Information Collection

Behavioral Risk Factor Surveillance Programs

IC 194062 under ICR 201008-0920-002 · OMB 0920-0870.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0870 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Behavioral Risk Factor Surveillance Programs Form
1 Management Information System (MIS) screen shots Att 4. NCCDPHP MIS Screen Shots.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Behavioral Risk Factor Surveillance Programs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Management Information System (MIS) screen shots	Att 4. NCCDPHP MIS Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	106	106
Annual IC Time Burden (Hours)	636	636
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.