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

Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.