Information Collection Request

Behavioral Risk Factor Surveillance System (BRFSS) - Emergency Request

ICR 201712-0920-008 · OMB 0920-1213 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
BRFSS - Optional Modules Form and Instruction New Available
BRFSS - Core Survey Form and Instruction New Available
BRFSS - Screen Form and Instruction New Available
BRFSS 2018 Justification Part B emergency 12 20 2018.docx Supporting Statement B Uploaded 2017-12-21 Available
BRFSS 2018 Justification Part A emergency 12 20 2017.docx Supporting Statement A Uploaded 2017-12-21 Available
BFRSS emergency request memo.pdf Supplementary Document Uploaded 2017-12-20 Available
IRB exempt 2016-2019 2988 Continuation.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 12 BRFSS Questionnaire Development Process.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf Supplementary Document Uploaded 2017-12-19 Available
Attachment 10 Data Collectors Protocol.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 9 Optional Modules and Split Samples by State.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 7d BRFSS 2015 Overview.pdf Supplementary Document Uploaded 2017-12-19 Repair queued
Attachment 7c BRFSS Weighting Documentation.pdf Supplementary Document Uploaded 2017-12-19 Available
Attachment 7b Sampling Geostrata by State.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 7a Adult Population and BRFSS Sample Size by State.docx Supplementary Document Uploaded 2017-12-19 Available
Attachment 2- List of BRFSS Awardees.docx Supplementary Document Uploaded 2017-12-19 Available
2017-22317.pdf Supplementary Document Uploaded 2017-12-19 Available
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf Supplementary Document Uploaded 2017-12-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229529 BRFSS - Optional Modules Form and Instruction New
229525 BRFSS - Core Survey Form and Instruction New
229524 BRFSS - Screen Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2018 2 Months From Approved
264,613 0 0
40,188 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
BRFSS - Core Survey NA BRFSS - Even-Numbered Year Core Questionnaire
BRFSS - Optional Modules NA BRFSS - 2018 Optional Questionnaire Modules
BRFSS - Screen NA BRFSS Landline and Cell Phone Screening Script

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 264,613 0 0 264,613 0 0
Annual Time Burden (Hours) 40,188 0 0 40,188 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No