Supporting Statement Part B

Department of Commerce

United States Census Bureau

Request for OMB Review

Supporting Statement B

National Survey of Children's Health

OMB Control No. 0607-0990

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

1. Universe and Respondent Selection

Sponsored primarily by the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB), the National Survey of Children’s Health (NSCH) is designed to produce data on the physical, emotional, and behavioral health of children under 18 years of age in the United States. Since its beginning, the NSCH has been a critical component in the estimation of the national and state-level prevalence for a variety of child health indicators in combination with information on the child’s family context and neighborhood environment.

Prior to the U.S. Census Bureau administering the survey, the National Survey of Children with Special Health Care Needs (NS-CSHCN) was a complementary survey designed to estimate the prevalence and impact of children with special health care needs (CSHCN) at both the state and national levels and to estimate the percent of households with children having one or more CSHCN under 18 years of age. Decreasing response rates prompted the HRSA MCHB to initiate a redesign of the NSCH and NS-CSHCN. This redesign included combining the original NSCH and NS-CSHCN into a single annual survey that is now known solely as the NSCH. In addition to combining content, the redesign also involved changing the sampling frame from a list-assisted Random Digit Dial (RDD) to an Address-Based Sample (ABS) frame. Results from each cycle, beginning with the 2015 NSCH Pretest and 2016 production NSCH, inform the multimode design for subsequent iterations of the survey.

A majority of addresses receive an initial attempt to collect information by Web (self-administered) and a non-response follow-up with a paper instrument sent by mail (self-administered). The remaining addresses, identified as most likely to respond by paper questionnaire, receive a paper instrument and a Web invitation in the first contact. Both modes are accompanied by Telephone Questionnaire Assistance (TQA) and Email Questionnaire Assistance (EQA). This multimode design differs significantly from the telephone, interviewer-administered mode that was originally used.

The NSCH will use an address-based sample derived from the Census Master Address File (MAF)¹ covering the 50 states and the District of Columbia. The 2020 NSCH will be conducted from June 2020 through January 2021. Households will be randomly sampled as described in section B.1.1. An invitation to participate in the NSCH with unique login information for the online survey instrument will be sent to each sampled household, and “High Paper” (or those more likely to respond by mail) addresses will also receive a paper instrument. The first section of the online instrument and the first paper instrument are screening instruments. Information on the presence of children within the household, child demographic information, as well as basic questions about each child’s health provided in these screeners will be used to determine whether the household is eligible for one of the three age-based surveys: 0 to 5 year old children, 6 to 11 year old children, or 12 to 17 year old children. This screener information is also used for the subsampling selection of a specific child within the household based on an oversampling of CSHCN and a subsequent oversample of young children (ages 0-5). In order to limit respondent burden, regardless of the number of eligible children, no more than one child per household will be sampled for the age-based topical surveys. Accordingly, only one topical survey will be administered to any given household. When responding via the online instrument, subsampling is instantaneous and respondents are able to continue seamlessly from the screener items to the topical section. When responding via the paper instrument, the screener is returned to Census by mail, and the topical instrument is sent back to the household for the subsampled child. The target population for the NSCH survey consists of children aged 17 or younger living in mailable residential housing units in the United States.

1. Sampling Households

For the 2020 NSCH, approximately 240,000 household addresses will be selected to participate in the survey. The main production sample will be comprised of about 217,000 addresses, while the state oversamples, if approved, making up an additional 23,000 addresses. The sample file is selected from the Census Master Address File (MAF) and supplemented with an administrative records-based flag, which serves to identify households with children. The Census Bureau’s Center for Economic Studies (CES) division has further developed an indicator based on multiple sources of administrative data which was adopted to identify households with children to improve sampling efficiency in the NSCH. As background, CES is an interdisciplinary group in the Research and Methodology Directorate, charged with the strategic re-use of administrative data from federal, state, and commercial providers. Information is combined from multiple sources to create new data products that are not possible to produce using single data sets.

