2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1061 BRFSS Field Test Questionnaire Example	Form and Instruction	Unchanged	Available
Form 0920-1061 Screener for 2018 BRFSS Field Test Example	Form and Instruction	Unchanged	Available
Form 0920-1061 2019 Approved Quesions by Optional Module	Form and Instruction	Unchanged	Available
2020 BRFSS questionnaire	Form and Instruction	Modified	Available
Form 0920-1061 Odd-Numbered Year BRFSS Core Questionnaire	Form and Instruction	Modified	Available
Form 0920-1061 Even-Numbered Year BRFSS Core Questionnaire	Form and Instruction	Modified	Available
Form 0920-1061 BRFSS Cell Phone Screen Script	Form and Instruction	Unchanged	Available
Form 0920-1061 BRFSS Landline Screen Script	Form and Instruction	Unchanged	Available
Attachment 10a 2020 BRFSS Data Collection Protocol and Dispositions.docx	Supplementary Document	Uploaded 2019-08-05	Available
2020 change request July 31 2019.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-08-05	Available
Attachment 13d 2019 List of Changes by Section and Module.docx	Supplementary Document	Uploaded 2019-05-09	Available
Attachment 13 2019 BRFSS Field test Questionnaire 4-30.docx	Supplementary Document	Uploaded 2019-05-09	Available
Attachment 13c Screener and Introductory Text.docx	Supplementary Document	Uploaded 2019-05-09	Available
2019 field test change request final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-05-09	Available
Attachment 14 Cognitive and Field Testing Results for 2019 New Questions and Modules.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 12 BRFSS Questionnaire Development Process.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 10 Calling Protocol and Dispositions.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 9 Optional Modules and Split Samples by State.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 7d BRFSS 2015 Overview.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 7c BRFSS Weighting Documentation.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 7b Sampling Geostrata by State.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 7a Adult Population and BRFSS Sample Size by State.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 6a Federal Register Notice.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 2- List of BRFSS Awardees.docx	Supplementary Document	Uploaded 2019-01-14	Available
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf	Supplementary Document	Uploaded 2019-01-14	Available
2019 Change request revised per OMB.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-08-27	Available
2018 Field test change request 10MAY2018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-05-10	Available
BRFSS 2019-2022 Justification Part A March 8 final.docx	Supporting Statement A	Uploaded 2019-03-11	Available
BRFSS 2019-2022 Justification Part B March 8 final.docx	Supporting Statement B	Uploaded 2019-03-11	Available
IRB exempt 2016-2019 2988 Continuation.docx	Supplementary Document	Uploaded 2017-12-19	Available
Change Request for 2017 Field test_04112017.docx	Justification for No Material/Nonsubstantive Change	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 ID	Collection	Type	Status	Form
229653	2018 Field Test - Survey	Form and Instruction	Unchanged	BRFSS Field Test Questionnaire Example
229652	Field Test - Screener	Form and Instruction	Unchanged	Screener for 2018 BRFSS Field Test Example
214640	BRFSS Optional Modules	Form and Instruction	Unchanged	2019 Approved Quesions by Optional Module
214638	BRFSS Core Survey	Form and Instruction	Modified	2020 BRFSS questionnaire
214638	BRFSS Core Survey	Form and Instruction	Modified	Odd-Numbered Year BRFSS Core Questionnaire
214638	BRFSS Core Survey	Form and Instruction	Modified	Even-Numbered Year BRFSS Core Questionnaire
214637	Cell Phone Screener	Form and Instruction	Unchanged	BRFSS Cell Phone Screen Script
214636	Landline Screener	Form and Instruction	Unchanged	BRFSS Landline Screen Script

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201908-0920-002
Status: Historical Active	Previous ICR Reference No: 201905-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061-19BNF
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: 08/14/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/05/2019
Terms of Clearance: Previous terms continue: 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

table that charts list comparision

	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 edits to the core questionnaire approval to divide one module into three, and minor changes to the protocol with no change in burden.

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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

table that charts list of burden

IC Title	Form No.	Form Name
2018 Field Test - Survey	0920-1061	BRFSS Field Test Questionnaire Example
BRFSS Core Survey	0920-1061, 0920-1061, none	Even-Numbered Year BRFSS Core Questionnaire ,   Odd-Numbered Year BRFSS Core Questionnaire ,   2020 BRFSS questionnaire
BRFSS Optional Modules	0920-1061	2019 Approved Quesions by Optional Module
Cell Phone Screener	0920-1061	BRFSS Cell Phone Screen Script
Field Test - Screener	0920-1061	Screener for 2018 BRFSS Field Test Example
Landline Screener	0920-1061	BRFSS Landline Screen Script

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ICR Summary of Burden

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	1,589,082	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:

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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: 08/05/2019

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