BRFSS Optional Modules

Behavioral Risk Factor Surveillance System (BRFSS)

OMB: 0920-1061

IC ID: 214640

Information Collection (IC) Details

View Information Collection (IC)

BRFSS Optional Modules
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1061 2018 Approved Questions by Optional Module Attachment 4 Approved Questions by Optional Module 12-19.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

440,000 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 440,000 0 0 0 0 440,000
Annual IC Time Burden (Hours) 110,000 0 0 0 0 110,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2017 Summary of Approved Optional Modules Attachment 4a-2017 Approved Optional Modules.docx 09/22/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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