Information Collection Request

National Health Interview Survey

ICR 201711-0920-013 · OMB 0920-0214 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0214 Re-Designed Re-Interview Questionnaire Form and Instruction New Available
Form 0920-0214 Main Re-Interview Questionnaire Form and Instruction New Repair queued
Form 0920-0214 Methodological Projects Form and Instruction New Available
Form 0920-0214 Re-Designed Child Section Questionnaire Form and Instruction New Available
Form 0920-0214 Re-Designed Adult Section Questionnaire Form and Instruction New Available
Form 0920-0214 Re-Designed Houshold Roster Section Questionnaire Form and Instruction New Available
Form 0920-0214 Main Supplement Questionnaire Form and Instruction New Available
Form 0920-0214 Main Child Section Questionnaire Form and Instruction New Available
Form 0920-0214 Main Adult Section Questionnaire Form and Instruction New Available
Form 0920-0214 Main Household Composition and Family Section Questionnaire Form and Instruction New Available
2017 Reinterview Questionnaire Form and Instruction Removed Available
2017 New Supplement Questions Form and Instruction Removed Available
2017 Sample Child Questionnaire Form and Instruction Removed Available
2017 Sample Adult Questionnaire Form and Instruction Removed Available
2017 Family Questionnaire with LOI Form and Instruction Removed Available
Att 12 Listing of Proposed Items for 2019 and 2020.docx Supplementary Document Uploaded 2017-12-27 Available
Att 11 - ERB Approval Notice.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 10d - Thank you letter.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 10c - Sup Mailings.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 10b - NHIS Brochure.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 10a - Advance Letter.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 9 - Redesign Consultations.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 8 - Data Collection Proc.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 4f - Main Q Flashcards.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 4e REV - Main Q Sup Descr.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 3d - Need Core Mod Redesigned Q.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 3c - Need Core Mod Main Q.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 3b - Main and Redes Ques Struc.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 3a - Redes Q Modules and Peri.pdf Supplementary Document Uploaded 2017-11-28 Available
Att 2b Public Comments.docx Supplementary Document Uploaded 2017-11-28 Available
Att 2a - 60 Day FRN 102417.pdf Supplementary Document Uploaded 2017-11-28 Available
2018 NHIS SSB 122717.doc Supporting Statement B Uploaded 2017-12-27 Available
2018 NHIS SSA 122717.docx Supporting Statement A Uploaded 2017-12-27 Available
Att 1 - Legislative Mandates.pdf Supplementary Document Uploaded 2016-11-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229175 Re-Designed Re-Interview Survey Form and Instruction NewRe-Designed Re-Interview Questionnaire
229174 Main Re-Interview Survey Form and Instruction NewMain Re-Interview Questionnaire
229173 Methodological Projects Form and Instruction NewMethodological Projects
229172 Re-Designed Child Questionnaire Form and Instruction NewRe-Designed Child Section Questionnaire
229171 Re-Designed Adult Questionnaire Form and Instruction NewRe-Designed Adult Section Questionnaire
229170 Re-Designed Household Roster Form and Instruction NewRe-Designed Houshold Roster Section Questionnaire
229169 Main Supplements Form and Instruction NewMain Supplement Questionnaire
229168 Main Child Core Form and Instruction NewMain Child Section Questionnaire
229167 Main Adult Core Form and Instruction NewMain Adult Section Questionnaire
229166 Main Household Composition and Family Core Form and Instruction NewMain Household Composition and Family Section Questionnaire
214142 Methodological Projects - Adult Family Member Other-Overview Description of Methodological and Testing Activit Removed
214116 Reinterview Survey Form and Instruction Removed2017 Reinterview Questionnaire
214115 New Supplements and Core Changes Form and Instruction Removed2017 New Supplement Questions
214114 Sample Child Core Questionnaire Form and Instruction Removed2017 Sample Child Questionnaire
214113 Sample Adult Core Questionnaire Form and Instruction Removed2017 Sample Adult Questionnaire
214112 Family Core Questionnaire Form and Instruction Removed2017 Family Questionnaire with LOI

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2020 36 Months From Approved 12/31/2019
154,375 0 160,000
47,735 0 49,000
0 0 0






Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
Family Core Questionnaire N/A
Main Adult Core 0920-0214
Main Child Core 0920-0214
Main Household Composition and Family Core 0920-0214
Main Re-Interview Survey 0920-0214
Main Supplements 0920-0214
Methodological Projects 0920-0214
Methodological Projects - Adult Family Member
New Supplements and Core Changes N/A
Re-Designed Adult Questionnaire 0920-0214
Re-Designed Child Questionnaire 0920-0214
Re-Designed Household Roster 0920-0214
Re-Designed Re-Interview Survey 0920-0214
Reinterview Survey N/A
Sample Adult Core Questionnaire N/A
Sample Child Core Questionnaire N/A

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 154,375 160,000 0 -5,625 0 0
Annual Time Burden (Hours) 47,735 49,000 0 -1,265 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No