Information Collection

BRFSS - Screen

IC 229524 under ICR 201712-0920-008 · OMB 0920-1213.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BRFSS - Screen	Form and Instruction
BRFSS Landline and Cell Phone Screening Script Attachment 8 Landline and Cell Phone Screening Script.docx	Form and Instruction

IC Title:

BRFSS - Screen

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	BRFSS Landline and Cell Phone Screening Script	Attachment 8 Landline and Cell Phone Screening Script.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 111,280

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	111,280	111,280
Annual IC Time Burden (Hours)	1,855	1,855
Annual IC Cost Burden (Dollars)	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.