№ files_lp_4_process_2_55266
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Introductory and questionnaire text from a public health survey conducted by the National Center for Health Statistics within the Centers for Disease Control and Prevention describing consent, confidentiality assurances, and survey questions on language use, health status, and anxiety symptoms.
Year:
2026
Country:
United States
Subject:
Public health survey and health status data collection
Document type:
Survey introduction and questionnaire excerpt
Organization:
National Center for Health Statistics
Parent organization:
Centers for Disease Control and Prevention
Regulatory reference:
Public Health Service Act Section 308(d); Confidential Information Protection and Statistical Efficiency Act
OMB Control Number:
0920-0222
Expiration date:
01/31/2026
Estimated response time:
15 minutes
Data protection:
Confidential statistical use of identifiable information
Participation conditions:
Voluntary participation with option to skip questions or withdraw
Contact for ethics questions:
NCHS Ethics Review Board
Contact phone:
1-800-223-8118
Survey mode:
Web questionnaire and phone interview
Main topics:
Language use, self-rated health status, chronic conditions, anxiety symptoms
Target population:
Members of the public participating in a health survey in the United States
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Year:
2021
Region / City:
United States
Topic:
Public health survey
Document Type:
Data collection form
Agency:
Centers for Disease Control and Prevention
Department:
National Center for Health Statistics
Approval Number:
OMB 0920-0222
Confidentiality:
Responses used only for statistical purposes
Target Population:
Study participants
Data Collected:
Demographics, education, employment, income
Expiration Date:
08/31/2021
Instructions Included:
Yes
Form Sections:
Source of awareness, Gender, Age, Marital status, Ethnicity, Race, Education, Employment, Household income
Statutory Basis:
Public Health Service Act, CIPSEA 2002
Year:
2023
Region / City:
United States
Topic:
Health Survey
Document Type:
Survey Protocol
Organization / Institution:
National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC)
Author:
NCHS
Target Audience:
Survey Respondents
Effective Period:
Ongoing
Approval Date:
2023
Date of Changes:
Not specified
Year:
2023
Region / City:
United States
Topic:
Health statistics, public health surveys
Document Type:
Survey questionnaire
Institution:
National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC)
Author:
National Center for Health Statistics (NCHS)
Target Audience:
Survey participants
Period of validity:
2023
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2023
Region / City:
United States
Topic:
Health statistics, Survey methodology
Document type:
Survey protocol
Institution:
National Center for Health Statistics (NCHS)
Author:
National Center for Health Statistics (NCHS)
Target audience:
Researchers, survey administrators, and statisticians
Period of validity:
Ongoing
Approval date:
2023
Date of amendments:
Not specified
Year:
2017
Organization:
National Center for Health Statistics (NCHS)
Type of document:
Survey questionnaire
Approval:
Executive Office of the President, Office of Management and Budget (OMB)
Target audience:
Users of the NCHS website
Purpose:
Assess user satisfaction with NCHS website and its information
Number of questions:
14
Data collection:
Voluntary and anonymous
Topics covered:
Website usability, information accessibility, data products usage, user demographics
Distribution method:
Online survey
Year:
2026
Organization:
National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC)
Document type:
Survey Questionnaire
Target population:
Adult U.S. residents
Mode of administration:
Web (CAWI) and Telephone (CATI)
Data collection period:
Round 1
Estimated completion time:
20 minutes
Confidentiality:
Responses kept confidential, used for statistical purposes only
Legal compliance:
Public Health Service Act Section 308(d), CIPSEA 2018, Federal Cybersecurity Enhancement Act 2015
Variables collected:
Demographics, health history, behaviors, opinions
Year:
2016
Region / City:
Hyattsville, MD
Subject:
Data collection for educational summer camp
Document Type:
Government clearance statement
Organization / Institution:
National Center for Health Statistics
Author:
Ryne Paulose
Target Audience:
Middle school students, parents, teachers
Period of validity:
2014–2017
Approval Date:
May 14, 2014
Date of Changes:
Not mentioned
Year:
2023
Region / Country:
United States
Topic:
Law enforcement training and officer wellness
Document type:
Survey supporting statement
Agency / Institution:
Bureau of Justice Statistics (BJS)
Author:
Bureau of Justice Statistics
Target audience:
Law enforcement agencies, policymakers, researchers
Survey period:
September 2023 – May 2024
Legal authority:
34 USC § 10132
Data collection agent:
RTI International
Sample size:
Approximately 3,500 general-purpose law enforcement agencies
Related programs:
Law Enforcement Core Statistics (LECS), LEMAS core survey, Census of Law Enforcement Training Academies (CLETA), Law Enforcement Suicide Data Collection (LESDC)
Note:
Year
