Nonsubstantive Change Request
NATIONAL HEALTH INTERVIEW SURVEY
OMB No. 0920-0214, Expiration Date 12/31/2026
Contact Information:
Stephen Blumberg, PhD
Division of Health Interview Statistics
National Center for Health Statistics/CDC
3311 Toledo Road
Hyattsville, MD 20782
301.458.4107 (voice)
December 8, 2025
Sections
A. INTRODUCTION
B. JUSTIFICATION
1. Circumstances Making the Collection of Information Necessary
2. Purpose and Use of Information Collection
12. Estimates of Annualized Burden Hours and Costs
15. Explanation for Program Changes or Adjustments
List of Attachments
Att 3b |
NHIS Snapshot 3 Year-Cycle Questionnaire Content and Periodicity
|
Att 5b |
2026 NHIS Proposed New Content - Concepts Measured, Duplication, and Proposed Uses of Data |
Att 9a |
2026 NHIS Roster Questionnaire |
Att 9b |
2026 NHIS Sample Adult Questionnaire |
Att 9c |
2026 NHIS Sample Child Questionnaire |
Att 9d |
2026 Reinterview Questionnaire |
-
NCHS National Health Interview Survey
A. INTRODUCTION
This is a request for approval of a nonsubstantive change to the National Health Interview Survey (NHIS) (OMB No. 0920-0214, Exp. Date 12/31/2026), conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). This nonsubstantive change requests changes in content for the 2026 NHIS.
Summary of 2025 NHIS Content Changes
The NHIS has been conducted every year since 1957. The current design of the NHIS questionnaire, implemented in 2019, features a rotational schedule consisting of annual core, rotating core, emerging content, and sponsored content modules. Summarized here are the proposed nonsubstantive changes from the 2025 NHIS to the 2026 NHIS.
The NHIS rotates core content onto the survey on a periodic basis such that all content will appear at least once in a three-year cycle begun in 2019. As of the end of 2024, all NHIS rotating core content has been fielded at least twice.
Removed Content
Rotating sample adult core content that was on the NHIS in 2025 and will rotate off the 2026 NHIS includes aspirin use, depression and anxiety, preventive services, and chronic pain. Sponsored content that will be removed includes content on Long COVID, pain management, epilepsy, preventive screening, menopause, concussions, caregiving, voice, swallowing, speech, and language difficulty, and tetanus vaccination.
Items on mental health and stressful life events will rotate off the sample child core. Sponsored content on Long COVID, voice, swallowing, speech, and language difficulty, and concussions will also be removed.
Added Content
Relative to 2025, the 2026 annual core content will include minor changes to the health insurance section in both the sample adult and sample child questionnaires. Five existing questions on reasons for lacking health coverage will be asked of additional respondents. In 2025, these questions were asked only of respondents who did not have insurance coverage at the time of interviewing; in 2026, these items will also be administered to any respondents who had a gap in coverage during the past year. There will also be two new questions within this section to allow for the collection of verbatim responses describing reasons for lacking health coverage.
The 2026 rotating sample adult content will include questions that were last fielded in the 2024 NHIS including fatigue, alcohol and cigarette use, physical activity, sleep, employment, and content of care (advised to increase physical activity). Rotating core content on dental and therapeutic care will continue from 2025.
Sample adult sponsored content for 2026 includes items on life satisfaction, whole person health, use of insulin and injectable GLP-1 medications, ADD and ADHD, social functioning, age of disability onset, pregnancy resulting in live birth, COVID-19 and other vaccinations, tobacco product use, social support and loneliness, social connectedness and isolation, chronic fatigue, immunosuppression, arthritis, content of care (advised to participate in a weight-loss program), diet and nutrition, hearing, and smoking cessation methods. Sponsored content on social functioning will be fielded for the first time in 2026. Sponsored content sections on smoking cessation methods and use of other tobacco products have been fielded previously; in 2026, this section will include additional items on smoking cessation and use of nicotine pouches. The remainder of the 2026 sponsored content is returning after being fielded in recent years.