Through combining data sources with the MAF, two flags will be available during sampling and survey data collection management. The three flags are described in detail in Appendix B:

• Flag 1: Child record linked to address (stratum 1); no child record linked to address, medium probability of children present (stratum 2a); no child record linked to address, low probability of children present (stratum 2b).

• Flag 2: Poverty; non-poverty (block, block-group, or tract level geographic definition).

Flag 1 is used in the sampling process. Flag 2 is used for sort and stratification. Flag 3 is used to tailor data collection mode switching based on small-area geographic characteristics.

The Flag 1 based sampling strata are mutually exclusive. Stratum 1 consists of addresses to which a specific child is linked using administrative records; other addresses are placed in Stratum 2. A statistical model using a variety of administrative data and small-area geographic characteristics assigns a probability of child presence to each address. These probabilities are used to further divide Stratum 2 into Stratum 2a and Stratum 2b; Stratum 2a addresses have a higher probability of child presence than Stratum 2b addresses. The probability threshold between 2a and 2b is selected in each state to maximize the number of addresses in Stratum 2b while maintaining an approximated 95% coverage rate of households with children in Strata 1 and 2a.

Addresses in Stratum 2b will not be included in sampling. Stratum 2b represents approximately 5% of households with children in each state (including all invalid mailing addresses); children are present in approximately 6% of addresses in Stratum 2b versus 17% of addresses in 2a and 79% in Stratum 1. Evaluation was done on this proposal using ACS responses across 16 variables representing 76 response categories. We compared relative frequencies for those categories when stratum 2b was included against frequencies without 2b addresses (using a 15% threshold), applying an offsetting weight to 2a responses. The average difference in the relative frequencies across the 76 response categories was less than 0.3 percentage points and less than the average margin of error. In practice, we have used a 5% threshold for assigning 2b addresses and we apply demographic controls in weighting (not just base weights), so this evaluation substantially overestimates the potential for bias in our frame when 2b is excluded. Evaluation of the characteristics of households in Strata 1, 2a and 2b demonstrate that excluding Stratum 2b significantly increases the efficiency of the sample (the percent of households with children present) and, in turn, the number of completed interviews. The impact on frame bias is negligible, and gains in sample efficiency allow us to better compensate for nonresponse bias (with nonresponse follow-up and weighting controls), improving both estimate precision and accuracy. Approximately 60% of the sample is expected to be drawn from Stratum 1.

Table B.1.1.A: Addressed-Based Sample by Stratum for the 2020 NSCH

	Stratum 1	Stratum 2a	Total
Sample Size	144,000	96,000	240,000
% of Sample	60%	40%
% Households w/ children	79%	17%	54%

State-level samples will be allocated to achieve an equal number of completed interviews in each state and the District of Columbia for the main production sample, while the four states that are pursuing an oversample will have additional requirements to meet the needs of their state. The sampling is designed for a base production sample size of approximately 217,000 addresses nationwide to yield roughly 700 completed interviews from households with children per state. The state oversamples for Colorado, Nebraska, Wisconsin, and Oregon are designed for a sample of approximately 23,000 addresses and expect to yield approximately 960 completed interviews per state.

See Appendix C for tables of estimated sample sizes per state for the production and state oversamples.

Variable sampling rates for the screener will be used in both Stratum 1 and Stratum 2a for each state. Within these strata, Flag 2 will be used to sort addresses for sampling. The 2020 NSCH will employ subsampling once data are collected for the screening items (Child Roster with Age, and CSHCN Screener Items 7-11). In the web instrument (Centurion) this will happen instantaneously as that section is completed. In the paper instrument, the screener interview is completed and returned to Census by the respondent, Census employs the subsampling rules to select a single child based on the reported data, and then mails the paper questionnaire with the appropriate topical questions back to the respondent. Reflecting the programmatic importance of collecting data on children with special health needs (CSHCN), in multi-child households, an 80% oversampling procedure is used for CSHCN following screener completion. Additionally, in multi-child households where the children are either all CSHCN or all Non-CSHCN, a 60% oversampling procedure of children aged 0-5 is used to increase the representation of children of this age group.

