Vestibular Visual Function Pilot Study
219202	Developmental Projects and Special Studies	Instruction	Modified
218880	Wearable Device Projects	Instruction	Unchanged
218879	Flexible Consumer Behavior Survey Phone Follow-up	Form	Unchanged	Flexible Consumer Behavior Survey (FCBS)
218879	Flexible Consumer Behavior Survey Phone Follow-up	Instruction	Unchanged
218863	Blood Pressure Methodology Phase 2	Instruction	Unchanged
213575	Blood Pressure Methodology Study Phase 1	Instruction	Unchanged
213574	NHANES Questionnaire	Form	Unchanged	NHANES Questionnaire and Data Collection Forms 2017-18

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 201708-0920-022
Status: Historical Active	Previous ICR Reference No: 201611-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17BAJ
Title: National Health and Nutrition Examination Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/08/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/01/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	12/31/2019	12/31/2019
Responses	27,514	0	27,514
Time Burden (Hours)	79,894	0	79,894
Cost Burden (Dollars)	0	0	0

---

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. Information is also provided for developmental studies.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

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

---

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

table that charts list of burden

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

---

ICR Summary of Burden

table that charts list 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	27,514	0	0	0	0
Annual Time Burden (Hours)	79,894	79,894	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

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

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

---

Common Form ICR:  No

---

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: 09/01/2017

---