[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

ICR 202212-0920-011

OMB: 0920-1061

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1061 BRFSS Optional Modules by Online Survey Form and Instruction	Unchanged
Form 0920-1061 BRFSS Optional Modules by Online Survey Form and Instruction	Unchanged
Form 0920-1061 BRFSS Core Survey by Online Survey Form and Instruction	Unchanged
Form 0920-1061 BRFSS Core Survey by Online Survey Form and Instruction	Unchanged
Form 0920-1061 2022 Field Test Questionnaire Form and Instruction	Unchanged
Form 0920-1061 2022 Field Test Questionnaire Form and Instruction	Unchanged
Form 0920-1061 2022 Field Test - Screener Form and Instruction	Unchanged
Form 0920-1061 2022 Field Test - Screener Form and Instruction	Unchanged
Form 0920-1061 BRFSS Optional Modules Form and Instruction	Unchanged
Form 0920-1061 BRFSS Optional Modules Form and Instruction	Unchanged
Form 0920-1061 BRFSS Core Survey Form and Instruction	Unchanged
Form 0920-1061 BRFSS Core Survey Form and Instruction	Unchanged
Form 0920-1061 Cell Phone Screener Form and Instruction	Unchanged
Form 0920-1061 Cell Phone Screener Form and Instruction	Unchanged
Form 0920-1061 Landline Screener Form and Instruction	Unchanged
Form 0920-1061 Landline Screener Form and Instruction	Unchanged
Response to Terms of Clearance about Testing of Changes in 2023 BRFSS Questionnaire.docx Supplementary Document	2023-01-03
2023 Questionnaire 20221121_OMB.docx Supplementary Document	2022-12-15
2023 Questionnaire 20221121_OMB.docx Supplementary Document	2022-12-15
2023 BRFSS Change Request 20221207.docx Justification for No Material/Nonsubstantive Change	2022-12-15
2023 BRFSS Change Request 20221207.docx Justification for No Material/Nonsubstantive Change	2022-12-15
2023 BRFSS Data Collection protocol 20221118.docx Supplementary Document	2022-12-15
2023 BRFSS Data Collection protocol 20221118.docx Supplementary Document	2022-12-15
2022 Field Test Change Request Form_FINAL_20220831.docx Supplementary Document	2022-09-01
2022 Field Test Change Request Form_FINAL_20220831.docx Supplementary Document	2022-09-01
Attachment 13d List of Changes in 2022 Field Test Questionnaire.docx Supplementary Document	2022-09-01
Attachment 13d List of Changes in 2022 Field Test Questionnaire.docx Supplementary Document	2022-09-01
2021BRFSS Att 16 Rpt on the BRFSS Core Questionnaire Redesign.docx Supplementary Document	2021-10-06
2021BRFSS Att 16 Rpt on the BRFSS Core Questionnaire Redesign.docx Supplementary Document	2021-10-06
2021BRFSS Att 15 BRFSS Modules by State & Split Samples.docx Supplementary Document	2021-10-06
2021BRFSS Att 15 BRFSS Modules by State & Split Samples.docx Supplementary Document	2021-10-06
2021BRFSS Att 14 BRFSS Crisis Protocol for Sensitive Questions.docx Supplementary Document	2021-10-06
2021BRFSS Att 14 BRFSS Crisis Protocol for Sensitive Questions.docx Supplementary Document	2021-10-06
2021BRFSS Att 11 Methods for BFRSS Question Adoption and Mod.docx Supplementary Document	2021-10-06
2021BRFSS Att 11 Methods for BFRSS Question Adoption and Mod.docx Supplementary Document	2021-10-06
2021BRFSS Att 10 2021 BRFSS Data Coll protocol.docx Supplementary Document	2021-10-06
2021BRFSS Att 10 2021 BRFSS Data Coll protocol.docx Supplementary Document	2021-10-06
2021BRFSS Att 9 BRFSS 2019 Summ Data Qual Rpt w Response Rates.pdf Supplementary Document	2021-10-06
2021BRFSS Att 9 BRFSS 2019 Summ Data Qual Rpt w Response Rates.pdf Supplementary Document	2021-10-06
2021BRFSS Att 8 State Adult Pop & BRFSS Sample Size 2019.docx Supplementary Document	2021-10-06
2021BRFSS Att 8 State Adult Pop & BRFSS Sample Size 2019.docx Supplementary Document	2021-10-06
2021BRFSS Att 7 BRFSS 2019 Weighting and Comparability Tech Doc.docx Supplementary Document	2021-10-06
2021BRFSS Att 7 BRFSS 2019 Weighting and Comparability Tech Doc.docx Supplementary Document	2021-10-06
2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx Supplementary Document	2021-10-06
