Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Field Test Survey	Form and Instruction	New	Available
Field Test Screener	Form and Instruction	New	Available
BRFSS Sample Questionnaire	Form	Unchanged	Available
BRFSS Optional Modules	Form	Unchanged	Available
BRFSS Core Survey	Form	Unchanged	Repair queued
Cellphone Screener	Form and Instruction	Modified	Available
Landline Screener	Form and Instruction	Modified	Available
SS-B_4 18 2016.docx	Supporting Statement B	Uploaded 2016-04-19	Available
SS-A_4 19 2016_rev 6 06 2016.docx	Supporting Statement A	Uploaded 2016-06-06	Repair queued
IRB 2988_Continuation9 (3) 2013.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 12 BRFSS Questionnaire Development Process.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 11 Summary Data Quality Report.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 10b-Coding for Technological Barriers.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 10a-2016 Calling Protocols and Dispostion.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 9-BRFSS Data Collectors by State.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 7d 2013 BRFSS Overview.pdf	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 7c 2013 Weighting Documentation.pdf	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 7b Sampling Geostrata by State.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 7a-US Population and BRFSS Sample Size.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 6b Summary of public comments.pdf	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 6a FRN 1 20 2016.pdf	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 5b-Summary of Optional Modules by State.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 4a-2016 Approved Optional Modules.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 3a-Summary of all core sections.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 2-List of BRFSS Awardees.docx	Supplementary Document	Uploaded 2016-04-14	Available
Attachment 1-Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-04-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221083	Field Test Survey	Form and Instruction	New	Field Test Survey
221082	Field Test Screener	Form and Instruction	New	Field Test Screener
214640	BRFSS Optional Modules	Form	Unchanged	BRFSS Sample Questionnaire
214640	BRFSS Optional Modules	Form	Unchanged	BRFSS Optional Modules
214638	BRFSS Core Survey	Form	Unchanged	BRFSS Core Survey
214637	Cell Phone Screener	Form and Instruction	Modified	Cellphone Screener
214636	Landline Screener	Form and Instruction	Modified	Landline Screener

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201604-0920-008
Status: Historical Active	Previous ICR Reference No: 201512-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/07/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/21/2016
Terms of Clearance: Prior terms continue: CDC is encouraged to provide more leadership to the states in the area of question development, ensuring that the state decision process is informed by approaches available to maximize the value of their data. As a general matter, OMB recommends that national surveys: a) ensure that questions new have undergone rigorous cognitive testing, and, if additional testing is needed, it is desirable to coordinate such testing with other agencies who seek data on similar topics; and b) work in the direction of harmonizing, to the extent meaningful, question wording for core and rotating modules with question wording on the principle nationally-representative surveys on a given topic (e.g., the National Health Interview Survey, National Survey on Drug Use and Health, the Current Population Survey, the American Housing Survey, etc.). OMB requests that when BRFSS submits changes to the base questionnaire for approval under the PRA, they indicate how the proposed BRFSS questions compare to relevant questions in existing national surveys.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	03/31/2018	03/31/2018
Responses	1,644,127	0	1,643,227
Time Burden (Hours)	256,297	0	255,915
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. The surveys produce state- or jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. Survey instruments are updated annually. This revision is to justify the addition of annual field tests.

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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:
	81 FR 3140	01/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 23498	04/21/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

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

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ICR Summary of Burden

table that charts list 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	1,644,127	1,643,227	0	900	0	0
Annual Time Burden (Hours)	256,297	255,915	0	382	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The revision includes the provision for annual field testing of the questionnaire and modules.

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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: 04/21/2016

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