Information Collection

BRFSS Core Survey

IC 214638 under ICR 201905-0920-004 · OMB 0920-1061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1061 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1061 BRFSS Core Survey	Form and Instruction
0920-1061 Even-Numbered Year BRFSS Core Questionnaire Attachment 3a Even- Numbered Year Core Questionnaire (2).docx	Form and Instruction
0920-1061 Odd-Numbered Year BRFSS Core Questionnaire Attachment 3b Odd-Numbered Year Core Questionnaire.docx	Form and Instruction
0920-1061 2019 BRFSS Questionnaire Attachment 5 2019 BRFSS Questionnaire 11-19.docx	Form and Instruction

IC Title:

BRFSS Core Survey

Agency IC Tracking Number:

0920-1061-18AXT

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1061	Even-Numbered Year BRFSS Core Questionnaire	Attachment 3a Even- Numbered Year Core Questionnaire (2).docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1061	Odd-Numbered Year BRFSS Core Questionnaire	Attachment 3b Odd-Numbered Year Core Questionnaire.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1061	2019 BRFSS Questionnaire	Attachment 5 2019 BRFSS Questionnaire 11-19.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	480,000	480,000
Annual IC Time Burden (Hours)	120,000	120,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.