Information Collection

2026 National Health Interview Survey (NHIS) Field Test

IC 279054 under ICR 202506-0607-001 · OMB 0607-0978.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Roster Questionnaire 2026 National Health Interview Survey (NHIS) Field Test	Form and Instruction
Sample Adult Questionnaire 2026 National Health Interview Survey (NHIS) Field Test	Form and Instruction
Roster and Sample Adult - Single Adult Questionnaire 2026 National Health Interview Survey (NHIS) Field Test	Form and Instruction
Roster and Sample Adult - All Adult Questionnaire 2026 National Health Interview Survey (NHIS) Field Test	Form and Instruction
Sample Child Questionnaire 2026 National Health Interview Survey (NHIS) Field Test	Form and Instruction
Enclosure 5 - Communication Materials_02122026.docx	Other-Communication Materials
Enclosure 6 - TQA Script 020426.docx	Other-TQA Script
Roster Questionnaire Enclosure 1 - Roster 021226.docx	Form and Instruction
Sample Adult Questionnaire Enclosure 2 - Sample Adult 020426.pdf	Form and Instruction
Roster and Sample Adult - Single Adult Questionnaire Enclosure 3a- Roster and Sample Adult - Single Adult 020426.pdf	Form and Instruction
Roster and Sample Adult - All Adult Questionnaire Enclosure 3b -Roster and Sample Adult- All Adult 020426.pdf	Form and Instruction
Sample Child Questionnaire Enclosure 4 - Sample Child_02122026.pdf	Form and Instruction
OMB memo_20260218.docx OMB Memo	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	n/a	No	Fillable Fileable
Form and Instruction	n/a	No	Fillable Fileable
Form and Instruction	n/a	No	Fillable Fileable
Form and Instruction	n/a	No	Fillable Fileable
Form and Instruction	n/a	No	Fillable Fileable
Other-Communication Materials		No	Fillable Fileable
Other-TQA Script		No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 124,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	124,200	124,200
Annual IC Time Burden (Hours)	23,577	23,577
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo		02/18/2026

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

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