Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2017 Field Test of Proposed Changes - Screener and Questionnaire	Form and Instruction	New	Available
2017 Field Test of Proposed Changes - Screener Only	Form and Instruction	New	Repair queued
Form Attachment 4b-2017 BRFSS Optional Modules	Form	Unchanged	Available
Form Attachment 5a-2017 BRFSS Core Survey	Form and Instruction	Unchanged	Available
Cell Phone Screener	Form and Instruction	Unchanged	Repair queued
Landline Screener	Form and Instruction	Unchanged	Repair queued
BRFSS-SOGI Lit Review Feb 2017_Final.docx	Supplementary Document	Uploaded 2017-05-15	Available
GLOBE Review Report 4-6-17.pdf	Supplementary Document	Uploaded 2017-05-15	Available
Focus Group on Sexual Orienation and Gender Identity Items_20170105.docx	Supplementary Document	Uploaded 2017-05-15	Available
Summary of BRFSS Research Activities on Sexual Orientation and Gender Identity.docx	Supplementary Document	Uploaded 2017-05-15	Available
2017 BRFSS SOGI Module Overview and Analysis Plan.docx	Supplementary Document	Uploaded 2017-05-15	Available
Change Request for 2017 Field test_04112017.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-04-14	Available
Att 13d-Source of questions on the 2017 BRFSS Field Test.docx	Supplementary Document	Uploaded 2017-04-14	Available
Attachment 1- Annotated Bibliography of BRFSS Reliability and Valdity studies (Revised).rtf	Supplementary Document	Uploaded 2016-11-21	Available
Original terms of clearance activities and update Revised.docx	Supplementary Document	Uploaded 2016-11-21	Available
2017 BRFSS Change Request 9 21 2016 b.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-09-22	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-2017 Calling Protocols and Dispostions.docx	Supplementary Document	Uploaded 2016-09-22	Repair queued
Attachment 9-BRFSS Data Collectors by State.docx	Supplementary Document	Uploaded 2016-04-14	Repair queued
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	Repair queued
Attachment 6a FRN 1 20 2016.pdf	Supplementary Document	Uploaded 2016-04-14	Available
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 ID	Collection	Type	Status	Form
226397	2017 Field Test of Proposed Changes - Screener and Questionnaire	Form and Instruction	New
226396	2017 Field Test of Proposed Changes - Screener Only	Form and Instruction	New
214640	BRFSS Optional Modules	Form	Unchanged
214638	BRFSS Core Survey	Form and Instruction	Unchanged
214637	Cell Phone Screener	Form and Instruction	Unchanged
214636	Landline Screener	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201704-0920-004
Status: Historical Active	Previous ICR Reference No: 201609-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 16ARJ
Title: Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/16/2017
	Date Received in OIRA: 04/17/2017
Terms of Clearance: Approved consistent with the understanding that the BRFSS program staff are committed to continue interagency collaboration to improve the performance of sexual orientation and gender identity questions. OMB will assist in making introductions to other programs involved in question development.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	03/31/2018	03/31/2018
Responses	1,643,767	0	1,643,227
Time Burden (Hours)	256,049	0	255,915
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. The surveys produce state- or jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. Information collection needs and priorities for 2018 were discussed by CDC and the states at the annual BRFSS partners meeting held March 26-29, 2017. At that time states voted on the items to be adopted in 2018. A field test of proposed changes is needed before the changes are formally incorporated into the CDC-sponsored core questions and optional modules for 2018. The 2017 field test includes 3 sections of the core, 3 modules, and changes in the introduction to the screener.

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Authorizing Statute(s): US Code: 42 USC 301 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 3140	01/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 23498	04/21/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Cell Phone Screener	none	Cellphone Screener
Landline Screener	none	Landline Screener
BRFSS Optional Modules	Attachment 4b-2017	2017 Approved Questions by Optional Module
BRFSS Core Survey	Attachment 5a-2017	2017 BRFSS Core Survey Questionnaire
2017 Field Test of Proposed Changes - Screener Only	NA	2017 Field Test Screener Only - U.S. General Population
2017 Field Test of Proposed Changes - Screener and Questionnaire	NA, NA	2017 Field Test Screener - Respondents (Adults >18 Years) ,   2017 Field Test of Proposed Changes to the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (Adults > 18 Years)

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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	1,643,767	1,643,227	0	540	0	0
Annual Time Burden (Hours)	256,049	255,915	0	134	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: Non-Substantive Change Request for 0920-1061 includes use of a Field Test and slight increase in Burden Hours.

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Annual Cost to Federal Government: $17,500,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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: 04/17/2017

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