Landline Screener

2021 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⚠️ Notice: This information collection may be referencing outdated material.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 Landline Screener Form and Instruction
0920-1061 BRFSS Landline Screen Script 2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx Form and Instruction
0920-1061 BRFSS Landline Screen Script 2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Landline Screener	Agency IC Tracking Number:	0920-1061

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	BRFSS Landline Screen Script	2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 173,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	173,000	-202,000	375,000
Annual IC Time Burden (Hours)	2,884	-3,366	6,250
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.