BRFSS Optional Modules by Online Survey

[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)

Documents and Forms

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

Information Collection (IC) Details

IC Title:	BRFSS Optional Modules 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 Optional Modules 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: 80,000	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	80,000	80,000
Annual IC Time Burden (Hours)	13,333	13,333
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.