ACBS Consent and Survey - child

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1204 can be found here:

Documents and Forms

Document Name Document Type
ACBS Consent and Survey - child Form
ACBS Consent and Survey - child Att5f ACBS Chld Cnsnt and Srvy .docx Form

Information Collection (IC) Details

IC Title:	ACBS Consent and Survey - child	Agency IC Tracking Number:

Is this a Common Form? No		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	none	ACBS Consent and Survey - child	Att5f ACBS Chld Cnsnt and Srvy .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,887	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	3,887	3,887
Annual IC Time Burden (Hours)	648	648
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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