NHIS Follow-up Health Study

Developmental Projects to Improve the National Health and Nutrition Examination Survey and Similar Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1208 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1208 NHIS Follow-up Health Study Form and Instruction
Attachment 1e - Appointment Scheduling and Reminders.docx Instruction
0920-1208 NHIS Follow-up Health Study Invitation to Participate Qu Attachment 1c - Invitation questions and help screen.docx Form and Instruction
0920-1208 Home Health Visit Data Collection Forms Attachment 1i - Main Data Collection Forms.docx Form and Instruction
Attachment 1a - Response to Exams After Surveys_clean.docx Response to exams after surveys IC Document
Attachment 1b - COVID Safety Precautions.docx COVID-19 Safety Precautions IC Document
Attachment 1d - Respondent brochure.docx Respondent Brochure IC Document
Attachment 1f - Respondent conversion letter and brochure.docx Respondent conversion letter and brochure IC Document
Attachment 1g - MeasuresLabTestHandoutCOVIDHandout.docx Health Measurements and Laboratory Tests on Blood & Urine IC Document
Attachment 1h - Consent Form.docx HOME VISIT CONSENT IC Document
Attachment 1j - Initial Report.docx Home Health Visit Data Collection Forms IC Document
Attachment 1k- Final Report.docx Final Report of Findings IC Document
Attachment 2 - NCHS Ethics Review Board (ERB) Approval .docx NCHS Ethics Review Board (ERB) Approval IC Document
NHIS FHS Supporting Statement A_Feb26.docx National Health Interview Survey (NHIS) Follow-up Health Study IC Document
NHIS FHS Supporting Statement B_Feb26.docx National Health Interview Survey (NHIS) Follow-up Health Study IC Document

Information Collection (IC) Details

IC Title:	NHIS Follow-up Health Study	Agency IC Tracking Number:	0920-1208-21DP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	0920-1208	NHIS Follow-up Health Study Invitation to Participate Questions	Attachment 1c - Invitation questions and help screen.docx	No	Fillable Fileable
Instruction			Attachment 1e - Appointment Scheduling and Reminders.docx	No	Fillable Fileable
Form and Instruction	0920-1208	Home Health Visit Data Collection Forms	Attachment 1i - Main Data Collection Forms.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	1,170	1,170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Response to exams after surveys	Attachment 1a - Response to Exams After Surveys_clean.docx	03/03/2021
COVID-19 Safety Precautions	Attachment 1b - COVID Safety Precautions.docx	03/03/2021
Respondent Brochure	Attachment 1d - Respondent brochure.docx	03/03/2021
Respondent conversion letter and brochure	Attachment 1f - Respondent conversion letter and brochure.docx	03/03/2021
Health Measurements and Laboratory Tests on Blood & Urine	Attachment 1g - MeasuresLabTestHandoutCOVIDHandout.docx	03/03/2021
HOME VISIT CONSENT	Attachment 1h - Consent Form.docx	03/03/2021
Home Health Visit Data Collection Forms	Attachment 1j - Initial Report.docx	03/03/2021
Final Report of Findings	Attachment 1k- Final Report.docx	03/03/2021
NCHS Ethics Review Board (ERB) Approval	Attachment 2 - NCHS Ethics Review Board (ERB) Approval .docx	03/03/2021
National Health Interview Survey (NHIS) Follow-up Health Study	NHIS FHS Supporting Statement A_Feb26.docx	03/03/2021
National Health Interview Survey (NHIS) Follow-up Health Study	NHIS FHS Supporting Statement B_Feb26.docx	03/03/2021

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