Survey Participant Questionnaire

[NCHS] National Health and Nutrition Examination Survey (NHANES)

Documents and Forms

Document Name Document Type
Form 0920-0950 Survey Participant Questionnaire Form and Instruction
0920-0950 Survey Participant Questionnaire Attachment_6b_Survey Participant Questionnaire_2024AUG29.docx Form and Instruction
0920-0950 Household Questionnaire Attachment_6c_Household Questionnaire_2024JULY16.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Survey Participant Questionnaire	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0950	Survey Participant Questionnaire	Attachment_6b_Survey Participant Questionnaire_2024AUG29.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0950	Household Questionnaire	Attachment_6c_Household Questionnaire_2024JULY16.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: 5,882	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,882	282	5,600
Annual IC Time Burden (Hours)	5,882	282	5,600
Annual IC Cost Burden (Dollars)	0	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.