Survey Participant Questionnaire

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

Documents and Forms

Document Name Document Type
Attachment_6d_Water Protocol_2024JULY16.docx Instruction
0920-0950 Survey Participant Questionnaire 17APR2025 0920-0950 Attachment_6b_Survey Participant Questionnaire_2025APR16.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Survey Participant Questionnaire	Agency IC Tracking Number:

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
Instruction			Attachment_6d_Water Protocol_2024JULY16.docx	N/A	No		Fillable Fileable
Form and Instruction	0920-0950	Survey Participant Questionnaire 17APR2025	0920-0950 Attachment_6b_Survey Participant Questionnaire_2025APR16.docx	N/A	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	Previously Approved
Annual Number of Responses for this IC	5,882	5,882
Annual IC Time Burden (Hours)	5,882	5,882
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.