ACBS Consent and Survey - adult

Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1204 can be found here:

Documents and Forms

Document Name Document Type
ACBS Consent and Survey - adult Form
ABCS Adult consent and questionnaire Att5e ACBS Adult CnsntQstnnr 20200805.docx Form

Information Collection (IC) Details

IC Title:	ACBS Consent and Survey - adult	Agency IC Tracking Number:

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	none	ABCS Adult consent and questionnaire	Att5e ACBS Adult CnsntQstnnr 20200805.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23,166	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	Previously Approved
Annual Number of Responses for this IC	23,166	3,212	19,954
Annual IC Time Burden (Hours)	3,861	535	3,326
Annual IC Cost Burden (Dollars)	0	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.