Information Collection Request

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

ICR 202312-0920-004 · OMB 0920-1061 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1061 BRFSS Optional Modules by Online Survey Form and Instruction Removed Available
Form 0920-1061 BRFSS Optional Modules by Online Survey Form and Instruction Removed Repair queued
Form 0920-1061 BRFFS Core Online Survey Form and Instruction Removed Available
Form 0920-1061 BRFSS Core Survey by Online Survey Form and Instruction Removed Repair queued
Form 0920-1061 2022 Field Test Questionnaire Form and Instruction Modified Available
Form 0920-1061 2022 Field Test Questionnaire Form and Instruction Modified Available
Form 0920-1061-24BN 2024 BRFSS Questionnaire (Field Test) Form and Instruction Modified Available
Form 0920-1061-24BN 2024 Field Test - Screener Form and Instruction Modified Repair queued
Form 0920-1061-24BN 2024 BRFSS Questionnaire (OPTIONAL MODULES) by Topic 6-30 Form and Instruction Modified Available
Form 0920-1061-24BN 2024 BRFSS Questionnaire - (OPTIONAL MODULES) Form and Instruction Modified Repair queued
Form 0920-1061-24BN 2024 BRFSS Questionnaire (CORE SURVEY - Sections by Year) Form and Instruction Modified Available
Form 0920-1061-24BN 2024 BRFSS Questionnaire (CORE SURVEY) Form and Instruction Modified Repair queued
Form 0920-1061-24BN 2024 BRFSS Questionnaire (Cell Phone Introduction) Form and Instruction Modified Available
Form 0920-1061-24BN Cell Phone Introduction Form and Instruction Modified Repair queued
Form 0920-1061-24BN 2024 BRFSS Questionnaire (Landline Introduction) Form and Instruction Modified Available
Form 0920-1061-24BN Landline Screener Form and Instruction Modified Repair queued
10a - 2024 Calling Protocol and Dispositions.docx Supplementary Document Uploaded 2023-12-11 Repair queued
2024 BRFSS Change 120423.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-11 Repair queued
Response to Terms of Clearance about Testing of Changes in 2023 BRFSS Questionnaire.docx Supplementary Document Uploaded 2023-01-03 Repair queued
2023 Questionnaire 20221121_OMB.docx Supplementary Document Uploaded 2022-12-15 Repair queued
2023 BRFSS Change Request 20221207.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-12-15 Repair queued
2023 BRFSS Data Collection protocol 20221118.docx Supplementary Document Uploaded 2022-12-15 Repair queued
2022 Field Test Change Request Form_FINAL_20220831.docx Supplementary Document Uploaded 2022-09-01 Repair queued
Attachment 13d List of Changes in 2022 Field Test Questionnaire.docx Supplementary Document Uploaded 2022-09-01 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 Repair queued
Attachment 13d List of Changes in 2021 Field Test Questionnaire.docx Supplementary Document Uploaded 2021-06-21 Repair queued
Attachment 13c Screener for the 2021 Field Test.docx Supplementary Document Uploaded 2021-06-21 Repair queued
Attachment 13 2021 BRFSS Field test questionniare.docx Supplementary Document Uploaded 2021-06-21 Repair queued
2021 field test change request.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-06-21 Repair queued
Attachment 10a 2021 BRFSS Data Collection Protocol.docx Supplementary Document Uploaded 2020-11-02 Repair queued
2021 BRFSS Change Request rev 10-21 cp.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-11-02 Repair queued
Attachment 10a 2020 BRFSS Data Collection Protocol and Dispositions.docx Supplementary Document Uploaded 2019-08-05 Repair queued
2020 change request July 31 2019.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-08-05 Repair queued
2019 field test change request final.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-05-09 Repair queued
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-08-27 Repair queued
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-05-10 Available
2021BRFSS SSA (003).docx Supporting Statement A Uploaded 2021-10-07 Repair queued
2021BRFSS SSB.docx Supporting Statement B Uploaded 2021-10-06 Repair queued
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-04-14 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
249661 BRFSS Optional Modules by Online Survey Form and Instruction RemovedBRFSS Optional Modules by Online Survey
249661 BRFSS Optional Modules by Online Survey Form and Instruction Removed
249660 BRFSS Core Survey by Online Survey Form and Instruction RemovedBRFFS Core Online Survey
249660 BRFSS Core Survey by Online Survey Form and Instruction Removed
229653 2022 Field Test Questionnaire Form and Instruction Modified2022 Field Test Questionnaire
229653 2022 Field Test Questionnaire Form and Instruction Modified
229652 2024 Field Test - Screener Form and Instruction Modified2024 BRFSS Questionnaire (Field Test)
229652 2024 Field Test - Screener Form and Instruction Modified
214640 2024 BRFSS Questionnaire - (OPTIONAL MODULES) Form and Instruction Modified2024 BRFSS Questionnaire (OPTIONAL MODULES) by Topic 6-30
214640 2024 BRFSS Questionnaire - (OPTIONAL MODULES) Form and Instruction Modified
214638 2024 BRFSS Questionnaire (CORE SURVEY) Form and Instruction Modified2024 BRFSS Questionnaire (CORE SURVEY - Sections by Year)
214638 2024 BRFSS Questionnaire (CORE SURVEY) Form and Instruction Modified
214637 Cell Phone Introduction Form and Instruction Modified2024 BRFSS Questionnaire (Cell Phone Introduction)
214637 Cell Phone Introduction Form and Instruction Modified
214636 Landline Screener Form and Instruction Modified2024 BRFSS Questionnaire (Landline Introduction)
214636 Landline Screener Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2024 12/31/2024 12/31/2024
1,526,400 0 1,967,540
240,474 0 274,554
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
2022 Field Test Questionnaire 0920-1061
2024 BRFSS Questionnaire (CORE SURVEY) 0920-1061-24BN
2024 BRFSS Questionnaire - (OPTIONAL MODULES) 0920-1061-24BN
2024 Field Test - Screener 0920-1061-24BN
BRFSS Core Survey by Online Survey 0920-1061
BRFSS Optional Modules by Online Survey 0920-1061
Cell Phone Introduction 0920-1061-24BN
Landline Screener 0920-1061-24BN

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,526,400 1,967,540 0 -441,140 0 0
Annual Time Burden (Hours) 240,474 274,554 0 -34,080 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No