Information Collection

NHANES Questionnaire

IC 213574 under ICR 201802-0920-009 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0950 NHANES Questionnaire and Data Collection Forms 2017-18 NHANES Questionnaire	Form
0920-0950 NHANES Questionnaire and Data Collection Forms 2017-18 Att_3b_Questionnaires 101816.docx	Form
Att_3a_Question Changes100516.docx Att 3a_Summary of 2017-18 Questionnaire Changes	IC Document
Att_3c _Questionnaire 15-16 101816.docx Att 3c_Questionnaire & Data Collections FOrms 2015-16	IC Document
Att_3d HH_Hand Cards 15-16.docx Att 3d_Hand Cards 2015-16	IC Document
Att_8 _Letters_scripts 17-18 100516.docx Att 8 Letters_scripts	IC Document
Att_9a_Consents_17-18 100516.docx Att 9a_Consent Forms	IC Document
ATT_9b_Adult Consent Brochure 100516.pdf Att 9b_Adult Consent Brochure	IC Document
Att_9c_Child_Assent_17-18 062818.docx Att 9c_ Child Assent Brochure	IC Document
Att_9d_Consents FAQ_17-18 101816.docx Att 9d_Consents FAQ	IC Document

IC Title:

NHANES Questionnaire

Agency IC Tracking Number:

0920-0950

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0950				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 14,410

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14,410	14,410
Annual IC Time Burden (Hours)	36,025	36,025
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3a_Summary of 2017-18 Questionnaire Changes		11/01/2016
Att 3c_Questionnaire & Data Collections FOrms 2015-16		11/01/2016
Att 3d_Hand Cards 2015-16		11/01/2016
Att 8 Letters_scripts		11/01/2016
Att 9a_Consent Forms		11/01/2016
Att 9b_Adult Consent Brochure		11/01/2016
Att 9c_ Child Assent Brochure		11/01/2016
Att 9d_Consents FAQ		11/01/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].