Child Questionnaire

[NCHS] National Health Interview Survey

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Child 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 Child Questionnaire	Att 9c - 2024 Sample Child Questionnaire 10-24-2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0214	Sample Child Questionnaire NHIS_2025	Att 9c NHIS_2025 Sample Child.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: 10,000	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	10,000	0	10,000
Annual IC Time Burden (Hours)	3,000	-667	3,667
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.