Emerging content on internet access and health information technology, language spoken at home, volunteer activities, civic engagement, and social supports for parents will be retained from the 2025 questionnaire. Additionally, four items from the 2025 rotating core content on depression and anxiety will be retained in 2026 as emerging content, as was done in 2023. This will ensure continued measurement of mental health symptoms across cycles.
The 2026 rotating sample child core will include items on service utilization (dental care, physical and other therapeutic care), BMI (height and weight), injury, physical activity, neighborhood characteristics, sleep, and screen time. All this rotating content has been fielded on the NHIS since the 2019 NHIS redesign. Sponsored content on COVID-19 vaccination will be retained from the 2025 sample child questionnaire, and sponsored content on chronic fatigue and hearing will be added for 2026.
Reinterview Questionnaire Changes
Finally, some questions on the reinterview questionnaire will be replaced to reflect new content changes within the 2026 NHIS. Two questions asking about whether the sampled adult remembered being asked about problems or difficulty with their voice or trouble speaking in the past 12 months and if they had pain in the past 3 months will be replaced by two questions asking whether the sampled adult remembered being asked about how often they ate fresh, frozen, or canned fruit and how many hours of sleep they had in a 24-hour period. Two questions asking whether the sample child respondent remembered being asked about if their child had ever been separated from a parent or guardian because the parent or guardian went to jail and whether their child lost consciousness or had been dazed due to a blow or jolt to the head in the past 12 months will be replaced with two questions asking whether they remember being asked if their child spent time most weekdays in front of a TV, computer, cellphone, or other electronic device and if their child had any accident where any part of his/her body was hurt in the past 3 months.
Detailed List of 2026 NHIS Content Changes
Annual Core Content
The NHIS includes a core set of annual content areas that are fielded each year. The following minor additions were made to the NHIS annual core to facilitate the collection of verbatim responses on reasons for lacking health coverage in past year.
Adults
Add 2 questions to facilitate collection of verbatim responses
Children
Add 2 questions to facilitate collection of verbatim responses
Rotating Content
The NHIS annually rotates content in and out of the questionnaire on a fixed schedule (see Attachment 3b).
Below is a list of rotating questions that will continue from 2025 to the 2026 NHIS.
Adults
Continue 3 questions on dental care
Continue 3 questions on physical or other therapeutic care
Children
Continue 3 questions on dental care
Continue 3 questions on physical and other therapeutic care
Below is a list of questions scheduled to be rotated in for the 2026 NHIS.
Adults
Rotate in 8 questions on repetitive strain injury
Rotate in 21 questions on injury
Rotate in 3 questions on fatigue
Rotate in 8 questions on alcohol use
Rotate in 5 questions on physical activities
Rotate in 8 questions on walking
Rotate in 7 questions on sleep
Rotate in 6 questions on detailed employment
Rotate in 1 question on content of care (advised to increase physical activity)
Rotate in 4 questions on cigarettes and e-cigarettes
Children
Rotate in 2 questions on BMI (height and weight)
Rotate in 18 questions on injury
Rotate in 6 questions on physical activity
Rotate in 4 questions on neighborhood characteristics
Rotate in 6 questions on sleep
Rotate in 1 question on screen time
Below is a list of questions scheduled to be rotated out for the 2026 NHIS. In accordance with the fixed schedule, questions on preventive services and chronic pain will return in 2027.
Adults
Rotate out 2 questions on aspirin use
Rotate out 6 questions on depression
Rotate out 5 questions on anxiety
Rotate out 17 questions on preventive services
Rotate out 10 questions on chronic pain
Children
Rotate out 33 questions on mental health (SDQ Questionnaire)
Rotate out 4 questions on stressful life events
Sponsored Content
The NHIS also works with sponsors from other CDC centers, NIH, and other government agencies to field content relevant to their missions.
Below is a list of sponsored questions that will continue from 2025 to the 2026 NHIS.
