National Health and Nutrition Examination Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0950 Hour Wearable Devices	Form and Instruction	New	Available
Form 0920-0950 24 Hour Wearable Devices	Form and Instruction	New	Repair queued
Form 0920-0950 Introductory Letter for SP Questionnaire	Form and Instruction	New	Available
Form 0920-0950 Developmental Projects & Special Studies Testing	Form and Instruction	New	Repair queued
Form 0920-0950 FCBS Phone Follow-Up	Form and Instruction	New	Available
Form 0920-0950 Flexible Consumer Behavior Survey Phone Follow-Up	Form and Instruction	New	Repair queued
Form 0920-0950 Dietary Interview	Form and Instruction	New	Available
Form 0920-0950 Day 1 and Day 2 Telephone Dietary Recall & Dietary Supplement	Form and Instruction	New	Repair queued
Form 0920-0950 MEC Interview & Examination 05APR2021	Form and Instruction	New	Available
Form 0920-0950 MEC Interview & Exam	Form and Instruction	New	Available
Form 0920-0950 Mobile Exam Center (MEC) Interview & Examination	Form and Instruction	New	Repair queued
Form 0920-0950 Household Interview	Form and Instruction	New	Available
Form 0920-0950 Household Interview	Form and Instruction	New	Repair queued
Form 0920-0950 Household Screener	Form and Instruction	New	Available
Form 0920-0950 Household Screener	Form and Instruction	New	Repair queued
Telephone Dietary Recall	Form	Removed	Repair queued
Telephone Dietary Recall and Dietary Supplements	Form	Removed	Repair queued
MEC Questionnaire and Exam	Form	Removed	Available
Mobile Exam Center Interview and Exam	Form	Removed	Repair queued
Screener and Non-response Bias Module	Form	Removed	Available
Screener	Form	Removed	Repair queued
Form 0920-0950 Blood - Infants Questionnaire	Form and Instruction	Removed	Available
Flexible Consumer Behavior Survey	Form	Removed	Available
Flexible Consumer Behavior Survey Phone Follow-up	Form	Removed	Repair queued
Household Interview	Form	Removed	Available
Household Interview	Form	Removed	Repair queued
Att_13f_NHANES Overview Brochure_11162020.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_12_Nonresponse Letter_11162020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11g_2021 Future Research Consent Form_201117.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11f_2021 MEC Adult Parental_Child_Consent_Assent Form_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11e_Adult-Parental-Consent-Assent-Brochure_201124.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11d_MEC Assent Brochure_7-11 years_2020_v4_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11c_Health Measurements List_Guest or Dry Run_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11b_Health Measurements List_201202.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_11a_2021 Home Interview Consent Form_201116.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10h_Spanish Advance Contact 4_Final Reminder Letter_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10g_Advance Contact 4_Final Reminder Letter_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10f_Spanish Advance Contact 3_Reminder Letter_11182020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10e_Advance Contact 3_Reminder Letter_11182020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10d_Spanish Advance Contact 2_Postcard_11162020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10c_Advance Contact 2_Postcard_11162020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10b_Spanish Advance Contact 1_Letter_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_10a_Advance Contact 1_Letter_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_9_ NHANES History_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_8_Agencies Consulted_21-22_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_7_3-5 Yr Urine Fact Sheet_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Available
Att_6b_Lab Assessments_19-20_FINAL_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_6a_Lab Assessments_21-22_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Available
Att_5b_Sample Design Tables 2019-20_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_5a_Sample Design Tables 2021-22_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_4_Developmental Project Report-Incentives.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_15_ERB Approval 121020.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14k_COVID-19 Antigen Screening Positive_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14j_COVID 19 Safety Flyer_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14i_Principal Letter_Final_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14h_Community Service Letter_2021_201117.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14g_Report of Findings_201124.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14f_Environmental Exposures Flyer_2011124.pdf	Supplementary Document	Uploaded 2020-12-28	Available
