Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Field Test Survey	Form	New	Repair queued
Screener	Form	New	Repair queued
2017 Field Test of Proposed Changes to the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (Adults > 18 Years)	Form and Instruction	Removed	Available
2017 Field Test Screener - Respondents (Adults >18 Years)	Form and Instruction	Removed	Available
2017 Field Test Screener Only - U.S. General Population	Form and Instruction	Removed	Available
BRFSS Optional Modules	Form	Modified	Available
BRFSS questionnaire	Form	Modified	Available
Odd-numbered year core questionnaire	Form	Modified	Available
Even-numbered year core questionnaire	Form	Modified	Available
Cellphone screener	Form	Modified	Available
Landline screener	Form	Modified	Available
Emergency Review Request Memo - BRFSS gap rbk Dec 14.docx	Supplementary Document	Uploaded 2017-12-14	Available
2018 Justification Part B emergency.docx	Supporting Statement B	Uploaded 2017-12-14	Available
BRFSS 2018 Justification Part A emergency_OMB and cp response clean copy....docx	Supporting Statement A	Uploaded 2017-12-14	Available
IRB exempt 2016-2019 2988 Continuation.docx	Supplementary Document	Uploaded 2017-12-13	Repair queued
Attachment 12 BRFSS Questionnaire Development Process.docx	Supplementary Document	Uploaded 2017-12-13	Repair queued
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 10 Data Collectors Protocol.docx	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 9 Optional Modules and Split Samples by State.docx	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 7d BRFSS 2015 Overview.pdf	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 7c BRFSS Weighting Documentation.pdf	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 7b Sampling Geostrata by State.docx	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 7a Adult Population and BRFSS Sample Size by State.docx	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf	Supplementary Document	Uploaded 2017-12-13	Available
Attachment 2- List of BRFSS Awardees.docx	Supplementary Document	Uploaded 2017-12-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
229460	Field Test Survey	Form	New	Field Test Survey
229459	Field Test screener	Form	New	Screener
226397	2017 Field Test of Proposed Changes - Screener and Questionnaire	Form and Instruction	Removed	2017 Field Test of Proposed Changes to the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (Adults > 18 Years)
226397	2017 Field Test of Proposed Changes - Screener and Questionnaire	Form and Instruction	Removed	2017 Field Test Screener - Respondents (Adults >18 Years)
226396	2017 Field Test of Proposed Changes - Screener Only	Form and Instruction	Removed	2017 Field Test Screener Only - U.S. General Population
214640	BRFSS Optional Modules	Form	Modified	BRFSS Optional Modules
214638	BRFSS Core Survey	Form	Modified	BRFSS questionnaire
214638	BRFSS Core Survey	Form	Modified	Odd-numbered year core questionnaire
214638	BRFSS Core Survey	Form	Modified	Even-numbered year core questionnaire
214637	Cell Phone Screener	Form	Modified	Cellphone screener
214636	Landline Screener	Form	Modified	Landline screener

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201712-0920-003
Status: Historical Inactive	Previous ICR Reference No: 201704-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061
Title: Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/21/2017
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 12/18/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/14/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	2 Months From Approved	03/31/2018
Responses	1,643,767	0	1,643,767
Time Burden (Hours)	256,049	0	256,049
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.

Emergency Justfication: This is an emergency approval request to cover the gap between the end of calendar year 2017 and the time when a pending revision of OMB# 0920-1061 can reach OMB and be approved. Due to circumstances beyond the control of the CDC program, the revision request cannot be approved before January 1, 2018.

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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

Did the Agency receive public comments on this ICR? No

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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
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)
BRFSS Core Survey	none, none, none	Even-numbered year core questionnaire ,   Odd-numbered year core questionnaire ,   BRFSS questionnaire
BRFSS Optional Modules	none	BRFSS Optional Modules
Cell Phone Screener	none	Cellphone screener
Field Test Survey	none	Field Test Survey
Field Test screener	none	Screener
Landline Screener	none	Landline screener

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This emergency request is to allow for the continuation of BRFSS while the revision request is processed at CDC and HHS. Annual changes are made to the questionnaires and optional modules.

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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

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: 12/14/2017

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