The first of three contact materials tests that will be conducted with sampled addresses during the 2020 NSCH is a redesigned survey contact materials design experiment. This test is intended to evaluate a completely redesigned suite of mailed survey invitation packages that are informed by two rounds of cognitive testing. These redesigned contact materials differ from the traditional NSCH packages and include modifications to the formatting, style, and content of both the letters and envelopes. Thirty percent of the production sample addresses will be randomly assigned to the redesign treatment group, see Table B.1.1.B. Cases that are assigned to the redesign group for the initial mailing will also receive nonresponse follow-up mailings (and topical invitations, if applicable) in this redesigned format. While the final versions of these materials are currently being developed, mock-ups of the redesigned traditional and redesigned letters can be found in Appendix E and Appendix F. It is anticipated that providing respondents with a cohesive and informative set of mail packages that highlight key facts, relatable images, and make use of uniform colors may encourage households to read the enclosed materials and ultimately respond to the survey. Higher response can reduce follow-up costs and nonresponse bias. The redesigned mail package treatment group will be closely monitored throughout data collection and may be used in a greater or lesser capacity with follow-up mailings.

Table B.1.1.B: Redesigned Survey Contact Materials Experiment - Production

Redesign Treatment Group	Screener Sample Size	Mailing Group	Envelope Used
Control	168,000	High Paper	BC-1776(0977)
		Low Paper	BC-1328(0977)
Treatment	72,000	High Paper	BC-1776(0977R)
		Low Paper	BC-1328(0977R)
Total	240,000

The second contact material test planned during the 2020 NSCH is an envelope size test that will be conducted during the first follow-up screener mailing within the Low Paper (70%) treatment group. In previous cycles, our mailing strategy involved sending the screener web invite letter to this group in a standard business size envelope. However, we mail the screener invitation letter to the High Paper (30%) group in a larger, flat mail envelope. Since we do not know the impacts of the standard business size invite package vs. the flat mail package, this cycle we plan on selecting 50% of the Low Paper addresses that will receive a first follow-up mailing and instead send them their web invite letter within the larger, flat mail envelope. Evaluation of the treatment group will be determined by differential response between the two groups.

The third contact material test included in the 2020 NSCH is the United States Postal Service (USPS) priority mail envelope test. This test will be conducted during the initial paper topical mailing which will only be sent to those households who return a paper screener and indicate that their household has eligible children. This priority mail envelope is a product of design collaboration between the U.S. Census Bureau and the USPS and has been approved for use in address based surveys. This test stems from the positive results of the 2018 NSCH certified mail test indicating that, when delivered, it increased response by 7.5 percentage points. This priority mail treatment will be assigned to 50% of all initial topical mailings. Results of this test will help determine if it is an effective mailing strategy that could be used during future cycles of the production screener. As with the complete redesigned survey contact materials, the USPS priority mail envelope treatment group will be closely monitored throughout data collection and may be used in a greater or lesser capacity with follow-up mailings.

The 2020 NSCH production sample will also include two key, non-experimental design elements. First, a screener cash incentive split between $2 (30%) and $5 (60%) will be mailed to 90% of sampled addresses. The remaining 10% of households function as a control group and will receive no incentive in order to monitor the effectiveness of the cash incentive. The addresses that will receive the cash incentive will be selected randomly from the sampled addresses. This incentive strategy is designed to increase response and reduce nonresponse bias within the constraints of the budget. The incentive amount was chosen following an incentive test in 2016 and results of the same non-experimental design element utilized in the 2019 NSCH. The results of each have demonstrated that the $2 incentive significantly increased response compared to having no incentive. In addition, the $5 incentive was proven to be a more costly but also more effective strategy at encouraging participation.