Att_14e_Lab Blood Flyer_201124.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14d_Appt Reminder Call Script_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14c_Appt Reminder Letter_NoFasting_201116.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14b_Appt Reminder Letter_Fasting_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_14a_Appointment Slips-v8_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_13e_Welcome to NHANES Brochure_11162020.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_13d_Make A Plan_Card-v3_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_13c_Sample Selection Brochure_v5_201029.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_13b_Confidentiality Flyer_2021_113020.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_13a_Introductory Letter for SP Questionnaire_v6_201029.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3h_Dietary Hand Card_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3j_FCBS PFU Hand Card_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3k_2019-2020 Instruments_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3d_HH Interview HandCard_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3f_MEC Interview Hand Card_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_3a_Exam&Question Changes_201129.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_2b_Public Comments to the 60-day Federal Register Notice.pdf	Supplementary Document	Uploaded 2020-12-28	Available
Att_2a_60 Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2020-12-28	Repair queued
Att_1_Applicable Laws or Regulations_102620.docx	Supplementary Document	Uploaded 2020-12-28	Repair queued
Sup_Stat_A_201210.docx	Supporting Statement A	Uploaded 2020-12-28	Available
Sup_Stat_B_201210.docx	Supporting Statement B	Uploaded 2020-12-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
245125	24 Hour Wearable Devices	Form and Instruction	New	Hour Wearable Devices
245125	24 Hour Wearable Devices	Form and Instruction	New
245124	Developmental Projects & Special Studies Testing	Form and Instruction	New	Introductory Letter for SP Questionnaire
245124	Developmental Projects & Special Studies Testing	Form and Instruction	New
245123	Flexible Consumer Behavior Survey Phone Follow-Up	Form and Instruction	New	FCBS Phone Follow-Up
245123	Flexible Consumer Behavior Survey Phone Follow-Up	Form and Instruction	New
245121	Day 1 and Day 2 Telephone Dietary Recall & Dietary Supplement	Form and Instruction	New	Dietary Interview
245121	Day 1 and Day 2 Telephone Dietary Recall & Dietary Supplement	Form and Instruction	New
245120	Mobile Exam Center (MEC) Interview & Examination	Form and Instruction	New	MEC Interview & Examination 05APR2021
245120	Mobile Exam Center (MEC) Interview & Examination	Form and Instruction	New	MEC Interview & Exam
245120	Mobile Exam Center (MEC) Interview & Examination	Form and Instruction	New
245119	Household Interview	Form and Instruction	New	Household Interview
245119	Household Interview	Form and Instruction	New
245118	Household Screener	Form and Instruction	New	Household Screener
245118	Household Screener	Form and Instruction	New
233004	24 Hour Blood Pressure Pilot	Instruction	Removed
233002	Telephone Dietary Recall and Dietary Supplements	Form	Removed	Telephone Dietary Recall
233002	Telephone Dietary Recall and Dietary Supplements	Form	Removed
233001	Mobile Exam Center Interview and Exam	Form	Removed	MEC Questionnaire and Exam
233001	Mobile Exam Center Interview and Exam	Form	Removed
233000	Screener	Form	Removed	Screener and Non-response Bias Module
233000	Screener	Form	Removed
219202	Developmental Projects and Special Studies	Form and Instruction	Removed	Blood - Infants Questionnaire
219202	Developmental Projects and Special Studies	Instruction	Removed
218879	Flexible Consumer Behavior Survey Phone Follow-up	Form	Removed	Flexible Consumer Behavior Survey
218879	Flexible Consumer Behavior Survey Phone Follow-up	Form	Removed
213574	Household Interview	Form	Removed	Household Interview
213574	Household Interview	Form	Removed

