Re-Designed Adult Questionnaire

Changes to 2020 National Health Interview Survey in light of Novel Coronavirus (2019-nCoV)

OMB: 0920-0214

IC ID: 229171

Documents and Forms
Information Collection (IC) Details

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Re-Designed Adult Questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0214 Redesigned Adult Questionnaire Att 2 AdultQuestionnaire Word 120819.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population  49 FR 37693

27,000 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 27,000 0 0 0 0 27,000
Annual IC Time Burden (Hours) 22,050 0 0 0 0 22,050
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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