Form 0920-0278 2019-2020 Re-Interview Study

Form Approved

OMB No. 0920-0278

Exp. Date 06/30/2021

Attachment C: 2019 NHAMCS Reinterview Study List of All Proposed Questions

Notice– Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0278).

Assurance of confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note). This law requires the federal government to protect federal computer networks by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security weaknesses. If information sent through government networks triggers a cyber threat indicator, the information may be intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the government.

These are the seven proposed 2019 Reinterview Study questions Census will develop based on NHAMCS interviewing needs.

1. Verifies correct contact person.

2. Did an interviewer visit or call regarding (name of sampled facility)?

3. Did the interviewer conduct the interview in person or over the telephone?

4. Was the interviewer polite and professional?  If no, please provide comments.

5. Did the interviewer use a laptop computer? 

6. Our records show that on X date, the sampled address was vacant.  Is this correct?

7. The interviewer is asked two questions.

   1. Was the original outcome correct?

   2. Do you suspect falsification?

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