Adults
Continue 1 question on life satisfaction
Continue 3 questions on insulin use
Continue 1 question on injectable medications (GLP-1)
Continue 3 questions on blood sugar and A1C testing
Continue 5 questions on ADD and ADHD
Continue 8 questions on whole person health
Continue 1 question on age of disability onset
Continue 1 question on pregnancy resulting in live birth
Continue 1 question on Tdap vaccination
Continue 2 questions on COVID-19 vaccination
Continue 1 question on shingles vaccination
Continue 1 question on RSV vaccination
Continue 5 questions on other tobacco products
Continue 2 questions on social support and loneliness
Continue 4 questions on social connectedness and isolation
Children
Continue 2 questions on COVID-19 vaccination
Below is a list of sponsored questions to be added in the 2026 NHIS.
Adults
Add 2 questions on social functioning
Add 2 questions on chronic fatigue
Add 2 questions on immunosuppression
Add 5 questions on arthritis
Add 2 questions on content of care (advised to participate in a weight-loss program)
Add 14 items on diet and nutrition
Add 25 questions on hearing
Add 9 items on smoking cessation methods
Add 2 questions on other tobacco products (nicotine pouches)
Children
Add 2 questions on chronic fatigue
Add 25 items on hearing
Below is a list of sponsored questions to be removed from the 2026 NHIS.
Adults
Remove 4 questions on Long COVID
Remove 1 question on stress from living with diabetes
Remove 11 questions on pain management
Remove 4 questions on epilepsy
Remove 22 questions on preventive screening
Remove 5 questions on menopause
Remove 5 questions on concussions
Remove 1 question on caregiving
Remove 17 questions on voice, swallowing, speech, and language difficulty
Remove 1 question on tetanus vaccination
Children
Remove 4 questions on Long COVID
Remove 17 questions on voice, swallowing, speech, and language difficulty
Remove 5 questions on concussions
Emerging Content
Finally, as part of the redesigned NHIS some survey time is allotted to capture emerging public health issues or to support weighting and calibration for the NCHS Rapid Surveys System (OMB# 0920-1408, expires 6/30/2026).
Below is a list of emerging content questions that will continue from 2025 to the 2026 NHIS.
Adults
Continue 5 questions on Internet access and health information technology
Continue 6 questions on language spoken at home
Continue 2 questions on volunteer activities
Continue 2 questions on civic engagement
Continue 3 questions on social supports for parents
Continue 4 questions on depression and anxiety
B. JUSTIFICATION
Background
The NHIS is conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), to comply with the NCHS mandate under 42 USC 242k to collect, on an annual basis, statistically valid data on the amount, distribution, and effects of illness and disability in the population and on the utilization of health care services for such conditions. NHIS data are used widely throughout the Department of Health and Human Services (DHHS) to monitor trends in illness and disability and to track progress toward achieving many of the health objectives for the nation. The data are also used by the public health research community for epidemiologic and policy analysis of such issues as characterizing those with various health problems, measuring levels of health insurance coverage, determining barriers to accessing and using health care, and evaluating the impact of changes in federal health programs.
In accordance with the 1995 initiative to increase the integration of surveys within DHHS, respondents to the NHIS serve as the sampling frame for the Medical Expenditure Panel Survey (MEPS; OMB# 0935-0118, expires 3/31/2027). MEPS uses completed interviews from the NHIS to identify and select the desired sample, contact that sample to collect additional data, and combine their survey data with the original NHIS data. These procedures reduce survey costs, reduce overall burden on the public, and increase the amount of data available for critical health-related analysis.
The NHIS has been conducted every year since 1957. The current design of the NHIS questionnaire implemented in 2019 features a rotational schedule consisting of annual core, rotating core and sponsored content modules. Attachment 3b provides a visual depiction of the content and module structure. The NHIS sample adult and sample child questionnaires include annual core content that is scheduled to be fielded every year, rotating content that is fielded periodically, emerging content to address new topics of growing interest to NCHS, CDC, and DHHS, and sponsored content that is fielded when external funding is available.
The purposes of the NHIS are (1) to provide national data on an annual basis on the prevalence of chronic conditions and impairments, the extent of disability, the utilization of health care services, and other health-related topics; (2) to provide more detailed information on selected topics periodically and on a one time basis; and (3) to provide a sampling frame for the Medical Expenditure Panel Survey and other follow-back surveys. It is also a main provider of data for the Congressionally mandated Health, United States report and provides data for many indicators used in monitoring progress toward current Healthy People goals and for detailing health disparities; and (4) provide a gold standard to benchmark and calibrate estimates from the NCHS Rapid Surveys System (OMB# 0920-1408, expires 6/30/2026).
