Information Collection Request

Behavioral Risk Factor Surveillance System (BRFSS)

ICR 201606-0920-009 · OMB 0920-1061 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Field Test Survey Form and Instruction Unchanged Available
Field Test Screener Form and Instruction Modified Available
BRFSS Optional Modules Form Unchanged Available
BRFSS Core Survey Form Unchanged Available
Cell Phone Screener Form and Instruction Unchanged Available
Landline Screener Form and Instruction Unchanged Available
Change Request for Field test_06224016.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-06-27 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 Available
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 Repair queued
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 IDCollectionTypeStatusForm
221906 2016 Field Test of Proposed Changes to 2017 BRFSS Other-WORD New
221083 Field Test Survey Form and Instruction Unchanged
221082 Field Test Screener Form and Instruction Modified
214640 BRFSS Optional Modules Form Unchanged
214638 BRFSS Core Survey Form Unchanged
214637 Cell Phone Screener Form and Instruction Unchanged
214636 Landline Screener Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2018 03/31/2018 03/31/2018
1,644,807 0 1,644,127
256,559 0 256,297
0 0 0





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 1,644,807 1,644,127 0 680 0 0
Annual Time Burden (Hours) 256,559 256,297 0 262 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No