[NCHS] National Health Interview Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Sample Child	Form and Instruction	New	Repair queued
Form 0920-22IA Health Exam	Form and Instruction	Removed	Repair queued
Form 0920-0214 Adolescent Follow-back Survey	Form and Instruction	Removed	Available
Re-Interview Survey	Form and Instruction	Modified	Missing upstream
Methodological Projects	Form and Instruction	Modified	Repair queued
Child Questionnaire	Form and Instruction	Modified	Repair queued
Adult Questionnaire	Form and Instruction	Modified	Missing upstream
Household Roster	Form and Instruction	Modified	Repair queued
Att 13 - ADDP-DEMO-PIA-FY23_SAOP-Approved-Delegated (1).pdf	Supplementary Document	Uploaded 2023-11-14	Missing upstream
Att 12 - Healthy People 2030 Objectives Slated for NHIS.pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 11 Protocol #2019-09 NHIS Amendment #16 Changes for the 2024 NHIS (OCD20230823.03).pdf	Supplementary Document	Uploaded 2023-11-14	Missing upstream
Att 11 Human Subjects Clearance.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 10d NHIS Thank You Letter.pdf	Supplementary Document	Uploaded 2023-11-14	Available
Att 10c Supplemental Mailings.pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 10b NHIS Brochure.pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 10a.03 Sample Adult Advance Letter.pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 10a.02 Campus Student Advance Letter.rtf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 10a.01 Household Advance Letter.pdf	Supplementary Document	Uploaded 2023-11-14	Missing upstream
Att 8 - Precision Tables.xlsx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 5b - 2024 NHIS Proposed New Content - Concepts Measured Duplication and Proposed Use of Data.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 5a - 2024 NHIS Sponsored Content Added - Concepts Measured.docx	Supplementary Document	Uploaded 2023-11-14	Missing upstream
Att 3f Proposed Child Sponsored and Emerging Content 2024 2025 2026.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 3e Proposed Adult Sponsored and Emerging Content 2024 2025 2026.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 3d NHIS Annual and Rotating Core 2024, 2025, 2026 - Sample Child.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 3c NHIS Annual and Rotating Core 2024, 2025, 2026 - Sample Adult.docx	Supplementary Document	Uploaded 2023-11-14	Missing upstream
Att 3b NHIS Snapshot 3 Year-Cycle Questionnaire Content and Periodicity.pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 3a NHIS Survey Content Overview.pdf	Supplementary Document	Uploaded 2023-11-14	Available
Att 2d Responses to Comments.docx	Supplementary Document	Uploaded 2023-11-14	Repair queued
Att 2 - 60 Day Federal Register Notice 10-24-2023.pdf	Supplementary Document	Uploaded 2023-11-14	Missing upstream
2024 NHIS SSB 2023-11-8-2023.docx	Supporting Statement B	Uploaded 2023-11-14	Repair queued
2024 NHIS SSA 2023-11-3-2023_final.docx	Supporting Statement A	Uploaded 2023-11-14	Repair queued
Att 1 Legislative Mandates (Excerpts).pdf	Supplementary Document	Uploaded 2023-11-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
263385	Sample Child	Form and Instruction	New
244155	Health Exam	Form and Instruction	Removed
244154	Adolescent Follow-back Survey	Form and Instruction	Removed
229175	Re-Interview Survey	Form and Instruction	Modified
229173	Methodological Projects	Form and Instruction	Modified
229172	Child Questionnaire	Form and Instruction	Modified
229171	Adult Questionnaire	Form and Instruction	Modified
229170	Household Roster	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0214	ICR Reference No: 202311-0920-005
Status: Received in OIRA	Previous ICR Reference No: 202303-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0214
Title: [NCHS] National Health Interview Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/15/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2023
Responses	100,167	102,700
Time Burden (Hours)	39,192	38,095
Cost Burden (Dollars)	0	0

---

Abstract: DHIS collects on an annual basis, statistically valid data on the amount, distribution, and effects of illness and disability in the population and on the utilization of health care services for such conditions. NHIS data are used widely throughout the Department of Health and Human Services (DHHS) to monitor trends in illness and disability and to track progress toward achieving many of the health objectives for the nation. This Revision includes updated Survey information and burden edits.

---

Authorizing Statute(s): US Code: 42 USC 242 Name of Law: Public Health Service Act
   PL: Pub.L. 107 - 347 511 Name of Law: Confidential Information Protection and Statistical Efficiency Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 56823	08/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 78041	11/14/2023
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Adolescent Follow-back Survey	0920-0214	Adolescent Follow-back Survey
Adult Questionnaire	None	2024 NHIS Sample Adult Questionnaire
Child Questionnaire	None	2024 NHIS Sample Child Questionnaire
Health Exam	0920-22IA	Att 6 LifeSatisfaction
Household Roster	None	2024 NHIS Roster Questionnaire
Methodological Projects	n/a	Methodological Projects
Re-Interview Survey	None	2024 NHIS Reinterview Questionnaire
Sample Child 	n/a	NHIS Teen Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	100,167	102,700	0	3,667	-6,200	0
Annual Time Burden (Hours)	39,192	38,095	0	5,167	-4,070	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: The change in burden is due to adjustments in respondents, expected burden, and modifications to the instruments.

---

Annual Cost to Federal Government: $47,000,000

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

---

Common Form ICR:  No

---

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: 11/15/2023

---