Appendix F-2019 Nsch Screener Card Letters

Appendix F – 2019 NSCH Screener Card Test Letters_FINAL.pdf

National Survey of Children's Health

APPENDIX F-2019 NSCH SCREENER CARD LETTERS

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⚠️ Notice: This form may be outdated.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

Dear (insert City) 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 your state 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:
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 Census Bureau is conducting this
survey under the authority of Title 13, United States Code (U.S.C.), 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 and in the bottom
right corner of this page. If this number were not displayed, we could not conduct this survey.
Thank you for your help.

Steven D. Dillingham
Director
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?
0

4 or more

Mailing Instructions: 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.

NSCH-11W(SC)

OMB No. 0607-0990: Approval Expires XX/XX/XXXX

NSCH-11W(SC2) – Web Push Screener
Card Test - Screener card forthcoming
(Group C) – REVISED 4/2/2019

Responding to this survey is easy:

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 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 Census Bureau is conducting this survey
under the authority of Title 13, United States Code (U.S.C.), 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.

Steven D. Dillingham
Director

NSCH-11W(NSC) – Web Push Screener Card
Test Group Letter, No Mention of Screener
Card (Group D) – ADDED 4/2/19

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 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 Census Bureau is conducting this survey
under the authority of Title 13, United States Code (U.S.C.), 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.

Steven D. Dillingham
Director

NSCH-PCWS – Screener Card Test Pressure Sealed Reminder Postcard, No mention of screener card (Group
B)– REVISED 4/2/2019

Dear (insert City) 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.

Steven D. Dillingham
Director

NSCH-12W(SC) – Web Push Screener
Card Letter with Perforated Screener
Card (Group C) – REVISED 4/2/19
Dear (insert City) 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 in your state and across the United States. Your response
is important 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.

Steven D. Dillingham
Director
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?

4 or more

NSCH-12W(SC)

OMB No. 0607-0990: Approval Expires XX/XX/XXXX

NSCH-PCS – Screener Card Test Pressure
Sealed Reminder Postcard, Screener Card
Forthcoming (Group D) – ADDED 4/2/2019

If you do not respond online, we will contact you again to provide another way to respond. If you
need assistance, or have questions, please call 1–800–845–8241 or email us at
[email protected].
Thank you for your help.

Steven D. Dillingham
Director

NSCH-13W(SC) – Web Push Screener
Card Letter with Perforated Screener
Card (Groups B, C, D) – ADDED 4/2/19
Dear (insert City) Resident:
Recently we requested your participation in the National Survey of Children’s Health (NSCH). If you have
already responded, please accept our sincere thanks. If you have not yet responded, please do so right
away. The information gathered in this survey is critical to understanding children’s health care needs in
your state and across the country. The success of this survey depends upon your participation. 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.
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.

Steven D. Dillingham
Director

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?

4 or more

OMB No. 0607-0990: Approval Expires XX/XX/XX

NSCH-PCS2 – Screener Card Test Pressured Sealed Final Postcard (Groups B, C and D) – REVISED 4/2/19
Dear (insert City) 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 your state and across the country.
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.

Steven D. Dillingham
Director

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