Additionally, data collection procedures will be modified based on the block group-level paper-only response probability. Since 2012, the American Community Survey (ACS) respondents have been able to submit survey forms over the Internet in addition to completing and mailing back a paper questionnaire. Modeled Web and paper response mode probabilities by block group were initially estimated using ACS response mode choices summarized at the block group. These estimates are adjusted and updated using NSCH response mode choices modeled on block group-level characteristics. Sample households will be located within block groups and assigned a paper-only response probability – the probability the household would not respond to a web invite but would subsequently respond to a paper questionnaire. Paper-only response probabilities can vary within block groups by stratum (Flag 1). The 30% of households with the highest paper-only response probabilities will be flagged as ‘High Paper’ and will receive a paper questionnaire with the initial web invitation. The other 70% of households will be flagged as “Low Paper” and receive their first paper questionnaires in the second follow-up mailing. See Appendix B for additional details.

The following Table B.1.1.C is a summary of the comparisons that will be performed between the incentive and control groups, and between ‘High Paper’ and ‘Low Paper’ households, based on the maximum eligible sample. It is anticipated the $2 incentive will increase screener returns by 3.6 percentage points and the $5 incentive will increase response by 6.3 percentage points. It is anticipated that the effect of the incentives will vary by Web group (“High paper” versus “Low paper”).

The Fisher Exact Test is used to derive power in Table B.1.1.D based on the sample sizes and anticipated response differentials of the comparison groups. The high statistical power for the incentive comparison, the design comparison, and the two envelope comparisons (power≈1) indicates that there is a near zero probability of concluding there is no difference in response when, in fact, there is one. There is sufficient power to reliably detect the effect of the redesign within the incentive groups and High Paper treatment groups.

Table B.1.1.C: Incentive and Mailing Treatment Group Comparisons

Incentive	Initial Cases	Design Test Group	Maximum Sample for Design Comparison	Mode Collection Group	Maximum Sample by Paper	Treatment Groups (TG)
$2	72,000 (38.1%)	Traditional Group	50,400 (37.5%)	Low Paper	35,280 (37.5%)	1
				High Paper	15,120 (37.5%)	2
		Redesign Group	21,600 (39.5%)	Low Paper	15,120 (39.5%)	3
				High Paper	6,480 (39.5%)	4
$5	144,000 (40.8%)	Traditional Group	100,800 (40.2%)	Low Paper	70,560 (40.2%)	5
				High Paper	30,240 (40.2%)	6
		Redesign Group	43,200 (42.2%)	Low Paper	30,240 (42.2%)	7
				High Paper	12,960 (42.2%)	8
Control	24,000 (34.5%)	Traditional Group	16,800 (33.9%)	Low Paper	11,760 (33.9%)	9
				High Paper	5,040 (33.9%)	10
		Redesign Group	7,200 (35.9%)	Low Paper	5,040 (35.9%)	11
				High Paper	2,160 (35.9%)	12

Table B.1.1.D: Production Treatment Group Comparisons

Incentive Comparisons	Design Comparisons by Incentive	Design Comparisons by Paper	Envelope Treatments
$2 v. Control TG(1+2+3+4) v. TG(9+10+11+12)  p=0.05, power≈1 p=0.10, power≈1	Traditional Group v. Redesign Group TG(1+2+5+6+9+10) v. TG(3+4+7+8+11+12) p=0.05, power≈1 p=0.10, power≈1		Business Size v. Flat Mail Follow-Up Approx. 69,000 cases each p=0.05, power≈1 p=0.10, power≈1
$5 v. Control TG(5+6+7+8) v. TG(9+10+11+12)  p=0.05, power≈1 p=0.10, power≈1	Traditional Group v. Redesign Group in $2 TG(1+2) v. TG(3+4) p=0.05, power≈1 p=0.10, power≈1	Traditional Group v. Redesign Group in Low Paper TG(1+5+9) v. TG(3+7+11) p=0.05, power≈1 p=0.10, power≈1	Traditional v. Priority Mail Topical Approx. 8,400 cases each p=0.05, power≈1 p=0.10, power≈1
	Traditional Group v. Redesign Group in $5 TG(5+6) v. TG(7+8) p=0.05, power≈1 p=0.10, power≈1	Traditional Group v. Redesign Group in High Paper TG(2+6+10) v. TG(4+8+12) p=0.05, power≈1 p=0.10, power≈1

