Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Document Name	Status
Form 0920-1061 2018 Field Test - Survey Form and Instruction	Unchanged
Form 0920-1061 2018 Field Test - Screener Form and Instruction	Unchanged
Form 0920-1061 BRFSS Optional Modules Form and Instruction	Modified
Form 0920-1061 BRFSS Core Survey Form and Instruction	Modified
Form 0920-1061 Cell Phone Screener Form and Instruction	Unchanged
Form 0920-1061 Landline Screener Form and Instruction	Unchanged
Attachment 14 Cognitive and Field Testing Results for 2019 New Questions and Modules.docx Supplementary Document	2018-08-27
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change	2018-08-27
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change	2018-05-10
Attachment 13d List of Changes by Section and Module.docx Supplementary Document	2018-05-10
Attachment 6b Response to Public Comments.docx Supplementary Document	2018-01-09
BRFSS 2018 Justification Part A 01MAR2018.DOCX Supporting Statement A	2018-03-01
BRFSS 2018 Justification Part B Dec 20.docx Supporting Statement B	2018-01-08
IRB exempt 2016-2019 2988 Continuation.docx Supplementary Document	2017-12-19
Attachment 12 BRFSS Questionnaire Development Process.docx Supplementary Document	2017-12-19
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf Supplementary Document	2017-12-19
Attachment 10 Data Collectors Protocol.docx Supplementary Document	2017-12-19
Attachment 9 Optional Modules and Split Samples by State.docx Supplementary Document	2017-12-19
Attachment 7d BRFSS 2015 Overview.pdf Supplementary Document	2017-12-19
Attachment 7c BRFSS Weighting Documentation.pdf Supplementary Document	2017-12-19
Attachment 7b Sampling Geostrata by State.docx Supplementary Document	2017-12-19
Attachment 7a Adult Population and BRFSS Sample Size by State.docx Supplementary Document	2017-12-19
Attachment 2- List of BRFSS Awardees.docx Supplementary Document	2017-12-19
2017-22317.pdf Supplementary Document	2017-12-19
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf Supplementary Document	2017-12-19
BRFSS-SOGI Lit Review Feb 2017_Final.docx Supplementary Document	2017-05-15
GLOBE Review Report 4-6-17.pdf Supplementary Document	2017-05-15
Focus Group on Sexual Orienation and Gender Identity Items_20170105.docx Supplementary Document	2017-05-15
Summary of BRFSS Research Activities on Sexual Orientation and Gender Identity.docx Supplementary Document	2017-05-15
2017 BRFSS SOGI Module Overview and Analysis Plan.docx Supplementary Document	2017-05-15
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change	2017-04-14
Att 13d-Source of questions on the 2017 BRFSS Field Test.docx Supplementary Document	2017-04-14
2017 BRFSS Change Request 9 21 2016 b.docx Justification for No Material/Nonsubstantive Change	2016-09-22

IC Document Collections

IC ID	Document Title	Status
229653	2018 Field Test - Survey Form and Instruction	Unchanged
229652	2018 Field Test - Screener Form and Instruction	Unchanged
214640	BRFSS Optional Modules Form and Instruction	Modified
214638	BRFSS Core Survey Form and Instruction	Modified
214637	Cell Phone Screener Form and Instruction	Unchanged
214636	Landline Screener Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 201808-0920-020
Status: Historical Active	Previous ICR Reference No: 201805-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061-18AXT
Title: Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/05/2018
	Date Received in OIRA: 08/28/2018
Terms of Clearance: Approved consistent with the understanding that CDC will submit a revision request to OMB for modules on the topics that have not previously been approved by OMB for BRFSS, i.e., opioids and optional modules 3, 4, 22, and 27. Previous terms continue: Approved consistent with the understanding that the BRFSS program staff are committed to continue interagency collaboration to improve the performance of sexual orientation and gender identity questions. OMB will assist in making introductions to other programs involved in question development. In addition, when changes to this ICR are limited to modifying existing questions, including those designed to add depth/additional detail and cycle in and out methodological modules that have been cleared under this OMB number in the past years (with modest updates), CDC will submit these changes as non-substantive changes. However, the addition of new question topics or modules or modifications to the sample will require that CDC submit a full revision of the ICR package to OMB.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	03/31/2021	03/31/2021
Responses	1,588,522	0	1,588,522
Time Burden (Hours)	241,262	0	241,262
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. Behavioral Risk Factor Surveillance System (BRFSS) surveys are conducted in collaboration with U.S. states, territories, and the District of Columbia. The surveys will produce state- or sub-state jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. CDC also creates a national level dataset that is used by HHS to evaluate its progress toward Healthy People 2020 goals and other policy needs. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. Information collection needs and priorities for 2018 were discussed by CDC and the states at the annual BRFSS partners meeting held March 26-29, 2017. This request is for OMB approval of the non-substantive changes and notification of new changes for use in the 2019 BRFSS. A Revision will be sent to OMB with all new changes.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 48087	10/16/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 816	01/08/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Cell Phone Screener	0920-1061	BRFSS Cell Phone Screen Script
Landline Screener	0920-1061	BRFSS Landline Screen Script
BRFSS Optional Modules	0920-1061, 0920-1061	2018 Approved Questions by Optional Module ,   2019 Approved Quesions by Optional Module
BRFSS Core Survey	0920-1061, 0920-1061, 0920-1061	Even-Numbered Year BRFSS Core Questionnaire ,   Odd-Numbered Year BRFSS Core Questionnaire ,   2019 BRFSS Questionnaire
2018 Field Test - Screener	0920-1061	Screener for 2018 BRFSS Field Test
2018 Field Test - Survey	0920-1061	2018 BRFSS Field Test Questionnaire

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,588,522	1,588,522	0	0	0	0
Annual Time Burden (Hours)	241,262	241,262	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $17,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/28/2018

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