Information Collection

Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing

IC 242498 under ICR 201912-0920-011 · OMB 0920-1291.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1291 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing	Form
BRFSS questionnaire 1291 Att 1 2021 BRFSS Questionnaire (1).docx	Form
RDD Push to Web Recruitment 1291 Att 2 RDD Push-to-Web Recruitment Text (1).docx	Form and Instruction
Internet Panel Recruitment 1291 Att 3 Example of Internet Panel Recruitment Text (1).docx	Form and Instruction
1291 Cover Form (1).docx Request for genIC	IC Document

IC Title:

Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing

Agency IC Tracking Number:

0920-1291-20PY

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	BRFSS questionnaire	1291 Att 1 2021 BRFSS Questionnaire (1).docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	RDD Push to Web Recruitment	1291 Att 2 RDD Push-to-Web Recruitment Text (1).docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	Internet Panel Recruitment	1291 Att 3 Example of Internet Panel Recruitment Text (1).docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34,000	34,000
Annual IC Time Burden (Hours)	5,920	5,920
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for genIC	1291 Cover Form (1).docx	07/08/2020

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