Information Collection

BRFSS Questionnaire - (OPTIONAL MODULES)

IC 214640 under ICR 202411-0920-013 · OMB 0920-1061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1061 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1061 BRFSS Questionnaire - (OPTIONAL MODULES)	Form and Instruction
Form 0920-1061 BRFSS Questionnaire (OPTIONAL MODULES) BRFSS Questionnaire - (OPTIONAL MODULES)	Form and Instruction
0920-1061 BRFSS Questionnaire (OPTIONAL MODULES) BRFSS Attachment 13 Draft 2025 BRFSS Questionnaire_2025_2027 Cycle.docx	Form and Instruction
0920-1061 BRFSS Questionnaire (OPTIONAL MODULES) BRFSS Attachment 13 Draft 2025 BRFSS Questionnaire_2025_2027 Cycle_compliant3.docx	Form and Instruction

IC Title:

BRFSS Questionnaire - (OPTIONAL MODULES)

Agency IC Tracking Number:

0920-1061

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1061				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 440,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	440,000	440,000
Annual IC Time Burden (Hours)	110,000	110,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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