Adult Questionnaire

National Health Interview Survey

OMB: 0920-0214

IC ID: 229171

Documents and Forms
Information Collection (IC) Details

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Adult Questionnaire 0920-0214
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0214 Adult Questionnaire Att 9b - 2021 NHIS Sample Adult Questionnaire.pdf 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

30,000 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 30,000 0 3,000 0 0 27,000
Annual IC Time Burden (Hours) 24,000 0 1,950 0 0 22,050
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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