2021 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1061 BRFSS Optional Modules by Online Survey	Form and Instruction	Unchanged	Available
Form 0920-1061 BRFSS Optional Modules by Online Survey	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 BRFFS Core Online Survey	Form and Instruction	Unchanged	Available
Form 0920-1061 BRFSS Core Survey by Online Survey	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 2021 BRFFS Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-1061 2021 Field Test - Survey	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 Field Test Screener	Form and Instruction	Unchanged	Available
Form 0920-1061 Field Test - Screener	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 Attachment 4 Optional Modules by Topic 6-30	Form and Instruction	Unchanged	Available
Form 0920-1061 BRFSS Optional Modules	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 2021BRFSS Att 3 Core Questionnaire Sections by Year	Form and Instruction	Unchanged	Available
Form 0920-1061 BRFSS Core Survey	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 Phone Screening Scripts and Subject Recruitment	Form and Instruction	Unchanged	Available
Form 0920-1061 Cell Phone Screener	Form and Instruction	Unchanged	Repair queued
Form 0920-1061 BRFSS Landline Screen Script	Form and Instruction	Unchanged	Available
Form 0920-1061 Landline Screener	Form and Instruction	Unchanged	Repair queued
Attachment 13d List of Changes in 2022 Field Test Questionnaire (AutoRecovered).docx	Supplementary Document	Uploaded 2022-05-16	Available
Attachment 13c Screener for the 2022 Field Test.docx	Supplementary Document	Uploaded 2022-05-16	Repair queued
2022 Field Test for 2023 BRFSS Questionnaire_20220429_v4.docx	Supplementary Document	Uploaded 2022-05-16	Repair queued
2022 Field Test Change Request Form_FINAL_4 30 2022.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-05-16	Repair queued
2021BRFSS Att 16 Rpt on the BRFSS Core Questionnaire Redesign.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 15 BRFSS Modules by State & Split Samples.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 14 BRFSS Crisis Protocol for Sensitive Questions.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 11 Methods for BFRSS Question Adoption and Mod.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 10 2021 BRFSS Data Coll protocol.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 9 BRFSS 2019 Summ Data Qual Rpt w Response Rates.pdf	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 8 State Adult Pop & BRFSS Sample Size 2019.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 7 BRFSS 2019 Weighting and Comparability Tech Doc.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 3 Core Questionnaire Sections by Year.docx	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 1 Auth Legis.pdf	Supplementary Document	Uploaded 2021-10-06	Repair queued
2021BRFSS Att 2 BRFSS Awardees Lis.docx	Supplementary Document	Uploaded 2021-10-06	Available
2021BRFSS SSA (003).docx	Supporting Statement A	Uploaded 2021-10-07	Repair queued
2021BRFSS SSB.docx	Supporting Statement B	Uploaded 2021-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249661	BRFSS Optional Modules by Online Survey	Form and Instruction	Unchanged	BRFSS Optional Modules by Online Survey
249661	BRFSS Optional Modules by Online Survey	Form and Instruction	Unchanged
249660	BRFSS Core Survey by Online Survey	Form and Instruction	Unchanged	BRFFS Core Online Survey
249660	BRFSS Core Survey by Online Survey	Form and Instruction	Unchanged
229653	2021 Field Test - Survey	Form and Instruction	Unchanged	2021 BRFFS Questionnaire
229653	2021 Field Test - Survey	Form and Instruction	Unchanged
229652	Field Test - Screener	Form and Instruction	Unchanged	Field Test Screener
229652	Field Test - Screener	Form and Instruction	Unchanged
214640	BRFSS Optional Modules	Form and Instruction	Unchanged	Attachment 4 Optional Modules by Topic 6-30
214640	BRFSS Optional Modules	Form and Instruction	Unchanged
214638	BRFSS Core Survey	Form and Instruction	Unchanged	2021BRFSS Att 3 Core Questionnaire Sections by Year
214638	BRFSS Core Survey	Form and Instruction	Unchanged
214637	Cell Phone Screener	Form and Instruction	Unchanged	Phone Screening Scripts and Subject Recruitment
214637	Cell Phone Screener	Form and Instruction	Unchanged
214636	Landline Screener	Form and Instruction	Unchanged	BRFSS Landline Screen Script
214636	Landline Screener	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 202205-0920-007
Status: Historical Inactive	Previous ICR Reference No: 202110-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061-22FL
Title: 2021 Field Test Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 07/29/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/17/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2024	12/31/2024	12/31/2024
Responses	1,968,400	0	1,968,400
Time Burden (Hours)	287,798	0	287,798
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. Behavioral Risk Factor Surveillance System (BRFSS) surveys are conducted in collaboration with U.S. states, territories, and the District of Columbia. The surveys will produce state- or sub-state jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. CDC also creates a national level dataset that is used by HHS to evaluate its progress toward Healthy People 2020 goals and other policy needs. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. The BRFSS package includes general plans to conduct a field test of new content each year and it is done via a change request. This change request covers this year’s field test. This Change Request is for question edits to the core questionnaire and minor changes to the screener with no change in burden.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 14115	03/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 48148	08/27/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
2021 Field Test - Survey	0920-1061	2021 BRFFS Questionnaire
BRFSS Core Survey	0920-1061	2021BRFSS Att 3 Core Questionnaire Sections by Year
BRFSS Core Survey by Online Survey	0920-1061	BRFFS Core Online Survey
BRFSS Optional Modules	0920-1061	Attachment 4 Optional Modules by Topic 6-30
BRFSS Optional Modules by Online Survey	0920-1061	BRFSS Optional Modules by Online Survey
Cell Phone Screener	0920-1061	Phone Screening Scripts and Subject Recruitment
Field Test - Screener	0920-1061	Field Test Screener
Landline Screener	0920-1061	BRFSS Landline Screen Script

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a proposed revision to the current BRFFS screening. The request is for approval of 287,798 burden hours.

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Annual Cost to Federal Government: $24,967,312

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/17/2022

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