ICR Details

OMB Control No: 0920-0950	ICR Reference No: 202012-0920-018
Status: Historical Active	Previous ICR Reference No: 202002-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0950
Title: National Health and Nutrition Examination Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/12/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/21/2021
Terms of Clearance: Approved consistent with the understanding that NCHS will: a) conduct analyses to communicate the potential implications of these COVID-19 -related design and protocol changes for trend analysis, particularly subpopulation specific analyses and b) explore ways to use its monitoring trailers to better capture experiences in disadvantaged communities or subpopulations.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	11/30/2021
Responses	35,200	0	39,500
Time Burden (Hours)	65,630	0	68,417
Cost Burden (Dollars)	0	0	1,632,030

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Abstract: The National Health and Nutrition Examination Survey (NHANES) is a continuous nationally representative sample of the civilian, non-institutionalized U.S. population. The survey is unique in that it contains interview, laboratory and physical examination segments. The examination component is conducted in mobile examination centers that travel to fifteen survey locations each year. NHANES data have been the cornerstone for numerous national health and nutrition policy and surveillance activities. This request for Revision includes obtaining clearance to conduct NHANES sample person and family interviews; Mobile Examination Center (MEC) examinations and interviews. The Program is making changes specific to 2021-22 data collection to adapt the survey due to the COVID-19 disease pandemic and related concerns. These changes impact a broad range of survey areas, such as sample design, operational procedures (e.g., interview and examination modes and MEC hours), NHANES content (questionnaires, exam components, and laboratory measures), and outreach materials. Additionally, a priority in making COVID-19 related changes to NHANES content is to ensure safety for participants and staff as well as to add COVID-19 antibody laboratory assessments and COVID-19 questions relevant to interpreting these assessments. NHANES will collect data on a single-year nationally representative sample of 5,000 people during 2021–2022, oversampling children (0-19 years old) and older persons (60 years and over).

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: PHSA
   PL: Pub.L. 104 - 170 301 Name of Law: Food Quality Protection Act
   PL: Pub.L. 110 - 234 4403 Name of Law: Food, Conservation, and Energy Act of 2008
   US Code: 21 USC 393 Name of Law: Federal Food, Drug and Cosmetic Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 43848	07/20/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 3153	01/14/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
24 Hour Blood Pressure Pilot
24 Hour Wearable Devices	0920-0950	Hour Wearable Devices
Day 1 and Day 2 Telephone Dietary Recall & Dietary Supplement	0920-0950	Dietary Interview
Developmental Projects & Special Studies Testing	0920-0950	Introductory Letter for SP Questionnaire
Developmental Projects and Special Studies	0920-0950	Blood - Infants Questionnaire
Flexible Consumer Behavior Survey Phone Follow-Up	0920-0950	FCBS Phone Follow-Up
Flexible Consumer Behavior Survey Phone Follow-up	none	Flexible Consumer Behavior Survey
Household Interview	none	Household Interview
Household Interview	0920-0950	Household Interview
Household Screener	0920-0950	Household Screener
Mobile Exam Center (MEC) Interview & Examination	0920-0950, 0920-0950	MEC Interview & Exam ,   MEC Interview & Examination 05APR2021
Mobile Exam Center Interview and Exam	none	MEC Questionnaire and Exam
Screener	none	Screener and Non-response Bias Module
Telephone Dietary Recall and Dietary Supplements	none	Telephone Dietary Recall

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ICR Summary of Burden

table that charts list 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	35,200	39,500	0	35,200	-39,500	0
Annual Time Burden (Hours)	65,630	68,417	0	65,630	-68,417	0
Annual Cost Burden (Dollars)	0	1,632,030	0	0	-1,632,030	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: No

Burden Reduction Due to:

Short Statement: This request includes obtaining clearance to conduct NHANES household eligibility screening; sample person household and family interviews; NHANES examinations and interviews at the Mobile Examination Center (MEC); laboratory assessments; and telephone follow-up interviews and other follow-up activities for 2021-2022. In 2021-22, the program is making changes to respond to ongoing concerns about response rates and to adapt operations in light of the COVID-19 pandemic. This revision includes 65,630 burden hours.

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Annual Cost to Federal Government: $46,200,000

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]? No

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? Yes

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Common Form ICR:  No

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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: 01/21/2021

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