Household Interview

National Health and Nutrition Examination Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0950 Household Interview Form and Instruction
0920-0950 Household Interview Att_3c_HH Interview_201129.docx Form and Instruction
0920-0950 Household Interview Att_3c_HH Interview_201129.docx Form and Instruction
0920-0950 Household Interview (with current Covid mods) Att. 1a COQ_HH_220808_CLEAN COPY.docx Form and Instruction
0920-0950 Household Interview (with current Covid mods) Att. 1a COQ_HH_220808_CLEAN COPY.docx Form and Instruction
0920-0950 Household Interview (with current Rx mods) Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.docx Form and Instruction
0920-0950 Household Interview (with current Rx mods) Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Household Interview	Agency IC Tracking Number:	0920-0950

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0950	Household Interview	Att_3c_HH Interview_201129.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	Household Interview (with current Covid mods)	Att. 1a COQ_HH_220808_CLEAN COPY.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	Household Interview (with current Rx mods)	Att. 3a RXQ_COVID Med_220614_westat_NCHS_CLEAN COPY.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population	FR Citation: 49 FR 37693

Number of Respondents: 5,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	5,600	5,600
Annual IC Time Burden (Hours)	5,600	5,600
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.