2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx Supplementary Document	2021-10-06
2021BRFSS Att 3 Core Questionnaire Sections by Year.docx Supplementary Document	2021-10-06
2021BRFSS Att 3 Core Questionnaire Sections by Year.docx Supplementary Document	2021-10-06
2021BRFSS Att 1 Auth Legis.pdf Supplementary Document	2021-10-06
2021BRFSS Att 1 Auth Legis.pdf Supplementary Document	2021-10-06
2021BRFSS Att 2 BRFSS Awardees Lis.docx Supplementary Document	2021-10-06
2021BRFSS Att 2 BRFSS Awardees Lis.docx Supplementary Document	2021-10-06
Attachment 13d List of Changes in 2021 Field Test Questionnaire.docx Supplementary Document	2021-06-21
Attachment 13d List of Changes in 2021 Field Test Questionnaire.docx Supplementary Document	2021-06-21
Attachment 13c Screener for the 2021 Field Test.docx Supplementary Document	2021-06-21
Attachment 13c Screener for the 2021 Field Test.docx Supplementary Document	2021-06-21
Attachment 13 2021 BRFSS Field test questionniare.docx Supplementary Document	2021-06-21
Attachment 13 2021 BRFSS Field test questionniare.docx Supplementary Document	2021-06-21
2021 field test change request.docx Justification for No Material/Nonsubstantive Change	2021-06-21
2021 field test change request.docx Justification for No Material/Nonsubstantive Change	2021-06-21
Attachment 10a 2021 BRFSS Data Collection Protocol.docx Supplementary Document	2020-11-02
Attachment 10a 2021 BRFSS Data Collection Protocol.docx Supplementary Document	2020-11-02
2021 BRFSS Change Request rev 10-21 cp.docx Justification for No Material/Nonsubstantive Change	2020-11-02
2021 BRFSS Change Request rev 10-21 cp.docx Justification for No Material/Nonsubstantive Change	2020-11-02
Attachment 10a 2020 BRFSS Data Collection Protocol and Dispositions.docx Supplementary Document	2019-08-05
Attachment 10a 2020 BRFSS Data Collection Protocol and Dispositions.docx Supplementary Document	2019-08-05
2020 change request July 31 2019.docx Justification for No Material/Nonsubstantive Change	2019-08-05
2020 change request July 31 2019.docx Justification for No Material/Nonsubstantive Change	2019-08-05
2019 field test change request final.docx Justification for No Material/Nonsubstantive Change	2019-05-09
2019 field test change request final.docx Justification for No Material/Nonsubstantive Change	2019-05-09
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change	2018-08-27
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change	2018-08-27
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change	2018-05-10
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change	2018-05-10
2021BRFSS SSA (003).docx Supporting Statement A	2021-10-07
2021BRFSS SSA (003).docx Supporting Statement A	2021-10-07
2021BRFSS SSB.docx Supporting Statement B	2021-10-06
2021BRFSS SSB.docx Supporting Statement B	2021-10-06
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change	2017-04-14
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change	2017-04-14

IC Document Collections

IC ID	Document Title	Status
249661	BRFSS Optional Modules by Online Survey Form and Instruction	Unchanged
249661	BRFSS Optional Modules by Online Survey Form and Instruction	Unchanged
249660	BRFSS Core Survey by Online Survey Form and Instruction	Unchanged
249660	BRFSS Core Survey by Online Survey Form and Instruction	Unchanged
229653	2022 Field Test Questionnaire Form and Instruction	Unchanged
229653	2022 Field Test Questionnaire Form and Instruction	Unchanged
229652	2022 Field Test - Screener Form and Instruction	Unchanged
229652	2022 Field Test - Screener Form and Instruction	Unchanged
214640	BRFSS Optional Modules Form and Instruction	Unchanged
214640	BRFSS Optional Modules Form and Instruction	Unchanged
214638	BRFSS Core Survey Form and Instruction	Unchanged
214638	BRFSS Core Survey Form and Instruction	Unchanged
214637	Cell Phone Screener Form and Instruction	Unchanged
214637	Cell Phone Screener Form and Instruction	Unchanged
214636	Landline Screener Form and Instruction	Unchanged
214636	Landline Screener Form and Instruction	Unchanged