2. Within-Household Sampling

Eligible children within households that have a completed screener will be sampled for one of the three age-based topical surveys: 0 to 5-year-old children (T1), 6 to 11-year-old children (T2), or 12 to 17-year-old children (T3). As previously mentioned only one child per household will be selected for a topical questionnaire in an effort to minimize respondent burden.

In order to select the sample child from a household, it must first be determined whether each eligible child is a Child with Special Health Care Needs (CSHCN) or a Child without Special Health Care Needs (Non-CSHCN). Children are considered to have special health care needs if the respondent answers “Yes” to at least one question in one of three categories listed below. These questions are part of the screener questionnaire, which was developed by researchers, practitioners, family advocates, and policy makers to identify CSHCN in household surveys².

CSHCN are identified by asking respondents if each child rostered in the screening instrument: 1) needs or uses more medical care, mental health services, or educational services than is usual for most children of the same age; 2) if the child needs or uses specialized therapies, mental health counseling, or prescription medications; and/or 3) if the child is limited or prevented in any way in his or her ability to do things that most children of the same age can do because of a medical, behavioral, or other health condition that is expected to last at least one year.

Households Types (HHTYP) are mutually exclusive and exhaustive (See Table B.1.2.A). An 80 percent oversampling is applied for those households having both CSHCN and Non-CSHCN present; i.e., household types 4, 6, and 7. An additional 60 percent oversampling of children aged 0-5 years occurs in household types 3 and 5. This second oversample is designed to offset the age bias of the CSHCN oversample; younger children are less likely to be identified with special health care needs.

Table B.1.2.A: Strategies for Selecting the NSCH Sample Child

House-hold Type	Number of Eligible Children in Household	Number of Eligible Non-CSHCN,CSHCN	% Probability of Selection for Non-CSHCN		% Probability of Selection for CSHCN		Notes
1	0 or ‘blank’	0,0	0				No eligible children in household.
2	1	1,0 or 0,1	100%				Single child is always selected.
3	2	2,0 or 0,2	If only 1 child is aged 0-5 years, that child’s probability of selection is 62% and the other child’s probability of selection is 38%. Otherwise, each child has an equal chance of selection (50%).				Includes 60% oversampling of children aged 0-5 years.
4	2	1,1	36%			64%	Includes 80% oversampling of CSHCN.
5	3	3,0 or 0,3	If only 1 child is aged 0-5 years, that child’s probability of selection is 44% and each of the other two children have an equal chance of selection (28%). If 2 children are aged 0-5 years, each has a probability of selection of 38% and the other child has a probability of selection (24%). If all 3 children are aged 0-5 or aged 6-17 years, then each child has an equal chance of selection (33.3%).				Includes 60% oversampling of children aged 0-5 years.
6	3	2,1	53%			47%	Includes 80% oversampling of CSHCN.
7	3	1,2	22%			78%	Includes 80% oversampling of CSHCN.
8	4 or more	Any combination	Before the sort, each of the first 4 children has an equal probability of selection (25%).				Simple random selection of 1 of the first 4 (sorted) children, regardless of Non-CSHCN or CSHCN.

