National Health Interview Survey (NHIS) cognitive testing

Generic Clearance for Questionnaire Pretesting Research

Documents and Forms

Document Name Document Type
National Health Interview Survey (NHIS) cognitive testing Form and Instruction
Questionnaire NHIS Questionnaire (Attachment III).docx Form and Instruction
NHIS OMB letter (Attachment IV).docx OMB Memo IC Document
NHIS Communications (Attachment I).docx Communication Materials IC Document
NHIS Protocol (Attachment II).docx Protocol IC Document
Re_ Terms of Clearance - Census GenIC for NHIS Cog Testing - OMB Control No. 0607-0725_Redacted.pdf Terms of Clearance IC Document

Information Collection (IC) Details

IC Title:	National Health Interview Survey (NHIS) cognitive testing	Agency IC Tracking Number:

IC Status: Unchanged

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	Questionnaire	NHIS Questionnaire (Attachment III).docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	NHIS OMB letter (Attachment IV).docx	05/19/2025
Communication Materials	NHIS Communications (Attachment I).docx	05/19/2025
Protocol	NHIS Protocol (Attachment II).docx	05/19/2025
Terms of Clearance	Re_ Terms of Clearance - Census GenIC for NHIS Cog Testing - OMB Control No. 0607-0725_Redacted.pdf	06/09/2025

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