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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1061 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
BRFSS Core Survey Attachment 5a 2021 BRFSS Questionnaire 10-21 cp.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	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
Form and Instruction	none	BRFSS Core Survey	Attachment 5a 2021 BRFSS Questionnaire 10-21 cp.docx		No		Paper Only

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.