National Health Interview Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0214 Re-Designed Re-Interview Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-0214 Main Re-Interview Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-0214 Methodological Projects	Form and Instruction	Unchanged	Available
Form 0920-0214 Re-Designed Child Section Questionnaire	Form and Instruction	Unchanged	Available
Redesigned Adult Questionnaire	Form and Instruction	Modified	Available
Form 0920-0214 Re-Designed Houshold Roster Section Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-0214 Main Supplement Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-0214 Main Child Section Questionnaire	Form and Instruction	Unchanged	Available
Main Adult Core Questionnaire	Form and Instruction	Modified	Available
Form 0920-0214 Main Household Composition and Family Section Questionnaire	Form and Instruction	Unchanged	Available
Att 4 - Adv Letter 071618.pdf	Supplementary Document	Uploaded 2018-07-23	Available
Att 1 Proposed changes.docx	Supplementary Document	Uploaded 2018-07-23	Available
NHIS Nonsubstantive Change Request 071618.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-07-23	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 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 ID	Collection	Type	Status	Form
229175	Re-Designed Re-Interview Survey	Form and Instruction	Unchanged	Re-Designed Re-Interview Questionnaire
229174	Main Re-Interview Survey	Form and Instruction	Unchanged	Main Re-Interview Questionnaire
229173	Methodological Projects	Form and Instruction	Unchanged	Methodological Projects
229172	Re-Designed Child Questionnaire	Form and Instruction	Unchanged	Re-Designed Child Section Questionnaire
229171	Re-Designed Adult Questionnaire	Form and Instruction	Modified	Redesigned Adult Questionnaire
229170	Re-Designed Household Roster	Form and Instruction	Unchanged	Re-Designed Houshold Roster Section Questionnaire
229169	Main Supplements	Form and Instruction	Unchanged	Main Supplement Questionnaire
229168	Main Child Core	Form and Instruction	Unchanged	Main Child Section Questionnaire
229167	Main Adult Core	Form and Instruction	Modified	Main Adult Core Questionnaire
229166	Main Household Composition and Family Core	Form and Instruction	Unchanged	Main Household Composition and Family Section Questionnaire

ICR Details

OMB Control No: 0920-0214	ICR Reference No: 201807-0920-009
Status: Historical Active	Previous ICR Reference No: 201711-0920-013
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0214
Title: National Health Interview 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: 08/03/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/23/2018
Terms of Clearance: Previous terms continue. NCHS may continue to use the non-substantive change mechanism to modify existing questions, including those designed to add depth/additional detail and cycle in and out methodological modules that have been used in the past years (with modest updates). If new supplemental modules, new questionnaire instruments, or modifications to the sample are anticipated, a full revision of the ICR package must be submitted to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	12/31/2020	12/31/2020
Responses	154,375	0	154,375
Time Burden (Hours)	47,960	0	47,735
Cost Burden (Dollars)	0	0	0

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Abstract: The NHIS, conducted by the National Center for Health Statistics (NCHS) since 1957, collects, on an annual basis, nationally representative data on the amount, distribution, and effects of illness and disability in the population and on the utilization of health care services for such conditions. NHIS data are used widely throughout the Department of Health and Human Services (DHHS) to monitor trends in illness and disability and to track progress toward achieving many of the health objectives for the nation. The data are also used by the public health research community for epidemiologic and policy analysis of such issues as characterizing those with various health problems, measuring levels of health insurance coverage, determining barriers to accessing and using health care, and evaluating the impact of changes in federal health programs. The current design of the NHIS questionnaire was implemented in 1997, and consists of a standard basic or Core Module, covering general health topics and demographic characteristics that is repeated every year. In addition to the Core Module, each year supplementary questions or modules are included. Topics are rotated in and out of the annual NHIS depending on funding availability and data requirements of federal programs such as Healthy People 2020. This request seeks changes to the October 2018 field test, adding questions to 2 forms, that will increase burden by 3 minutes. The advance letter has been streamlined.

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Authorizing Statute(s): PL: Pub.L. 107 - 347 511 Name of Law: Confidential Information Protection and Statistical Efficiency Act
   US Code: 42 USC 242 Name of Law: Public Health Service Act
  

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:
	82 FR 39586	08/21/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 56604	11/29/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Main Adult Core	none	Main Adult Core Questionnaire
Main Child Core	0920-0214	Main Child Section Questionnaire
Main Household Composition and Family Core	0920-0214	Main Household Composition and Family Section Questionnaire
Main Re-Interview Survey	0920-0214	Main Re-Interview Questionnaire
Main Supplements	0920-0214	Main Supplement Questionnaire
Methodological Projects	0920-0214	Methodological Projects
Re-Designed Adult Questionnaire	none	Redesigned Adult Questionnaire
Re-Designed Child Questionnaire	0920-0214	Re-Designed Child Section Questionnaire
Re-Designed Household Roster	0920-0214	Re-Designed Houshold Roster Section Questionnaire
Re-Designed Re-Interview Survey	0920-0214	Re-Designed Re-Interview Questionnaire

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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	154,375	154,375	0	0	0	0
Annual Time Burden (Hours)	47,960	47,735	0	225	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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 request for change includes adding questions to two forms with a slight increase in burden, and streamlining the advance letter.

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Annual Cost to Federal Government: $42,000,000

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]? Yes

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: 07/23/2018

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