Adult Questionnaire

[NCHS] National Health Interview Survey

Documents and Forms

Document Name Document Type
Adult Questionnaire Form and Instruction
Sample Adult Questionnaire NHIS_2025 0920-0214 Sample Adult NHIS_2025_04_sponsor_report TEXT VERSION.docx Form and Instruction
0920-0214 Sample Adult NHIS_2025_04_sponsor_report.pdf Sample Adult Questionnaire NHIS 2025 (pdf) IC Document

Information Collection (IC) Details

IC Title:	Adult Questionnaire	Agency IC Tracking Number:	0920-0214

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	n/a	Sample Adult Questionnaire NHIS_2025	0920-0214 Sample Adult NHIS_2025_04_sponsor_report TEXT VERSION.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: 33,000	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	33,000	33,000
Annual IC Time Burden (Hours)	26,950	26,950
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample Adult Questionnaire NHIS 2025 (pdf)	0920-0214 Sample Adult NHIS_2025_04_sponsor_report.pdf	05/22/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.