ExaminationAssent Brochure 7-11 years of age 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics AND PREVENTION 
This booklet contains facts for you about the 

National Health and Nutrition Examination Survey 
The National Health and Nutrition Examination 5urvey 

(NHANE5) studies the health and diet of people in this 

country. 

We go all over”the+United 5tates in these vans, 

The survey will look at how young people grow and develop. 

We wi II look at special hea lth, prob ilems that may affect 

kids. 
Our survey wants you to Gorne to this exam center. Your 

exam will help u5 find out more about the health of children 

your age. 

We will ask questions about 

what you eat and drink. 

You will change into special 

exam clothes at the exam 

Genter, 

National Health and Nutrition Examination 5urvey 
Our doctor will take your 

blood pressure. 

will see how much you 

gh and how tall you are., 

Our d&t&t will look at 

your teeth. 

National Health and Nutrition Examfnation 5urwy 
We Will,check’your .1 blood and

urine in our lab. 

We will give you money to 

thank you for helping us 

with our survey. ’ 

We will send you and your 

parentsa reportonyour 

exam. 

Our staff will answerany 

questions you have. 

We would like you to go to our mobile exam center vans for an exam. You will 

help us learn more about all children in the United 5tates. 

If you are 6 year&$ older, we will ask you about your feelings and about hbw 

you have been doin,g at home and school. Your mother (or other grown-up) will ” . 

be called to ans&,pr.these same questions about you. 
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FORM APPROVED: OMB # 0920-0237 

National Health ancll Nutrition Exarmination Survey (NHANES) 

Your parents say that you can take part in this special survey. You have just read about the 

survey in this book. The survey tells us about the health of people. We will ask you to have an 

exam at our vans that are here in your town. This exam is a little like going to the doctor. 

Other kids and their families will be at the center. You do not have to do this if you do not want 

to. If you take part, you will learn some things about yourself. You will help us learn a lot about 

other kids in the United States. 

If you want to take part in the survey, write your name below. 

Signature of participant 7-11 years old 

Print name of participant 

Signature of staff member Date 

SP ID 

Public reporting burden of this collection of information is estimated to average 6.6 hours per response for total participation, including the time 

for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the 

collection of information. An agency may not conduct or sponsor, and a person is not required to respond to collection of information unless it 

displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden to CDUATSDR Reports Clearance Officer; 1800 Clifton Road, MS D-24, Atlanta, 

GA 30333, ATTN: PRA (0920-0237). 
For more information about the National Center for Health Statistics and the National Health and 

Nutrition Examination Survey contact: 

Data Dissemination Branch 

National Center for Health Statistics 

Room 1064, Presidential Building 

6525 Belcrest Road 

Hyattsville, Maryland 20782-2003 

Telephone: (301) 458-4636 

E-mail: nchsquery@ cdc.gov 

Internet: www.cdc.gov/nchs/ 

O-0049 (1 l/99)