Topic:
Wellness Policy, Nutrition, Physical Activity
Document Type:
Assessment Tool
Organization:
Arizona Department of Education
Author:
Arizona Department of Education
Target Audience:
School administrators, educators, school staff
Period of validity:
Ongoing
Year:
2022
Region / City:
Arizona
Subject:
Mental health, school wellness
Document Type:
Application Instructions
Organization:
Arizona Department of Education
Author:
Arizona Department of Education
Target Audience:
Local Educational Agencies (LEAs), school personnel, community partners
Period of validity:
09/30/2021 - 09/29/2026
Approval Date:
September 30, 2021
Amendment Date:
N/A
Document type:
Standard Operating Procedure
Title:
Health and Wellness Center Staffing
Organization:
Job Corps
Department:
Health and Wellness Center
Regulatory reference:
Policy and Requirements Handbook (PRH) Chapter 5.2 R3, R5; Exhibits 5-3 and 5-6; Information Notice 15-27
Responsible role:
Center Director
Approval authority:
Regional Office or National Office in consultation with Regional Health Specialists
Scope:
Health and Wellness Center staffing and supervision
Applicable professions:
Health and Wellness Director, Registered Nurse, Licensed Practical/Vocational Nurse, physicians, nurse practitioners, physician assistants, dental staff, TEAP specialists, mental health professionals
Licensing requirement:
State licensure and compliance with state and federal practice acts
Staffing standards reference:
PRH Exhibit 5-6
Status:
Example standard operating procedure requiring center-specific adaptation
Effective date:
Not specified
Geographic applicability:
United States, state-specific practice laws
Year:
2023
Region / City:
Santa Fe
Topic:
Employee Wellness, Mental Health
Document Type:
Resolution
Organization:
City of Santa Fe
Author:
Councilor Amanda Chavez, Councilor Chris Rivera
Target Audience:
City Employees
Period of Action:
2023-2025
Approval Date:
Not specified
Date of Changes:
Not specified
Context:
A resolution by the City of Santa Fe to establish a two-year pilot program supporting the physical and mental wellbeing of employees, including new leave benefits for wellness and fitness.
Year:
2026
Region / City:
Bellevue, Washington
Subject:
Nuclear Medicine Technology
Document Type:
Application Checklist
Institution:
Bellevue College
Author:
Bellevue College
Target Audience:
Prospective students applying to the Nuclear Medicine Technology program
Period of Validity:
Until February 27, 2026
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2023
Region / City:
Cleveland, Ohio
Theme:
Student wellness, physical education, nutrition
Document Type:
District Wellness Plan
Organization / Institution:
Cleveland Metropolitan School District
Author:
Cleveland Metropolitan School District
Target Audience:
School staff, students, families, community partners
Period of Action:
Ongoing
Approval Date:
Not specified
Date of Revisions:
Not specified
Year:
2024
Region / City:
British Columbia
Theme:
Disaster Recovery, Mental Health, Community Wellness
Document Type:
Toolkit
Author:
Not specified
Target Audience:
Policy makers, managers, clinicians, physicians, community members
Period of Effectiveness:
Ongoing
Approval Date:
July 2024
Date of Changes:
Not specified
Year:
2025
Region / City:
Maryland
Theme:
Workplace Wellness
Document Type:
Application and Guidance
Organization:
Maryland Department of Health, Prevention and Health Promotion Administration, Center for Chronic Disease Prevention and Control
Author:
Maryland Department of Health
Target Audience:
Maryland businesses
Period of Action:
2025
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2023
Region/City:
United States
Subject:
Health and Wellness Review, Applicant Evaluation, Medical Condition Assessment
Document Type:
Form
Organization:
Job Corps
Author:
Job Corps Health and Wellness Director
Target Audience:
Health professionals, Disability Coordinators, Job Corps staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2024
Region / City:
N/A
Subject:
Document Management
Document Type:
Policy
Organization / Institution:
Hirsch Wellness Network, Inc.
Author:
N/A
Target Audience:
Employees of Hirsch Wellness Network, Inc.
Effective Period:
N/A
Approval Date:
10.17.24
Modification Date:
N/A
Year:
2023
Region / City:
Mt. SAC campus
Topic:
Mental Health Support and Wellness Services
Document Type:
Meeting Minutes
Organization / Institution:
Mt. SAC
Author:
Seth Meyers, Haneen Alghita-Aguilar, and others
Target Audience:
Staff and committee members involved in mental health support and wellness
Period of Action:
2023-2024 academic year
Approval Date:
September 12th, 2023
Date of Changes:
None
Type of document:
Student wellness plan template with completed responses
Activity:
Application Activity: Wellness Plan
Goal categories:
Physical health; Social health
Goal 1 target:
Blood sugar levels around 110 and below
Goal 1 deadline:
30 days; yearly physical in May
Goal 2 target:
Contact and visit ministering sisters and family once a week
Goal 2 deadline:
About 2 weeks for self-reflection in journal
Context:
A completed student wellness-plan worksheet outlining two SMART goals—one physical and one social—based on course lesson material.