Form 1 Mail Materials

Generic Clearance for Questionnaire Pretesting Research

NSCH 2019 Mail Materials for Cognitive Testing_OMB

NSCH Mail Materials Cognitive Testing

OMB: 0607-0725

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Download: docx | pdf

NSCH11wa_1

Shape1

Dear (insert City) Resident:



Y our address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.


Responding to this survey is easy:

Shape2
  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.



Shape3



Shape4

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs











Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Thank you for your help.

Steven D. Dillingham, Director













Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH11wa_ 2

Shape5

Dear (insert City) Resident:



Your address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.


Responding to this survey is easy:

Shape6

Shape7 Shape8

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs



  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.













Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Thank you for your help.

Steven D. Dillingham, Director














Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.



NSCH11wa_ 3

Dear (insert City) Resident:

Your address has been selected to participate in the National Survey of Children’s Health. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.

Responding to this survey is easy:

Shape9 Shape10
  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.














The success of this survey depends on your participation. The results will help your state better understand and respond to the health and healthcare needs of children and families. Results from the National Survey of Children’s Health are used to determine:


  • School programs for children with learning and developmental conditions

  • Healthcare programs for mothers and children

  • Support for families of children with special healthcare needs

  • State level funding for children’s health programs


Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director









Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

.

NSCH12wa(SC)_ 1

Shape11

Dear (insert City) Resident:



R ecently, we requested your participation in the National Survey of Children’s Health. If you have completed the survey prior to receiving this mailing, please accept our thanks. If you have not yet responded, we encourage you to complete the survey online. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.


Responding to this survey is easy:

Shape12

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs



Shape13

If there are children 0-17 years old in your household:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543

If you are unable to complete the survey online:

Answer the question at the bottom, detach the form and return it in the postage-paid envelope.



If there are NO children 0-17 years old in your household:

Let us know. Answer the question at the bottom of this letter, detach the form, and return it in the postage-paid envelope.

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.


Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Steven D. Dillingham, Director




Please fill out the form below, detach it on the perforated line, and return it in the postage-paid envelope.

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

Shape18 Shape14 Shape17 Shape16 Shape15

0 1 2 3 4 or more


Mailing Instructions: Place this card in the postage-paid envelope provided.

If the envelope has been misplaced, please mail this card to:

U.S. Census Bureau

ATTN: DCB 60-A

1201 E. 10th Street

Jeffersonville, IN 47132-0001


You may also call 1-800-845-8241 to request a replacement envelope.


Shape19 Public reporting burden for this collection of information is estimated to average 1 minute per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to DEMO.Paperwork@census.gov; use "Paperwork Project 0607-0990" as the subject.

NSCH12wa(SC)_ 2

Shape20

Dear (insert City) Resident:



R ecently, we requested your participation in the National Survey of Children’s Health. If you have completed the survey prior to receiving this mailing, please accept our thanks. If you have not yet responded, we encourage you to complete the survey online. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.


Responding to this survey is easy:

Shape21

Shape22

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs



If there are children 0-17 years old in your household:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543

If you are unable to complete the survey online:

Answer the question at the bottom, detach the form and return it in the postage-paid envelope.



If there are NO children 0-17 years old in your household:

Let us know. Answer the question at the bottom of this letter, detach the form, and return it in the postage-paid envelope.

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.


Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Steven D. Dillingham, Director



Please fill out the form below, detach it on the perforated line, and return it in the postage-paid envelope.

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

Shape24 Shape23 Shape25 Shape26 Shape27

0 1 2 3 4 or more



Mailing Instructions: Place this card in the postage-paid envelope provided.

If the envelope has been misplaced, please mail this card to:

U.S. Census Bureau

ATTN: DCB 60-A

1201 E. 10th Street

Jeffersonville, IN 47132-0001


You may also call 1-800-845-8241 to request a replacement envelope.


Shape28 Public reporting burden for this collection of information is estimated to average 1 minute per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to DEMO.Paperwork@census.gov; use "Paperwork Project 0607-0990" as the subject.


NSCH12wa(SC)_ 3

Dear (insert City) Resident:


Recently, we requested your participation in the National Survey of Children’s Health. If you have completed the survey prior to receiving this mailing, please accept our thanks. If you have not yet responded, we encourage you to complete the survey online. This survey collects information that is used to improve the health of children and families in your community and throughout the United States.



Responding to this survey is easy:

Shape30 Shape29

Shape31

Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.




The success of this survey depends on your participation. The results will help your state better understand and respond to the health and health care needs of children and families. Results from the National Survey of Children’s Health are used to determine:


  • School programs for children with learning and developmental conditions

  • Healthcare programs for mothers and children

  • Support for families of children with special healthcare needs

  • State level funding for children’s health programs


Answers to frequently asked questions are on the back of this letter. If you need assistance or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Steven D. Dillingham, Director



Please fill out the form below, detach it on the perforated line, and return it in the postage-paid envelope.

