BRFSS Core Survey

2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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
2020 BRFSS questionnaire Attachment 5a 2020 questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	BRFSS Core Survey	Agency IC Tracking Number:	0920-1061-18AXT

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	2020 BRFSS questionnaire	Attachment 5a 2020 questionnaire.docx		No		Paper Only
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

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 %

	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

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.