Sample Child 

[NCHS] National Health Interview Survey

Documents and Forms

Document Name Document Type
Sample Child  Form and Instruction
NHIS Teen Survey Att 7 - NHIS Teen - Content Summary and Field Dates.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Sample Child	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	n/a	NHIS Teen Survey	Att 7 - NHIS Teen - Content Summary and Field Dates.docx		Yes	Yes	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: 333	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	333	-334	667
Annual IC Time Burden (Hours)	83	-84	167
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.