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Landline Screener
Behavioral Risk Factor Surveillance System (BRFSS)
OMB: 0920-1061
IC ID: 214636
OMB.report
HHS/CDC
OMB 0920-1061
ICR 202207-0920-014
IC 214636
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1061 can be found here:
2023-12-11 - No material or nonsubstantive change to a currently approved collection
2022-12-16 - No material or nonsubstantive change to a currently approved collection
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
View Information Collection (IC)
IC Title:
Landline Screener
Agency IC Tracking Number:
0920-1061
Is this a Common Form?
No
IC Status:
Unchanged
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
Federal Enterprise Architecture Business Reference Module
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 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
173,000
0
0
0
0
173,000
Annual IC Time Burden (Hours)
2,884
0
0
0
0
2,884
Annual IC Cost Burden (Dollars)
0
0
0
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.