Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Document Name	Status
BRFSS Optional Modules Form	New
BRFSS Core Survey Form	New
Cell Phone Screener Form and Instruction	New
Landline Screener Form and Instruction	New
Attachment 7d 2013 BRFSS Overview.pdf Supplementary Document	2015-03-26
Attachment 7c 2013 Weighting Documentation.pdf Supplementary Document	2015-03-26
IRB 2988_Continuation9 (3) 2013.docx Supplementary Document	2015-01-14
Attachment 11-BRFSS Questionnaire Development Process.docx Supplementary Document	2015-01-14
Attachment 10b-Coding for Technological Barriers.docx Supplementary Document	2015-01-14
Attachment 10a-Disposition Table with Callback Rules.docx Supplementary Document	2015-01-14
Attachment 9-BRFSS Data Collectors by State.docx Supplementary Document	2015-01-14
Attachment 7-U S Population and BRFSS Sample Size.docx Supplementary Document	2015-01-14
Attachment 6b-Summary of Public Comments.pdf Supplementary Document	2015-01-14
Attachment 6a-FRN 9 15 2014.pdf Supplementary Document	2015-01-14
Attachment 2-List of BRFSS Awardees.docx Supplementary Document	2015-01-14
Attachment 1-Authorizing Legislation.pdf Supplementary Document	2015-01-14
BRFSS SS-B_3 23 2015.docx Supporting Statement B	2015-03-26
BRFSS SS-A_3 23 2015.docx Supporting Statement A	2015-03-26

IC Document Collections

IC ID	Document Title	Status
214640	BRFSS Optional Modules Form	New
214638	BRFSS Core Survey Form	New
214637	Cell Phone Screener Form and Instruction	New
214636	Landline Screener Form and Instruction	New

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201501-0920-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14AYC
Title: Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/30/2015
	Date Received in OIRA: 01/21/2015
Terms of Clearance: This ICR is approved with the following terms of clearance: (1) OMB requires, at a minimum, an annual non substantive change request for changes in sample size and/or questionnaires at least three months before the planned data collection in the field, allowing OMB sufficient time to suggest changes, if needed, before data collection instruments are finalized. (2) Additional information should be provided in the next submission to explain how CDC is calculating and communicating effective sample sizes, and ensuring calculation of appropriate standard errors. (3) In the next submission, CDC will provide plans for ongoing work in the areas of non-response bias and benchmarking, as well as providing documentation and explanation of what has been done in these areas so far. (4) CDC is strongly encouraged to engage early with OMB on potential changes to the study design (e.g. use of internet panels rather than telephone surveys).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved
Responses	1,643,227	0	0
Time Burden (Hours)	255,915	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Behavioral Risk Factor Surveillance System (BRFSS) is a nationwide system of customized, cross-sectional telephone health surveys involving states, territories, and the District of Columbia.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 54983	09/15/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 2428	01/16/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Landline Screener	none	Landline Interview Screener
Cell Phone Screener	none	Cell Phone Screener
BRFSS Optional Modules	none, none	BRFSS Optional Modules ,   BRFSS Sample Questionnaire
BRFSS Core Survey	none	BRFSS Core Survey

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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	1,643,227	0	0	0	0	1,643,227
Annual Time Burden (Hours)	255,915	0	0	0	0	255,915
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:

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Annual Cost to Federal Government: $17,500,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

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Common Form ICR:  No

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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: 01/21/2015

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