Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ACBS Consent and Survey - child	Form	New	Available
ACBS Consent and Survey - adult	Form	New	Available
Cellphone Screener - Child	Form	New	Available
Landline Screener - Child	Form	New	Repair queued
Cell Phone Screener - Adult	Form	New	Available
Landline Screener - Adult	Form	New	Available
Att18 ACBS Nonresponse Plan.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att17b Sources for the ACBS Child Questions.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att17a Sources for the ACBS Adult Questions.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att16 Design and Operation of the National Asthma Survey.pdf	Supplementary Document	Uploaded 2017-10-31	Available
Att15 History and analysis report ACBS.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att14 SDQReportACBS.docx	Supplementary Document	Uploaded 2017-10-31	Repair queued
Att12 ACBS Response Rate Formulae.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att13 ACBS TOC Usr Mnl Dt Anlyss Wkgrps.docx	Supplementary Document	Uploaded 2016-12-07	Available
Att12 ACBS Response Rate Formulae.docx	Supplementary Document	Uploaded 2017-10-31	Available
Att11 ACBS 2013 Rspn Rts by State SID.docx	Supplementary Document	Uploaded 2016-12-07	Available
Att10 ACBS Dspstn Codes Rules .docx	Supplementary Document	Uploaded 2016-12-07	Available
Att9 ACBS Qustnnre Chngs edits.docx	Supplementary Document	Uploaded 2016-12-07	Available
Att8b BRFSS IRB Exempt Approval.docx	Supplementary Document	Uploaded 2016-12-07	Available
Att8a ACBS NCEH-ATSDR Research Determination Form-OSSigned.pdf	Supplementary Document	Uploaded 2016-12-07	Repair queued
Att7 ACBS Dt Cllctn Prcss Flwchrt .docx	Supplementary Document	Uploaded 2016-12-07	Available
Att6 BRFSS-Questionnaire 2015 .docx	Supplementary Document	Uploaded 2016-12-07	Available
Att4 ACBS Dt Cllctn Gdlns .docx	Supplementary Document	Uploaded 2016-12-07	Available
Att3 ACBS 2013 Awrde Stts.docx	Supplementary Document	Uploaded 2016-12-07	Available
Att2 ACBS 60-day.pdf	Supplementary Document	Uploaded 2016-12-07	Available
Att1 ACBS Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-12-07	Repair queued
SSB ACBS OMB clean.docx	Supporting Statement B	Uploaded 2017-10-31	Available
SSA ACBS.docx	Supporting Statement A	Uploaded 2017-10-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224745	ACBS Data Submission Layout	Other-Data layout	New
224744	ACBS Consent and Survey - child	Form	New
224743	ACBS Consent and Survey - adult	Form	New
224742	Cellphone Screener - Child	Form	New
224741	Landline Screener - Child	Form	New
224740	Cell Phone Screener - Adult	Form	New
224739	Landline Screener - Adult	Form	New

ICR Details

OMB Control No: 0920-1204	ICR Reference No: 201612-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16AWJ
Title: Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)
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: 11/06/2017
	Date Received in OIRA: 12/12/2016
Terms of Clearance: Approved consistent with ACBS staff commitment to collaborate with BRFSS staff to more transparently present a) joint response rates from BRFSS and ACBS and b) potential non-response bias. Tables of prevalence estimates and risk factors disseminated by CDC (either through its web page or publications) should more clearly communicate the caveats of state-to-state comparisons. Over the next three years, ACBS staff should work to streamline the instrument to reduce unnecessary burden and ensure that the question wording is synchronized with more recent studies.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved
Responses	61,204	0	0
Time Burden (Hours)	6,029	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal is to add depth to the existing body of asthma data and address questions surrounding the health and experiences of persons with asthma. Data are collected through a follow-up survey approximately two weeks after the BRFSS survey. Information is used by asthma control programs in state health departments and at the federal level.

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Authorizing Statute(s): US Code: 42 USC 247 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 52874	08/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 89467	12/12/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Cell Phone Screener - Adult	none	Cellphone screener - adult
Cellphone Screener - Child	none	Cellphone screener - child
Landline Screener - Child	none	Landline screener - child
Landline Screener - Adult	none	Landline screener - adult
ACBS Consent and Survey - child	none	ACBS Consent and Survey - child
ACBS Data Submission Layout
ACBS Consent and Survey - adult	none	ACBS Consent and Survey - adult

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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	61,204	0	0	61,204	0	0
Annual Time Burden (Hours)	6,029	0	0	6,029	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: This is an existing collection without an OMB number.

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Annual Cost to Federal Government: $1,702,413

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 12/12/2016

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