2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Document Name	Status
Form 0920-1061 2018 Field Test - Survey Form and Instruction	Unchanged
Form 0920-1061 Field Test - Screener Form and Instruction	Unchanged
Form 0920-1061 BRFSS Optional Modules Form and Instruction	Unchanged
Form 0920-1061 BRFSS Core Survey Form and Instruction	Unchanged
Form 0920-1061 Cell Phone Screener Form and Instruction	Unchanged
Form 0920-1061 Landline Screener Form and Instruction	Unchanged
Attachment 13d 2019 List of Changes by Section and Module.docx Supplementary Document	2019-05-09
Attachment 13 2019 BRFSS Field test Questionnaire 4-30.docx Supplementary Document	2019-05-09
Attachment 13c Screener and Introductory Text.docx Supplementary Document	2019-05-09
2019 field test change request final.docx Justification for No Material/Nonsubstantive Change	2019-05-09
Attachment 14 Cognitive and Field Testing Results for 2019 New Questions and Modules.docx Supplementary Document	2019-01-14
Attachment 12 BRFSS Questionnaire Development Process.docx Supplementary Document	2019-01-14
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf Supplementary Document	2019-01-14
Attachment 10 Calling Protocol and Dispositions.docx Supplementary Document	2019-01-14
Attachment 9 Optional Modules and Split Samples by State.docx Supplementary Document	2019-01-14
Attachment 7d BRFSS 2015 Overview.pdf Supplementary Document	2019-01-14
Attachment 7c BRFSS Weighting Documentation.pdf Supplementary Document	2019-01-14
Attachment 7b Sampling Geostrata by State.docx Supplementary Document	2019-01-14
Attachment 7a Adult Population and BRFSS Sample Size by State.docx Supplementary Document	2019-01-14
Attachment 6a Federal Register Notice.pdf Supplementary Document	2019-01-14
Attachment 2- List of BRFSS Awardees.docx Supplementary Document	2019-01-14
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf Supplementary Document	2019-01-14
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change	2018-08-27
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change	2018-05-10
BRFSS 2019-2022 Justification Part A March 8 final.docx Supporting Statement A	2019-03-11
BRFSS 2019-2022 Justification Part B March 8 final.docx Supporting Statement B	2019-03-11
IRB exempt 2016-2019 2988 Continuation.docx Supplementary Document	2017-12-19
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change	2017-04-14
2017 BRFSS Change Request 9 21 2016 b.docx Justification for No Material/Nonsubstantive Change	2016-09-22

IC Document Collections

IC ID	Document Title	Status
229653	2018 Field Test - Survey Form and Instruction	Unchanged
229652	Field Test - Screener Form and Instruction	Unchanged
214640	BRFSS Optional Modules Form and Instruction	Unchanged
214638	BRFSS Core Survey Form and Instruction	Unchanged
214637	Cell Phone Screener Form and Instruction	Unchanged
214636	Landline Screener Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201905-0920-004
Status: Historical Active	Previous ICR Reference No: 201812-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061-19AUZ
Title: 2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/10/2019
	Date Received in OIRA: 05/09/2019
Terms of Clearance: Approved consistent with the understanding that CDC will coordinate with NCHS and SAMHSA in the development of the opioid questions. Previous terms continue: CDC may submit non-substantive change requests when changes to this ICR are limited to modifying existing questions, including those designed to add depth/additional detail, and cycle in and out question modules that have been cleared under this OMB number in the past years (with modest updates). CDC is required to submit a full revision request to OMB for modules on the topics that have not previously been approved by OMB for use in BRFSS or changes to the study design, sample frame, weighting, or administration protocol

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	03/31/2022	03/31/2022
Responses	1,589,082	0	1,589,082
Time Burden (Hours)	241,519	0	241,519
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. Behavioral Risk Factor Surveillance System (BRFSS) surveys are conducted in collaboration with U.S. states, territories, and the District of Columbia. The surveys will produce state- or sub-state jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. CDC also creates a national level dataset that is used by HHS to evaluate its progress toward Healthy People 2020 goals and other policy needs. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. This Change Request is for approval of the 2019 Field Test.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 47171	09/18/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 2516	02/07/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Field Test - Screener	0920-1061	Screener for 2018 BRFSS Field Test Example
2018 Field Test - Survey	0920-1061	BRFSS Field Test Questionnaire Example
Cell Phone Screener	0920-1061	BRFSS Cell Phone Screen Script
Landline Screener	0920-1061	BRFSS Landline Screen Script
BRFSS Optional Modules	0920-1061	2019 Approved Quesions by Optional Module
BRFSS Core Survey	0920-1061, 0920-1061, 0920-1061	Even-Numbered Year BRFSS Core Questionnaire ,   Odd-Numbered Year BRFSS Core Questionnaire ,   2019 BRFSS Questionnaire

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ICR Summary 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	1,589,082	0	0	0	0
Annual Time Burden (Hours)	241,519	241,519	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Small adjustment in the number of field test responses.

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Annual Cost to Federal Government: $17,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/09/2019

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