Each household will be pre-assigned a value for each of the eight Household Types that corresponds with the oversampling criteria in the Probability of Selection column in the table above. This value denotes the order of the child (0, 1, 2, 3, or 4) that should be selected after the proper sorting of eligible children has occurred. For HHTYP 1 and HHTYP 2, no sorting occurs because there are either no eligible children or one eligible child who will always be selected. For HHTYP 3 through HHTYP 8, children will be sorted by their special needs status (CSHCN children first followed by Non-CSHCN) and then sorted by age (youngest to oldest). Finally, HHTYP 8 children will be sorted by their special needs status (CSHCN children first followed by Non-CSHCN), then sorted by name, and then sorted by age (youngest to oldest).

3. Expected Yield

The respondent universe for the NSCH is adults ages 18 or older who live in the U.S., have a valid household address, and who are parents or caregivers of at least one child who is under 18 years of age living in the same household. Those households that do not have any infants or children are asked to mark “No” to the first question on the screener which asks, “Are there any children 0 - 17 years old who usually live or stay at this address?” and would then screen-out of the remaining survey questions.

The initial base sample size (not including the state-based oversamples) for the production NSCH is approximately 217,000 unique addresses nationwide. These addresses are then split by strata. Response probabilities are estimated using response patterns from the 2018 and 2019 NSCH. The expected analytic sample sizes are listed in Table B.1.3.A.

Table B.1.3.A: Expected Base Sample Sizes of NSCH Production Incentive Treatment Groups

Initial Sample	Stratum Stratum 1: 60% Stratum 2a: 40%		Incentive Group $0: 10% $2: 30% $5: 60%		Valid Addresses S1: 93% S2: 76%	Completed Screeners $2: +3.6% $5: +6.3%		Households With Kids Stratum 1: 79% Stratum 2a: 17%		Completed Topicals S1: 75% S2: 71%
217,000	1	130,000	$0	13,000	12,000	4,800		3,800		2,800
			$2	39,000	36,500	15,500		12,500		9,200
			$5	78,000	72,500	33,500		26,500		20,000
	2a	87,000	$0	8,700	6,600	3,000		500		350
			$2	26,000	20,000	9,500		1,600		1,100
			$5	52,500	39,500	20,000		3,400		2,400
Totals					187,000		86,500		48,000	36,000
per State					3,700		1,700		950	700

4. Estimation Procedures

There will be written specifications for weighting the data that will have been collected in the 2020 NSCH for people in households selected from the Census Master Address File (MAF). The data from the MAF are supplemented with administrative records based flags to indicate the presence of children in the household. Instructions for computing adjustments (e.g., under coverage and nonresponse) and several final household and person-level weights will be provided.

5. Nonresponse Bias Analysis

Standard 1.3 of the OMB Standards and Guidelines for Statistical Surveys (2006) states that “Agencies must design the survey to achieve the highest practical rates of response, commensurate with the importance of survey uses, respondent burden, and data collection costs, to ensure that survey results are representative of the target population so that they can be used with confidence to inform decisions.” Implicit in this standard is the assumption that the frame variables used at the design stage are sufficiently predictive of the collection variables for this to be feasible. Under this assumption, standard nonresponse bias analyses techniques can and will be applied to frame data variables to study potential areas of nonresponse bias (both item and unit) in the survey estimates.

2. Survey Collection Procedures

This section describes the data collection procedures that will be used in the NSCH. The Census Bureau will request survey participation from approximately 240,000 households via one of two modes: Web survey or paper questionnaire. The primary mode for the majority of respondents is a letter invitation with the Web URL and a unique login ID included in the letter. The secondary mode will be a mailed paper screener questionnaire with the Web URL and login ID included in the questionnaire package. Addresses identified as most likely to respond only by paper questionnaire are provided a paper screener questionnaire in the initial mailing. See Appendix E for the traditional production sample letters and Appendix F for the redesigned production sample letters.

The first section of the production survey instrument is a screener. The household will be screened to determine if there are any children under 18 years of age who usually live or stay at that address. Those households that meet the eligibility criteria roster all children living at that address and answer questions to determine the special needs status of each child. Detailed information will be collected for all children living in the household. Those households that are deemed to have eligible children will be directed to complete the survey about one specific child living at that address.

