National Survey of Children's Health

Forms and Documents

Document Name	Status
Form NSCH-S1 National Survey of Children's Health Form and Instruction	Unchanged
Modified Non Substantive Change Request - 2018 NSCH 122917.docx Justification for No Material/Nonsubstantive Change	2017-12-29
Non Substantive Change Request - 2018 NSCH.docx Justification for No Material/Nonsubstantive Change	2017-12-06
2017 NSCH Non Substantive Change Request_TopicalIncentive _draft.docx Justification for No Material/Nonsubstantive Change	2017-10-17
NSCH 2017 OMB 83-i.pdf Supplementary Document	2017-03-28
Pre-Submission Notice 2017 NSCH_FINAL DRAFT.docx Supplementary Document	2017-03-28
PRA Executive Summary Form v1.2_ 2-17-17.pdf Supplementary Document	2017-04-12
NSCH_OMB_AppendixD.docx Supplementary Document	2017-03-28
NSCH_OMB_AppendixC.docx Supplementary Document	2017-04-04
NSCH_OMB_AppendixB.docx Supplementary Document	2017-03-28
NSCH_OMB_AppendixA.pdf Supplementary Document	2017-03-28
Part A - NSCH 2017 Production OMB.docx Supporting Statement A	2017-04-04
Part B - NSCH 2017 Production OMB.docx Supporting Statement B	2017-03-28

IC Document Collections

IC ID	Document Title	Status
220525	National Survey of Children's Health Form and Instruction	Unchanged

ICR Details

OMB Control No: 0607-0990	ICR Reference No: 201712-0607-002
Status: Historical Active	Previous ICR Reference No: 201710-0607-007
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: National Survey of Children's Health
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/29/2017
	Date Received in OIRA: 12/07/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	05/31/2019	05/31/2019
Responses	266,906	0	266,906
Time Burden (Hours)	16,573	0	16,573
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Survey of Children’s Health (NSCH) enables the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) to produce national and state-based estimates on the health and well-being of children, their families, and their communities as well as estimates of the prevalence and impact of children with special health care needs. Data will be collected using two modes. The first mode is an Internet survey that contains the screener and topical instruments. The Internet instrument first will take the respondent through the screener questions. If the household screens into the study, the respondent will be taken directly into one of the three age-based topical sets of questions. The second mode that is a mailout/mailback of a self-administered paper-and-pencil interviewing (PAPI) screener instrument followed by a separate mailout/mailback of a PAPI age-based topical instrument. This submission requests approval for a large-scale (N = 156,054 addresses) national Web and Paper-and-Pencil Interview (PAPI) survey. Incentives ($2 bill) will be included in the initial invite letter for 90% of the sample, while the other 10% of the sample will not receive an incentive as a way to monitor incentive effectiveness. The survey will consist of two experiments to evaluate opportunities to incorporate efficiencies in the data collection process. The first experiment will test the efficacy of an infographic in the initial mail package and conditional upon funding, the second experiment will test the efficacy of incentives in the topical mailings. The design and content of the NSCH 2017 survey is based on preliminary 2016 NSCH results.

---

Authorizing Statute(s): US Code: 13 USC Section 8(b) Name of Law: null
   US Code: 42 USC Section 701(a)(2) Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 249	12/28/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 17409	04/11/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
National Survey of Children's Health	NSCH-S1, NSCH-T3, NSCH-T1, NSCH-S-S1, NSCH-S-T1, NSCH-S-T2, NSCH-S-T3, NSCH-T2	NSCH-Screener - English ,   NSCH Topical 1 (0-5) - English ,   NSCH Topical 2 (6-11) - English ,   NSCH Topical 3 (12-17) - English ,   NSCH-Screener - Spanish ,   NSCH Topical 1 (0-5) - Spanish ,   NSCH Topical 2 (6-11) - Spanish ,   NSCH Topical 3 (12-17) - Spanish

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	266,906	266,906	0	0	0	0
Annual Time Burden (Hours)	16,573	16,573	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Program change-reduction in the sample size.

---

Annual Cost to Federal Government: $4,925,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/07/2017

---