National Health Interview Survey

OMB Control No: 0920-0214	ICR Reference No: 201107-0920-008
Status: Historical Active	Previous ICR Reference No: 201009-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Health Interview Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/25/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/26/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved	01/31/2013
Responses	212,940	0	220,400
Time Burden (Hours)	55,343	0	34,977
Cost Burden (Dollars)	0	0	0

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Abstract: The annual NCHS National Health Interview Survey (NHIS) is a major source of general statistics on the health of the U.S. population and has been in the field every year since 1957. This household-based survey collects demographic and health-related information on a nationally representative sample of households throughout the country. This request is to extend data collection and to increase the sample size for 2011, 2012, and 2013.

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Authorizing Statute(s): PL: Pub.L. 101 - 445 301 Name of Law: The National Nutrition Monitoring and Related Research Act of 1990    PL: Pub.L. 104 - 170 136 Name of Law: The Food Quality Protection Act of 1996    US Code: 42 USC 242 Name of Law: Public Health Service Act    US Code: 42 USC 306 Name of Law: Public Health Service Act    PL: Pub.L. 111 - 148 1 Name of Law: The Patient Protection and Affordable Care Act

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 39533	07/09/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44337	07/25/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

IC Title Form No. Form Name Supplements--Line 8 3f Family Health Insurance--Health Care Reform Reinterview Survey--Line 9 3h 2011 NHIS Reinterview Instrument Screens Adult Epilepsy--Line 10 10 Adult Epilepsy--Line 10 Adult Quality of Life--Line 11 11 Adult Quality of Life--Line 11 Child Record Check--Line 12 12 Child Record Check--Line 12 Teen Record Check--Line 13 13 Teen Record Check--Line 13 Child Mental Health--Line 14 14 Child Mental Health--Line 14 Reinterview Survey--Line 15 15 Reinterview Survey--Line 15 Screener Questionnaire--Line 1 1 OMB Statement and Screener Section of the Family Core - line 2 3a Family Core Adult Core--line 3 3b Adult Core Child Core--line 4 3c 2011 NHIS Questionnaire--Sample Child Child Record Check--Line 5 3d Child Record Check--Immunization History Questionnaire Teen Record Check--Line 6 3e National Health Interview Provider Survey--Teen National Health Interview Survey--Line 7 3g Child Immunization Provider--NHIS Instrument Spec Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	212,940	220,400	0	-7,460	0	0
Annual Time Burden (Hours)	55,343	34,977	0	20,366	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The total number of respondents and burden hours is higher because the sample size has been increased to provide more state-level estimates

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Annual Cost to Federal Government: $31,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Petunia Gissendaner 4046390164

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(i) Why the information is being collected;
			(ii) Use of information;
			(iii) Burden estimate;
			(iv) Nature of response (voluntary, required for a benefit, or mandatory);
			(v) Nature and extent of confidentiality; and
			(vi) Need to display currently valid OMB control number;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date: 07/26/2011

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