Information Collection

Household Roster

IC 229170 under ICR 202504-0920-017 · OMB 0920-0214.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Household Roster	Form and Instruction
2024 NHIS Roster Questionnaire Household Roster	Form and Instruction
Form 0920-0214 Household Roster NHIS_2025 Household Roster	Form and Instruction
2024 NHIS Roster Questionnaire Att 9a - 2024 NHIS Roster Questionnaire 10-24-2023.pdf	Form and Instruction
2024 NHIS Roster Questionnaire Att 9a - 2024 NHIS Roster Questionnaire 10-24-2023.pdf	Form and Instruction
0920-0214 Household Roster NHIS_2025 Att 9a NHIS_ 2025 Roster.pdf	Form and Instruction
0920-0214 Household Roster NHIS_2025 Att 9a NHIS_ 2025 Roster.pdf	Form and Instruction

IC Title:

Household Roster

Agency IC Tracking Number:

0920-0214

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None				Yes	Yes	Fillable Fileable
Form and Instruction	0920-0214			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: 36,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	36,000	36,000
Annual IC Time Burden (Hours)	2,400	2,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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