Information Collection

NHIS Follow-up Health Study

IC 246088 under ICR 202003-0920-001 · OMB 0920-1208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1208 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1208 NHIS Follow-up Health Study	Form and Instruction
Attachment 1e - Appointment Scheduling and Reminders.docx	Instruction
0920-1208 NHIS Follow-up Health Study Invitation to Participate Qu Attachment 1c - Invitation questions and help screen.docx	Form and Instruction
0920-1208 Home Health Visit Data Collection Forms Attachment 1i - Main Data Collection Forms.docx	Form and Instruction
Attachment 1a - Response to Exams After Surveys_clean.docx Response to exams after surveys	IC Document
Attachment 1b - COVID Safety Precautions.docx COVID-19 Safety Precautions	IC Document
Attachment 1d - Respondent brochure.docx Respondent Brochure	IC Document
Attachment 1f - Respondent conversion letter and brochure.docx Respondent conversion letter and brochure	IC Document
Attachment 1g - MeasuresLabTestHandoutCOVIDHandout.docx Health Measurements and Laboratory Tests on Blood & Urine	IC Document
Attachment 1h - Consent Form.docx HOME VISIT CONSENT	IC Document
Attachment 1j - Initial Report.docx Home Health Visit Data Collection Forms	IC Document
Attachment 1k- Final Report.docx Final Report of Findings	IC Document
Attachment 2 - NCHS Ethics Review Board (ERB) Approval .docx NCHS Ethics Review Board (ERB) Approval	IC Document
NHIS FHS Supporting Statement A_Feb26.docx National Health Interview Survey (NHIS) Follow-up Health Study	IC Document
NHIS FHS Supporting Statement B_Feb26.docx National Health Interview Survey (NHIS) Follow-up Health Study	IC Document

IC Title:

NHIS Follow-up Health Study

Agency IC Tracking Number:

0920-1208-21DP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	0920-1208	NHIS Follow-up Health Study Invitation to Participate Questions	Attachment 1c - Invitation questions and help screen.docx	No	Fillable Fileable
Instruction			Attachment 1e - Appointment Scheduling and Reminders.docx	No	Fillable Fileable
Form and Instruction	0920-1208	Home Health Visit Data Collection Forms	Attachment 1i - Main Data Collection Forms.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	1,170	1,170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Response to exams after surveys	Attachment 1a - Response to Exams After Surveys_clean.docx	03/03/2021
COVID-19 Safety Precautions	Attachment 1b - COVID Safety Precautions.docx	03/03/2021
Respondent Brochure	Attachment 1d - Respondent brochure.docx	03/03/2021
Respondent conversion letter and brochure	Attachment 1f - Respondent conversion letter and brochure.docx	03/03/2021
Health Measurements and Laboratory Tests on Blood & Urine	Attachment 1g - MeasuresLabTestHandoutCOVIDHandout.docx	03/03/2021
HOME VISIT CONSENT	Attachment 1h - Consent Form.docx	03/03/2021
Home Health Visit Data Collection Forms	Attachment 1j - Initial Report.docx	03/03/2021
Final Report of Findings	Attachment 1k- Final Report.docx	03/03/2021
NCHS Ethics Review Board (ERB) Approval	Attachment 2 - NCHS Ethics Review Board (ERB) Approval .docx	03/03/2021
National Health Interview Survey (NHIS) Follow-up Health Study	NHIS FHS Supporting Statement A_Feb26.docx	03/03/2021
National Health Interview Survey (NHIS) Follow-up Health Study	NHIS FHS Supporting Statement B_Feb26.docx	03/03/2021

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