COVID-Related Questions Sample Adult 2019 Follow-back

Changes to 2020 National Health Interview Survey in light of Novel Coronavirus (2019-nCoV)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0214 COVID-Related Questions Sample Adult 2019 Follow-back Form and Instruction
0920-0214 Sample Adult 2019 Follow-back 2020 Q3 Emergency NHIS Attachment A 06012020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	COVID-Related Questions Sample Adult 2019 Follow-back	Agency IC Tracking Number:	0920-0214-20PP

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0214	Sample Adult 2019 Follow-back	2020 Q3 Emergency NHIS Attachment A 06012020.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 16,129	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	16,129	16,129
Annual IC Time Burden (Hours)	14,247	14,247
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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