Cellphone Screener - Child

[NCEH] Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)

Documents and Forms

Document Name Document Type
Cellphone Screener - Child Form
Cell Phone Screener - Child Att5d ACBS Cllphn Scrnr Child 2023 Rev06262023_OS.docx Form
Cell Phone Screener - Child Att5d ACBS Cllphn Scrnr Child 2023 Rev06262023_OS.docx Form

Information Collection (IC) Details

IC Title:	Cellphone Screener - Child	Agency IC Tracking Number:

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	None	Cell Phone Screener - Child	Att5d ACBS Cllphn Scrnr Child 2023 Rev06262023_OS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,109	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,109	285	3,824
Annual IC Time Burden (Hours)	137	73	64
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.