A major strength of the NHIS is its ability to display health characteristics by selected demographic and socio-economic characteristics of the U.S. civilian, noninstitutionalized population. NHIS data are typically used for program planning and evaluation, public health education and health promotion and epidemiological research. Input to the design of questions is solicited from experts in a variety of organizations within the federal government, and from outside researchers and public health professionals.
In addition to the principal questionnaires, like in past years, a small subsample (<5%) of respondents will be reinterviewed as a quality control measure; the reinterview questionnaire is provided in Attachment 9d.
Time Estimates
The average burden for each survey component for one complete one-year survey cycle is shown in the table below.
The estimated overall average annual burden for 2026, including the roster, adult questionnaire, child questionnaire, methodological projects, and the reinterview component is 37,507 hours.
Lines 1-3 of the burden table represent the different sections of the NHIS questionnaire. Line 4 covers any methodological projects such as web and/or mail-based methodological projects, cognitive testing, and mixed-mode NHIS activities. Small quality control reinterview surveys of participating households are represented on line 6.
Estimated Annualized Burden Hours
Type of Respondent |
Form Name |
Number of Respondents |
Number of Responses per respondent |
Average Burden per Response (in hours) |
Total Burden Hours |
Adult Household Member |
Household Roster |
36,000 |
1 |
4/60 |
2,400 |
Sample Adult |
Adult Questionnaire |
33,000 |
1 |
48/60 |
26,400 |
Adult Family Member |
Child Questionnaire |
10,000 |
1 |
20/60 |
3,333 |
Adult Family Member |
Methodological Projects |
15,000 |
1 |
20/60 |
5,000 |
Adult Family Member |
Reinterview Survey |
5,500 |
1 |
5/60 |
458 |
Total |
|
|
|
|
37,591 |
Not all questions apply to each person, and the questionnaire instrument automatically skips over questions that do not apply, based on earlier information given by the respondent. Thus, no respondent is ever asked all of the questions in the questionnaire.
The estimate of response burden above is based on an average length of interview per household. Variations occur in individual household interview times primarily because of differing numbers of persons in the household and variations in the number of health conditions reported in the household.
The burden on any single member of a sample family also varies according to who is the designated respondent for each component. In some families the same adult could be the respondent for all of the major components: roster, adult, and child. In other families there could be a different respondent for each component. In the first case, the total average burden on the single respondent would be about one hour; in all other cases the burden on a single respondent would be less.
The NHIS-Teen will not be conducted in 2026, was removed from the table above.
B. Cost to Respondents
At an average wage rate of $36.43 per hour, the estimated annualized cost for the 37,591 burden hours is $1,366,380. (Wage information is from the Bureau of Labor Statistics: http://www.bls.gov/news.release/empsit.t19.htm.) This estimated cost does not represent an out-of-pocket expense but represents a monetary value attributed to the time spent doing the interview.
Estimated Annualized Burden Costs
Type of Respondent |
Form Name |
Total Burden Hours |
Hourly Wage Rate |
Total Respondent Costs |
Adult Household Member |
Household Roster |
2,400 |
$36.43 |
$87,432 |
Sample Adult |
Adult Questionnaire |
26,400 |
$36.43 |
$961,752 |
Adult Family Member |
Child Questionnaire |
3,300 |
$36.43 |
$120,219 |
Adult Family Member |
Methodological Projects |
4,950 |
$36.43 |
$180,329 |
Adult Family Member |
Reinterview Survey |
457 |
$36.43 |
$16,649 |
Total |
$1,366,380 |
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There is a slight decrease in average annualized burden for the 2026 NHIS compared to the 2025 NHIS. This decrease in burden is due to observed timings (actual average burden per response) for the 2025 NHIS, which were shorter than originally estimated. Additionally, the NHIS-Teen will not be conducted in 2026, so it was removed from the burden estimates.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | gnx5 |
| File Modified | 0000-00-00 |
| File Created | 2026-01-29 |