Cell Phone Screener

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

Documents and Forms

Document Name Document Type
Form 0920-1061 Cell Phone Screener Form and Instruction
0920-1061 BRFSS Questionnaire (Cell Phone Screener) BRFSS Attachment 5 Screening Scripts and Subject Recruitment_2025-2027 Cycle.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Cell Phone Screener	Agency IC Tracking Number:	0920-1061

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	BRFSS Questionnaire (Cell Phone Screener)	BRFSS Attachment 5 Screening Scripts and Subject Recruitment_2025-2027 Cycle.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 694,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	694,000	264,000	430,000
Annual IC Time Burden (Hours)	11,567	4,400	7,167
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.