BRFSS Feasibility Experiment for State-specific Module Data Collection in Cell Phone Samples

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1154 BRFSS Feasibility Experiment for State-specific Module Data Collection in Cell Phone Samples Form and Instruction
0920-1154 Questionnaire Content Att 4 BRFSS 1154 Questionnaire Content 3-15.docx Form and Instruction
Att 1 BRFSS 1154 2019 BRFSS Data Collection Guide Final ICRO.docx Data Collection Guide IC Document
Att 2 BRFSS 1154 Recruitment Text for Respondents Final.docx Recruitment Texts IC Document
Att 3 BRFSS 1154 Invitation Scripts Final.docx Invitation Scripts IC Document
SSA BRFSS Feasibility Test 3-15.docx SSA IC Document
SSB BRFSS Feasibility Test 3-15.docx SSB IC Document

Information Collection (IC) Details

IC Title:	BRFSS Feasibility Experiment for State-specific Module Data Collection in Cell Phone Samples	Agency IC Tracking Number:	0920-1154-19ACG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Questionnaire Content	Att 4 BRFSS 1154 Questionnaire Content 3-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Data Collection Guide	Att 1 BRFSS 1154 2019 BRFSS Data Collection Guide Final ICRO.docx	03/18/2019
Recruitment Texts	Att 2 BRFSS 1154 Recruitment Text for Respondents Final.docx	03/18/2019
Invitation Scripts	Att 3 BRFSS 1154 Invitation Scripts Final.docx	03/18/2019
SSA	SSA BRFSS Feasibility Test 3-15.docx	03/18/2019
SSB	SSB BRFSS Feasibility Test 3-15.docx	03/18/2019

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