National Survey of Children's Health

Appendix F – 2019 NSCH Screener Card Test Sample Letters

National Survey of Children's Health

OMB: 0607-0990

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0607-0990 can be found here:

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Appendix F: Screener Card Test Sample Letter

NSCH11 Screener Experiment

Dear Resident,
Your address has been selected to participate in the National Survey of Children’s Health (NSCH). This survey collects
information that is used to improve the health of children and families throughout the United States. The U.S. Census
Bureau conducts this survey on behalf of the U.S. Department of Health and Human Services. The success of this
survey depends on your participation. The results will help our nation better understand and respond to the health
care needs of children and families.
If you have children age 0-17 in your household:

Responding to this survey is easy:
1. Go to: https://respond.census.gov/nsch
2. Enter your Login ID: 18976543
If you are unable to complete the survey online:
Answer the question at the bottom, detach the form and
return it in the postage-paid envelope.

If no children age 0-17 are in your household:

Let us know. Answer the question at the bottom, detach
the form, and return it in the postage-paid envelope.

Your household was randomly selected as part of this voluntary survey. We cannot replace your household with another
one. The survey takes less than 5 minutes if there are no children in your household, and on average 33 minutes for
households with children. If you need assistance or have questions, please call 1–800–845–8241 or email us at:
[email protected].
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your
responses in a way that could identify your household. The U.S. Census Bureau is conducting this survey under the
authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701).
Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the
systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number
0607-0990 appears in the bottom left corner of the survey web page. If this number were not displayed we could not
conduct this survey.
Thank you for your help.

(NAME HERE)
Director of the U.S. Census Bureau

Please detach the form below on the perforated line and return it in the postage-paid envelope
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

How many children 0-17 years old usually live or stay at this address?

Mailing Instructions:

4 or more

Thank you. Place this card in the postage-paid envelope provided.
If the envelope has been misplaced, please mail this card to:
U.S. Census Bureau
ATTN: DCB 60-A
1201 E. 10th Street
Jeffersonville, IN 47132-0001
You may also call 1-800-845-8241 to request a replacement envelope.

Public reporting burden for this collection of information is estimated to average 1 minute per response. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990,
U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to
[email protected]; use "Paperwork Project 0607-0990" as the subject.
OMB No. 0607-0990: Approval Expires 05/31/2019

NSCH11wa – Treatment C (NSCH11wa Adapted Version 2) – English

Dear resident,
Your address has been selected to participate in the National Survey of Children’s Health (NSCH). This survey collects
information that is used to improve the health of children and families throughout the United States. The U.S. Census
Bureau conducts this survey on behalf of the U.S. Department of Health and Human Services.
Responding to this survey online is easy:
1. Go to: https://respond.census.gov/nsch
2. Enter your Login ID:

If there are no children age 0 to 17 in your household, we still want to hear from you. If you do not respond online we will
contact you again to provide another way to respond.
We are conducting this survey online to help us reduce costs and report results quickly. If you need assistance, or have
questions, please call 1–800–845–8241 or email us at: [email protected].
Your household was randomly selected as part of this voluntary survey. We cannot replace your household with another
one. The survey takes less than 5 minutes if there are no children in your household, and on average 33 minutes for
households with children.
The U.S. Census Bureau is required by law to protect your information. We are not permitted to publicly release your
responses in a way that could identify your household. The U.S. Census Bureau is conducting this survey under the
authority of Title 13, United States Code, Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701).
Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Per the Federal
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the
systems that transmit your data.
This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number
0607-0990 appears in the bottom left corner of the survey web page. If this number were not displayed we could not
conduct this survey.
The success of this survey depends on your participation. The results will help our nation better understand and
respond to the health care needs of children and families.

Thank you for your help.

(NAME HERE)
Director of the U.S. Census Bureau

NSCH12_Screener Experiment

Dear Resident,
Recently we requested your participation in the National Survey of Children’s Health (NSCH). If you have
completed the NSCH prior to receiving this mailing, please accept our thanks. If you have not yet responded, we
encourage you to complete the survey. This survey collects important information used to improve the health of
children and families throughout the United States. Your response is vital to the success of this survey. We
hope to hear from you soon.
If you have children age 0-17 in your household:

If no children age 0-17 are in your household:

Let us know. Answer the question at the bottom, detach
the form, and return it in the postage-paid envelope.

If you need assistance or have questions, please call 1–800–845–8241 or email us at: [email protected]. The
survey takes less than 5 minutes if there are no children in your household, and on average 33 minutes for households
with children.
The information gathered in this survey is critical to understanding children’s health care needs, both in your state and
across the country. Your household was scientifically selected from all of the households in the country and your response
represents thousands of other households. The U.S. Census Bureau is not permitted to publicly release your responses in
a way that could identify your household. By law, the Census Bureau can only use your responses for statistical research.
Thank you for your participation.

(NAME HERE)
Director of the U.S. Census Bureau

How many children 0-17 years old usually live or stay at this address?

Mailing Instructions:

4 or more

NSCH_pcw and NSCH_pc2

NSCH_pcw
Dear Resident:
Recently we mailed you a letter requesting your participation in the National Survey of Children’s Health. If
you have already responded to the survey, please accept our sincere thanks. If you have not yet completed your
survey, please do so right away.
Responding to this survey is easy:

1. Go to: https://respond.census.gov/nsch
2. Enter your Login ID:
If you need assistance, or have questions, please call 1–800–845–8241 or email us at
[email protected].
Thank you for your help.

Dr. Steven D. Dillingham
Director of the U.S. Census Bureau

NSCH_pc2
Dear Resident:
We’ve attempted to reach you to ask for your help with the National Survey of Children’s Health. Your
response will help us better understand the health care needs of children in the United States.
If you have already responded to the survey, please accept our sincere thanks. If you have not yet completed the
survey, please do so right away.
Responding to this survey is easy:
1. Go to: https://respond.census.gov/nsch
2. Enter your Login ID:

If you have questions, please call 1–800–845–8241 or email us at [email protected].
Thank you for your help.

Dr. Steven D. Dillingham
Director of the U.S. Census Bureau

File Type	application/pdf
Author	M Christopher Stringer (CENSUS/DSMD FED)
File Modified	2019-02-26
File Created	2019-02-26