Adult Questionnaire

[NCHS] National Health Interview Survey

Documents and Forms

Document Name Document Type
Adult Questionnaire Form and Instruction
2024 NHIS Sample Adult Questionnaire Att 9b - 2024 Sample Adult Questionnaire 10-24-2023.pdf Form and Instruction
0920-0214 Sample Adult Questionnaire NHIS_2025 Att 9b NHIS_2025_Sample Adult.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Adult Questionnaire	Agency IC Tracking Number:	0920-0214

Is this a Common Form? No		IC Status: Modified

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	None	2024 NHIS Sample Adult Questionnaire	Att 9b - 2024 Sample Adult Questionnaire 10-24-2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0214	Sample Adult Questionnaire NHIS_2025	Att 9b NHIS_2025_Sample Adult.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population	FR Citation: 49 FR 37693

Number of Respondents: 33,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	33,000	0	33,000
Annual IC Time Burden (Hours)	26,950	-550	27,500
Annual IC Cost Burden (Dollars)	0	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.