BRFSS Core Survey by Online Survey

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

Documents and Forms

Document Name Document Type
BRFSS Core Survey by Online Survey Form and Instruction
BRFSS Online Survey Instrument BRFSS Attachment 17 - Example BRFSS Online Survey Instrument 2025-2027.docx Form and Instruction

Information Collection (IC) Details

IC Title:	BRFSS Core Survey by Online Survey	Agency IC Tracking Number:	0920-1061

Is this a Common Form? No		IC Status: New

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	n/a	BRFSS Online Survey Instrument	BRFSS Attachment 17 - Example BRFSS Online Survey Instrument 2025-2027.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	16,666	16,666
Annual IC Cost Burden (Dollars)	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.