Information Collection

BRFSS Core Survey

IC 214638 under ICR 201712-0920-003 · OMB 0920-1061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1061 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BRFSS Core Survey	Form
Even-numbered year core questionnaire Attachment 3a Even- Numbered Year Core Questionnaire.docx	Form
Odd-numbered year core questionnaire Attachment 3b Odd-numbered Year Core Questionnaire.docx	Form
BRFSS questionnaire Attachment 5 2018 BRFSS Questionnaire.docx	Form

IC Title:

BRFSS Core Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Even-numbered year core questionnaire	Attachment 3a Even- Numbered Year Core Questionnaire.docx	Yes	Yes	Fillable Fileable
Form	none	Odd-numbered year core questionnaire	Attachment 3b Odd-numbered Year Core Questionnaire.docx	Yes	Yes	Fillable Fileable
Form	none	BRFSS questionnaire	Attachment 5 2018 BRFSS Questionnaire.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	480,000	-14,650	494,650
Annual IC Time Burden (Hours)	120,000	-3,663	123,663
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.