Household Interview

National Health and Nutrition Examination Survey

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Household Interview Form
Household Interview Att_3d_HH SP Family Instruments 10_23_18.docx Form
Att_3e_HH SP Family_Hand Cards 081718.docx Household Interview Hand Cards IC Document

Information Collection (IC) Details

IC Title:	Household Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Household Interview	Att_3d_HH SP Family Instruments 10_23_18.docx		Yes	Yes	Fillable Fileable

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: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,000	-9,410	14,410
Annual IC Time Burden (Hours)	7,500	-28,525	36,025
Annual IC Cost Burden (Dollars)	178,950	178,950	0

Documents for IC

Title	Document	Date Uploaded
Household Interview Hand Cards	Att_3e_HH SP Family_Hand Cards 081718.docx	09/13/2018

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