Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Core--line 3 Modified 44250 10325 0 Form and Instruction 3b Adult Core
Child Core--line 4 Modified 17550 2633 0 Form and Instruction 3c 2011 NHIS Questionnaire--Sample Child
Child Record Check--Line 5 Modified 2120 177 0 Form and Instruction 3d Child Record Check--Immunization History Questionnaire
Family Core - line 2 Modified 58000 22233 0 Form and Instruction 3a Family Core
National Health Interview Survey--Line 7 Modified 10570 705 0 Form and Instruction 3g Child Immunization Provider--NHIS Instrument Spec Report
Reinterview Survey--Line 9 Modified 4000 333 0 Form and Instruction 3h 2011 NHIS Reinterview Instrument Screens
Screener Questionnaire--Line 1 Modified 10000 833 0 Form and Instruction 1 OMB Statement and Screener Section of the
Supplements--Line 8 Modified 58000 17400 0 Form and Instruction 3f Family Health Insurance--Health Care Reform
Teen Record Check--Line 6 Modified 8450 704 0 Form and Instruction 3e National Health Interview Provider Survey--Teen
Total burden requested under this ICR: 212940 55343 0  
To view an IC, click on IC Title