2018 Field Test - Screener

Behavioral Risk Factor Surveillance System (BRFSS)

OMB: 0920-1061

IC ID: 229652

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Information Collection (IC) Details

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2018 Field Test - Screener
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1061 Screener for 2018 BRFSS Field Test Attachment 13c Screener for 2018 Field Test.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

540 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 540 0 -360 0 0 900
Annual IC Time Burden (Hours) 9 0 -6 0 0 15
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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