“High Paper” addresses and “High Web” non-respondents will receive a two-phase self-administered paper questionnaire. In the first phase, similar to the Web, households will be screened to determine if there are any children under 18 years of age who usually live or stay at that address. Those households that meet the eligibility criteria go on to roster the children living at that address and answer questions to determine the special needs status of each child (up to 4 children). Detailed information will be collected for Child 1 – Child 4, while basic information (name, age, and sex) will be collected for Child 5 – Child 10. In the second phase, households that are deemed to have eligible children will be mailed one of the three age-based Topical questionnaires that request more information about one specific child living at that address. See Appendix A for a list of new and removed content for the 2020 NSCH, and Appendix D for draft versions of the 2020 NSCH Screener and Topical instruments.

The Topical survey (for both Web and paper) will cover the following content areas: child’s health and functional status; the child as an infant; health care services; experience with child’s health care providers; child’s health insurance coverage and experience of uninsured children in low income families; providing for the child’s health; the child’s learning, schooling, and activities; family functioning; parental health; neighborhood and community characteristics; and adult demographics.

The NSCH employs multiple contacts with households to maximize response. These include up to four web invitation letters, two pressure sealed reminder postcards, and two (‘Low Paper’) or four (‘High Paper’) paper questionnaires.

The U.S. Census Bureau is conducting the NSCH on the behalf of the HHS under Title 13, United States Code, Section 8(b), which allows the Census Bureau to conduct surveys on behalf of other agencies. Title 42 U.S.C. Section 701(a)(2) allows HHS to collect information for the purpose of understanding the health and well-being of children in the United States. There are also two separate partner agreements with the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities (CDC/NCBDDD) and the United States Department of Agriculture (USDA) in support of particular content on the topical questionnaires. The CDC/NCBDDD supports content on the receipt of training or interventions around the behavioral treatment of attention-deficit disorder and attention-deficit/hyperactivity disorder under the Public Health Service Act, Section 301, 42 U.S.C. § 241. The USDA supports content on food sufficiency under the Healthy, Hunger-Free Kids Act of 2010, Pub. L. 111-296. In particular, 42 U.S.C. 1769d(a) authorizes USDA to conduct research on the causes and consequences of childhood hunger included in 1769d(a)(4)(B), the geographic dispersion of childhood hunger and food insecurity. The data collected under this agreement are confidential under 13 U.S.C. Section 9. All access to Title 13 data from this survey is restricted to Census Bureau employees and those holding Census Bureau Special Sworn Status pursuant to 13 U.S.C. Section 23(c).

3. Methods to Maximize Participation Rates and Deal with Nonresponse

Both the NSCH redesigned letters and topical questionnaires underwent two rounds of cognitive testing to assess interpretation and evaluate comprehension. In designing the various modes of the NSCH Screener and Topical questionnaires, attention is placed on the following design elements to help increase cooperation by prospective respondents.

• In developing and refining specific questions, the goal will be to create a logical, clear questionnaire with concrete question wording and simple grammar.

• The Web and paper versions of the questionnaire will be attractive with clear and simple instructions on how to complete specific questions.

• Questions will be grouped according to subject areas.

• Questionnaire formatting will maximize readability, including appropriate question spacing, font type and size, along with easy to follow skip instructions.

• Questionnaire formatting considerations will also include the use of color and pictures to enhance respondent comprehension.

• Respondent contact strategies and letters have been carefully redesigned to grab the attention of the respondent and pique interest in the subject matter.

• Respondents will receive a $2 or $5 bill as an incentive to participate in the survey. See Section A.9 of the supporting statement for more information on incentives.

