Information Collection Request

Behavioral Risk Factor Surveillance System (BRFSS)

ICR 201712-0920-009 · OMB 0920-1061 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1061 2018 Field Test - Survey Form and Instruction New Available
Form 0920-1061 2018 Field Test - Screener Form and Instruction New Available
2017 Field Test of Proposed Changes - Screener and Questionnaire Form and Instruction Removed Available
2017 Field Test of Proposed Changes - Screener Only Form and Instruction Removed Available
Form 0920-1061 BRFSS Optional Modules Form and Instruction Modified Available
Form 0920-1061 BRFSS Core Survey Form and Instruction Modified Available
Form 0920-1061 Cell Phone Screener Form and Instruction Modified Available
Form 0920-1061 Landline Screener Form and Instruction Modified Available
Attachment 6b Response to Public Comments.docx Supplementary Document Uploaded 2018-01-09 Available
BRFSS 2018 Justification Part A 01MAR2018.DOCX Supporting Statement A Uploaded 2018-03-01 Available
BRFSS 2018 Justification Part B Dec 20.docx Supporting Statement B Uploaded 2018-01-08 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 Available
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
BRFSS-SOGI Lit Review Feb 2017_Final.docx Supplementary Document Uploaded 2017-05-15 Available
GLOBE Review Report 4-6-17.pdf Supplementary Document Uploaded 2017-05-15 Available
Focus Group on Sexual Orienation and Gender Identity Items_20170105.docx Supplementary Document Uploaded 2017-05-15 Available
Summary of BRFSS Research Activities on Sexual Orientation and Gender Identity.docx Supplementary Document Uploaded 2017-05-15 Available
2017 BRFSS SOGI Module Overview and Analysis Plan.docx Supplementary Document Uploaded 2017-05-15 Available
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-04-14 Available
Att 13d-Source of questions on the 2017 BRFSS Field Test.docx Supplementary Document Uploaded 2017-04-14 Available
2017 BRFSS Change Request 9 21 2016 b.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-09-22 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229653 2018 Field Test - Survey Form and Instruction New
229652 2018 Field Test - Screener Form and Instruction New
226397 2017 Field Test of Proposed Changes - Screener and Questionnaire Form and Instruction Removed
226396 2017 Field Test of Proposed Changes - Screener Only Form and Instruction Removed
214640 BRFSS Optional Modules Form and Instruction Modified
214638 BRFSS Core Survey Form and Instruction Modified
214637 Cell Phone Screener Form and Instruction Modified
214636 Landline Screener Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2021 36 Months From Approved 03/31/2018
1,589,082 0 1,643,767
241,518 0 256,049
0 0 0





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 1,589,082 1,643,767 0 -54,685 0 0
Annual Time Burden (Hours) 241,518 256,049 0 -14,531 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No