Information Collection

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

IC 235305 under ICR 201610-0920-009 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.