Health Exam

National Health Interview Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-22IA Health Exam Form and Instruction
0920-22IA Att 6 LifeSatisfaction Att 6 LifeSatisfaction_10-26-2021_clean.docx Form and Instruction
0920-22IA Att 6 LifeSatisfaction Att 6 LifeSatisfaction_10-26-2021_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Exam	Agency IC Tracking Number:	0920-22IA

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-22IA	Att 6 LifeSatisfaction	Att 6 LifeSatisfaction_10-26-2021_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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