Landline Screener

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

Documents and Forms

Document Name Document Type
Form 0920-1061-24BN Landline Screener Form and Instruction
0920-1061-24BN 2024 BRFSS Questionnaire (Landline Introduction) 5a - 2024 BRFSS Questionnaire.docx Form and Instruction
0920-1061-24BN 2024 BRFSS Questionnaire (Landline Introduction) 5a - 2024 BRFSS Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Landline Screener	Agency IC Tracking Number:	0920-1061-24BN

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 and Instruction	0920-1061-24BN	2024 BRFSS Questionnaire (Landline Introduction)	5a - 2024 BRFSS Questionnaire.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175,000	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	175,000	2,000	173,000
Annual IC Time Burden (Hours)	2,917	33	2,884
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.