Data collection for the NSCH will involve a series of mailings and nonresponse follow-up activities, encouraging questionnaire completion (see Appendix E – Traditional Production Sample Letters and Appendix F – Redesigned Production Sample Letters). Our proposed approach to data collection and nonresponse follow-up is based on previous project experience and recommendations made by Dillman and colleagues (2009)³.

Invitation Letter. An initial invitation letter will be mailed to all potential respondents providing details about the study, a Web URL with a unique login ID for accessing the Web version of the questionnaire (which combines the screener and topical into a consolidated instrument), and a toll-free number and email address for the individual to utilize if there are questions or comments. Only addresses identified as most likely to respond by paper questionnaire will receive a paper questionnaire in the initial mailing. In addition to the invitation letter, 90% of the production sample will also receive a token of appreciation (a $2 or $5 bill).

Additional mailings. Subsequent to the first and second invitation mailings, the Census Bureau will send all sample addresses a reminder pressure-sealed postcard containing the NSCH questionnaire Web URL with a unique login ID. All addresses will then receive two additional mailings with an invitation letter and paper questionnaire, conditional on nonresponse.

Hardcopy questionnaire mailing. For Mail mode cases, the topical questionnaire and accompanying cover letter will be personalized to fill in the sample child’s name and other identifying information to ensure that the survey is completed for the correct child. This level of personalization in the questionnaire improves data quality by reducing the opportunity for skip logic errors. It also results in a questionnaire that is as short as possible for the selected child. The shorter the questionnaire, the more likely the respondent is to complete it.

3. Individuals Responsible for Study Design and Performance

The Census Bureau will collect the information on behalf of HRSA MCHB. Contact information for the Census Bureau’s principal staff on the project are listed below:

Survey Operations, Data Collection, and Tabulation

Carolyn Pickering

Survey Director

U.S. Census Bureau, ADDP, HQ-7H153

4600 Silver Hill Road

Washington, DC 20233-0001

Phone: (301) 763-3873

Email: carolyn.m.pickering@census.gov

Leah Meyer

Assistant Survey Director

U.S. Census Bureau, ADDP, HQ-7H157

4600 Silver Hill Road

Washington, DC 20233-0001

Phone: (301) 763-7174

Email: leah.meyer@census.gov

Scott Albrecht

Survey Team Leader

U.S. Census Bureau, ADDP, HQ-7H036E

4600 Silver Hill Road

Washington, DC 20233-0001

Phone: (301) 763-5790

Email: scott.albrecht@census.gov

Sample Design

Tracy Mattingly      

Lead Scientist

U.S. Census Bureau, DSMD, HQ-7H161_1

4600 Silver Hill Road

Washington, DC 20233-0001

Phone: (301) 763-6445

Email: tracy.l.mattingly@census.gov

List of Attachments:

Appendix A – 2020 NSCH Questionnaire Content Revisions

Appendix B – 2020 NSCH Sample Frame and Sampling Flags Creation

Appendix C – 2020 NSCH Table of State Sample Sizes

Appendix D – 2020 NSCH Screener and Topical Questionnaire Drafts

Appendix E – 2020 NSCH Traditional Production Sample Letters

Appendix F – 2020 NSCH Redesigned Production Sample Letters

1 The MAF is a Title 13 data source, and all data collected are confidential under 13 U.S.C. Section 9. All access to Title 13 data from this survey is restricted to Census Bureau employees and those holding Census Bureau Special Sworn Status pursuant to 13 U.S.C. Section 23(c).

2 Bethell CD, Read D, Stein RE, Blumberg SJ, Wells N, Newacheck PW. Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2002 Jan-Feb; 2(1):38–48. This came from the 2005-2006 CSHCN Chartbook (pg 10): http://mchb.hrsa.gov/cshcn05/MI/NSCSHCN.pdf

3 Dillman, D.A.; Smyth, J.D.; Christian, L.M. (2009). Internet, mail and mixed-mode surveys: The tailored design method, 3rd edition. Hoboken, NJ: John Wiley & Sons.

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