National Health Interview Survey

Forms and Documents

Document Name	Status
Form 0920-0214 Re-Designed Re-Interview Survey Form and Instruction	Modified
Form 0920-0214 Main Re-Interview Survey Form and Instruction	Removed
Form 0920-0214 Methodological Projects Form and Instruction	Unchanged
Form 0920-0214 Re-Designed Child Questionnaire Form and Instruction	Modified
Form 0920-0214 Re-Designed Adult Questionnaire Form and Instruction	Modified
Form 0920-0214 Re-Designed Household Roster Form and Instruction	Modified
Form 0920-0214 Main Supplements Form and Instruction	Removed
Form 0920-0214 Main Child Core Form and Instruction	Removed
Main Adult Core Form and Instruction	Removed
Form 0920-0214 Main Household Composition and Family Core Form and Instruction	Removed
NHIS Nonsubstantive Change Request 2020 clean_120919PM.docx Justification for No Material/Nonsubstantive Change	2019-12-11
Att 4_AdvanceLetterRevised.pdf Supplementary Document	2019-12-11
Att 1 Changes to the rotating core and sponsored content.docx Supplementary Document	2019-12-11
Att 4 - Adv Letter 071618.pdf Supplementary Document	2018-07-23
Att 1 Proposed changes.docx Supplementary Document	2018-07-23
NHIS Nonsubstantive Change Request 071618.docx Justification for No Material/Nonsubstantive Change	2018-07-23
Att 12 Listing of Proposed Items for 2019 and 2020.docx Supplementary Document	2017-12-27
Att 11 - ERB Approval Notice.pdf Supplementary Document	2017-11-28
Att 10d - Thank you letter.pdf Supplementary Document	2017-11-28
Att 10c - Sup Mailings.pdf Supplementary Document	2017-11-28
Att 10b - NHIS Brochure.pdf Supplementary Document	2017-11-28
Att 9 - Redesign Consultations.pdf Supplementary Document	2017-11-28
Att 8 - Data Collection Proc.pdf Supplementary Document	2017-11-28
Att 4f - Main Q Flashcards.pdf Supplementary Document	2017-11-28
Att 4e REV - Main Q Sup Descr.pdf Supplementary Document	2017-11-28
Att 3d - Need Core Mod Redesigned Q.pdf Supplementary Document	2017-11-28
Att 3c - Need Core Mod Main Q.pdf Supplementary Document	2017-11-28
Att 3b - Main and Redes Ques Struc.pdf Supplementary Document	2017-11-28
Att 3a - Redes Q Modules and Peri.pdf Supplementary Document	2017-11-28
Att 2b Public Comments.docx Supplementary Document	2017-11-28
Att 2a - 60 Day FRN 102417.pdf Supplementary Document	2017-11-28
2018 NHIS SSB 122717.doc Supporting Statement B	2017-12-27
2018 NHIS SSA 122717.docx Supporting Statement A	2017-12-27
Att 1 - Legislative Mandates.pdf Supplementary Document	2016-11-30

IC Document Collections

IC ID	Document Title	Status
229175	Re-Designed Re-Interview Survey Form and Instruction	Modified
229174	Main Re-Interview Survey Form and Instruction	Removed
229173	Methodological Projects Form and Instruction	Unchanged
229172	Re-Designed Child Questionnaire Form and Instruction	Modified
229171	Re-Designed Adult Questionnaire Form and Instruction	Modified
229170	Re-Designed Household Roster Form and Instruction	Modified
229169	Main Supplements Form and Instruction	Removed
229168	Main Child Core Form and Instruction	Removed
229167	Main Adult Core Form and Instruction	Removed
229166	Main Household Composition and Family Core Form and Instruction	Removed

ICR Details

OMB Control No: 0920-0214	ICR Reference No: 201912-0920-009
Status: Historical Active	Previous ICR Reference No: 201807-0920-009
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 with change	Conclusion Date: 12/17/2019
	Date Received in OIRA: 12/11/2019
Terms of Clearance: Approved consistent with NCHS's commitment to develop guidelines for sponsored content, including the impact on the total length of the NHIS and the criteria to be used to determine if the sponsored content is appropriate for the NHIS. Non-substantive change mechanism may be used to modify existing questions and add depth/additional detail to existing questions. Requests to add questions, including cycling modules in or out, must be consistent with the principles of the recent redesign.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	12/31/2020	12/31/2020
Responses	88,450	0	154,375
Time Burden (Hours)	34,371	0	47,960
Cost Burden (Dollars)	0	0	0

---

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 healthcare 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 are repeated annually. 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 add and delete questions from both the rotating core and sponsored content. Meanwhile, the previous nonsubstantive change allowed for both the ongoing main survey and a bridge sample that was introduced to test the redesigned questions. Now that the redesigned questions have been tested, there is no need to maintain both sets of questionnaires. Consequently, the previous four main core instruments and the related reinterview survey will be discontinued for 2020 and the previously split sample will be consolidated into the redesigned instruments. Overall, the changes proposed herein decrease the overall previously approved burden hours from 47,960 to 33,921.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

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

---

Number of Information Collection (IC) in this ICR: 5

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

---

ICR Summary 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	88,450	154,375	0	-65,925	0	0
Annual Time Burden (Hours)	34,371	47,960	0	-13,589	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The changes proposed herein decrease the overall previously approved burden hours from 47,960 to 34,371.

---

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

---

Common Form ICR:  No

---

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: 12/11/2019

---