BRFSS - Optional Modules

Behavioral Risk Factor Surveillance System (BRFSS) - Emergency Request

Documents and Forms

Document Name Document Type
BRFSS - Optional Modules Form and Instruction
BRFSS - 2018 Optional Questionnaire Modules Attachment 4 Approved Questions by Optional Module 12-19.docx Form and Instruction

Information Collection (IC) Details

IC Title:	BRFSS - Optional Modules	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	BRFSS - 2018 Optional Questionnaire Modules	Attachment 4 Approved Questions by Optional Module 12-19.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 73,333	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	73,333	73,333
Annual IC Time Burden (Hours)	18,333	18,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.