--------------------------------------------------------------------------------------------------------------------------------------------

How many children age 0-17 usually live or stay at this address?

Shape33 Shape32 Shape34 Shape35 Shape36

0 1 2 3 4 or more


Mailing Instructions: Place this card in the postage-paid envelope provided.

If the envelope has been misplaced, please mail this card to:

U.S. Census Bureau

ATTN: DCB 60-A

1201 E. 10th Street

Jeffersonville, IN 47132-0001


You may also call 1-800-845-8241 to request a replacement envelope.


Shape37 Public reporting burden for this collection of information is estimated to average 1 minute per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0990, U.S. Census Bureau, 4600 Silver Hill Road, Room 8H590, Washington, DC 20233. You may e-mail comments to DEMO.Paperwork@census.gov; use "Paperwork Project 0607-0990" as the subject.

NSCH13_ 1

Shape38

Dear (insert City) Resident:



R ecently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.


Responding to this survey is easy:

Shape39
  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.



Shape40

Shape41

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs













Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Thank you for your help.

Steven D. Dillingham, Director











Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

.

NSCH13_ 2

Shape42

Dear (insert City) Resident:



Recently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.


Responding to this survey is easy:

Shape43

Shape44 Shape45

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs



  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.













Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


The success of this survey depends on your participation. The results will help your state better understand and respond to the health care needs of children and families.


Thank you for your help.

Steven D. Dillingham, Director













Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

.

NSCH13_ 3

Dear (insert City) Resident:

Recently, we wrote asking for your help with the National Survey of Children’s Health. If you have already responded, thank you. If you have not, we are asking you to complete this survey because your participation is important for its success. The survey period is ending soon.

Responding to this survey is easy:

Shape46 Shape47
  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID: 54387543


Even if there are no children 0-17 years old in your household, please log in to let us know.














The success of this survey depends on your participation. The results will help your state better understand and respond to the health and healthcare needs of children and families. Results from the National Survey of Children’s Health are used to determine:


  • School programs for children with learning and developmental conditions

  • Healthcare programs for mothers and children

  • Support for families of children with special healthcare needs

  • State level funding for children’s health programs


Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director











Si necesita una encuesta Español, llame gratuitamente a 1–800–845–8241.

NSCH21b_ 1



Shape48


D ear Parent or Caregiver:

A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your participation. The final step of this survey is to answer some follow-up questions about your child:

[NAME] [AGE][SEX]

Shape49

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs






This child was selected to ensure the survey results represent every type of child and health situation.



This survey should be filled out by a parent or adult caregiver who lives in this household and who is familiar with this child’s health and healthcare. Please return your completed questionnaire in the postage-paid envelope provided.



The success of this survey depends on your participation. The results will help our nation better understand and respond to the healthcare needs of children and families in your state and across the country.



If you need assistance with the survey or have questions, please call 1–800–845–8241 or email childrenshealth@census.gov.



Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director


Enclosure







.

NSCH21b_ 2




Shape50

Dear Parent or Caregiver:

A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your participation. The final step of this survey is to answer some follow-up questions about your child:

[NAME, AGE(or BABY), SEX]

Shape51

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs


  • State level funding for children’s health programs





This child was selected to ensure the survey results represent every type of child and health situation.



This survey should be filled out by a parent or adult caregiver who lives in this household and who is familiar with this child’s health and healthcare. Please return your completed questionnaire in the postage-paid envelope provided.



The success of this survey depends on your participation. The results will help our nation better understand and respond to the healthcare needs of children and families in your state and across the country.



If you need assistance with the survey or have questions, please call 1–800–845–8241 or email childrenshealth@census.gov.



Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director


Enclosure









NSCH21b_ 3




Dear Parent or Caregiver:

A few weeks ago you responded to the National Survey of Children’s Health. We greatly appreciate your participation. The final step of this survey is to answer some follow-up questions about your child:

[NAME, AGE(or BABY), SEX]

This child was selected to ensure the survey results represent every type of child and health situation.



This survey should be filled out by a parent or adult caregiver who lives in this household and who is familiar with this child’s health and healthcare. Please return your completed questionnaire in the postage-paid envelope provided.

The success of this survey depends on your participation. The results will help our nation better understand and respond to the healthcare needs of children and families in your state and across the country. Results from the National Survey of Children’s Health are used to determine:


  • School programs for children with learning and developmental conditions

  • Healthcare programs for mothers and children

  • Support for families of children with special healthcare needs

  • State level funding for children’s health programs



If you need assistance with the survey or have questions, please call 1–800–845–8241 or email childrenshealth@census.gov.



Thank you once again for your help.

Sincerely,

Steven D. Dillingham, Director


Enclosure









NSCH22B_1

Shape52

Dear Parent or Caregiver:



We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:



Shape53

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs



This child was selected to ensure the survey results represent every type of child and health situation.


The information collected in this survey will help your state better understand and respond to the health care needs of children and families. We ask for your response because this survey is the only way we have to gather this important information. Your household was scientifically selected from all of the households in the country and will represent thousands of other households.


Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director


Enclosure















NSCH22B_ 2

Shape54

Dear Parent or Caregiver:



We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:

Shape55

Results from the National Survey of Children’s Health are used to determine:


  • School programs

for children with learning and developmental conditions


  • Healthcare programs for mothers and children


  • Support for families of children with special healthcare needs



  • State level funding for children’s health programs





This child was selected to ensure the survey results represent every type of child and health situation.


The information collected in this survey will help your state better understand and respond to the health care needs of children and families. We ask for your response because this survey is the only way we have to gather this important information. Your household was scientifically selected from all of the households in the country and will represent thousands of other households.


Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director


Enclosure















NSCH22B_ 3

Dear Parent or Caregiver:



We recently contacted you to ask for your participation in the final step of the National Survey of Children’s Health. The final step is to answer some follow-up questions about:



This child was selected to ensure the survey results represent every type of child and health situation.


The information collected in this survey will help your state better understand and respond to the health care needs of children and families. We ask for your response because this survey is the only way we have to gather this important information. Your household was scientifically selected from all of the households in the country and will represent thousands of other households.


Results from the National Survey of Children’s Health are used to determine:


  • School programs for children with learning and developmental conditions

  • Healthcare programs for mothers and children

  • Support for families of children with special healthcare needs

  • State level funding for children’s health programs



Answers to frequently asked questions are on the back of this letter. If you are unable to complete the survey online, need assistance, or have additional questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.



Thank you for your help.

Steven D. Dillingham, Director


Enclosure





FAQ

Frequently Asked Questions


How was I chosen for the survey?

Your address was randomly selected to be part of this voluntary survey from all of the addresses in the United States. We do not know who lives at each address. Everyone has a chance to be picked. This process ensures that the addresses selected represent everyone in the United States.


Can you replace my address with another one?

You are important! No other household is the same as yours. We cannot swap one address for another. If we did that, the survey results would not accurately describe your state or the entire country.


What are you going to ask me?

The survey asks questions about children’s physical and emotional health. It also asks about factors that may influence children’s well-being, including medical care, family interactions, parental health, school experiences, and neighborhoods.


How long will it take?

The survey takes less than 5 minutes if there are no children in your household. For households with children, it takes 33 minutes on average.



Who authorizes this survey?

The Census Bureau is conducting this survey on behalf of the U.S. Department of Health and Human Services under the authority of Title 13, United States Code (U.S.C.), Section 8(b) and Section 501(a)(2) of the Social Security Act (42 USC §701). This survey has been approved by the Office of Management and Budget (OMB). The eight-digit OMB approval number 0607-0990 appears in the bottom right corner of this page, the bottom left corner of the survey web page, and the upper left corner of the paper questionnaire. If this number were not displayed, we could not conduct this survey.


What laws protect my privacy?

Federal law protects your privacy and keeps your answers confidential under Title 13, U.S.C. Section 9. Under the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.


No hablo Ingles. Ques es esto?

La Oficina del Censo de los EE. UU. está llevando a cabo la Encuesta Nacional de Salud de los Niños, una importante investigación nacional de los EE. UU. Necesitamos su ayuda. Esta encuesta proporciona información importante que se utiliza para mejorar la salud de los niños y familias en todos los Estados Unidos. Es muy fácil completar esta encuesta. Si necesita una encuesta Español, llame gratuitamente a este número 1–800–845–8241 o envíenos un correo electrónico a childrenshealth@census.gov.



N SCH-PCW_ 1

Dear (insert City) Resident:


Recently, we sent you a letter requesting your participation in the National Survey of Children’s Health. If you have already responded to the survey, please accept our sincere thanks. If you have not yet completed your survey, please do so right away.


Shape56 Responding to this survey is easy:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID:


If you are unable to complete the survey online, need assistance, or have questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director

N SCH-PCW_ 2

Dear (insert City) Resident:


Recently, we sent you a letter requesting your participation in the National Survey of Children’s Health. If you have already responded to the survey, please accept our sincere thanks. If you have not yet completed your survey, please do so right away.


Shape57 Responding to this survey is easy:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID:


If you are unable to complete the survey online, need assistance, or have questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director

N SCH-PCW_ 3


Dear (insert City) Resident:


Recently, we sent you a letter requesting your participation in the National Survey of Children’s Health. If you have already responded to the survey, please accept our sincere thanks. If you have not yet completed your survey, please do so right away.


Responding to this survey is easy:

  1. Go to: https://respond.census.gov/nsch

  2. Enter your Login ID:


If you are unable to complete the survey online, need assistance, or have questions, please call 1–800–845–8241 or email us at childrenshealth@census.gov.


Thank you for your help.

Steven D. Dillingham, Director

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRachel E Sloan (CENSUS/DSMD FED)
File Modified0000-00-00
File Created2021-01-15

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