2018 Field Test - Survey

2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

OMB: 0920-1061

IC ID: 229653

Information Collection (IC) Details

View Information Collection (IC)

2018 Field Test - Survey
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1061 BRFSS Field Test Questionnaire Example Attachment 13 Example of Field Test Questionnaire.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 0 0 0 500
Annual IC Time Burden (Hours) 375 0 0 0 0 375
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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