Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
NHIS 2007 Adult Core Questionnaire Modified 23400 6630 0 Form and Instruction Not Assigned Adult Identification
Form and Instruction Not Assigned Adult Health Behaviors
Form and Instruction Not Assigned Adult Health Status and Limitations
Form and Instruction Not Assigned Adult Socio-Demographic
Form and Instruction Not Assigned Adult Conditions
Form and Instruction Not Assigned Adult Access to Health Care and Utilization
Form and Instruction Not Assigned Adult AIDS Knowledge and Attitudes
NHIS 2007 Adult Topical Module Modified 23400 5850 0 Instruction
NHIS 2007 Child Core Questionnaire Modified 9400 1410 0 Form and Instruction Not Assigned Child Health Status and Limitations
Form and Instruction Not Assigned Child Access to Health Care and Utilization
Form and Instruction Not Assigned Child Identification
Form and Instruction Not Assigned Child Mental Health Brief Questionnaire
Form and Instruction Not Assigned Child Mental Health Services
Form and Instruction Not Assigned Child Influenza Immunization
NHIS 2007 Child Topical Module Modified 9400 627 0 Form and Instruction Not Assigned Child Topical Module
NHIS 2007 Family Core Questionnaire Modified 30000 11500 0 Form and Instruction Not Assigned Family Identification
Form and Instruction Not Assigned Family Health Status and Limitations
Form and Instruction Not Assigned Family Injury and Poisoning
Form and Instruction Not Assigned Family Access to Health Care and Utilization
Form and Instruction Not Assigned Family Health Insurance
Form and Instruction Not Assigned Family Socio-Demographic
Form and Instruction Not Assigned Family Income
Form and Instruction Not Assigned Recontact
NHIS 2007 Reinterview Survey Modified 3000 250 0 Form and Instruction Not Assigned Reinterview Survey
NHIS 2007 Screener Questionnaire Modified 15000 1250 0 Form and Instruction None Assigned Screener Questionnaire
Form and Instruction None Assigned Screener Survey
NIS 2008 Child Immunization Questionnaire Modified 1200 100 0 Form CDC 64.122 National Immunization Survey
NIS 2008 Teen Immunization Questionnaire Modified 4800 400 0 Form CDC 64.122 National Immunization Survey - Teen
Total burden requested under this ICR: 119600 28017 0  
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