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BRFSS Core Survey
2019 Field Test Behavioral Risk Factor Surveillance System (BRFSS)
OMB: 0920-1061
IC ID: 214638
OMB.report
HHS/CDC
OMB 0920-1061
ICR 202011-0920-001
IC 214638
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1061 can be found here:
2023-12-11 - No material or nonsubstantive change to a currently approved collection
2022-12-16 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-1061
BRFSS Core Survey
Form and Instruction
0920-1061 Even-Numbered Year BRFSS Core Questionnaire
Attachment 3a Even- Numbered Year Core Questionnaire (2).docx
Form and Instruction
0920-1061 Odd-Numbered Year BRFSS Core Questionnaire
Attachment 3b Odd-Numbered Year Core Questionnaire.docx
Form and Instruction
BRFSS Core Survey
Attachment 5a 2021 BRFSS Questionnaire 10-21 cp.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
BRFSS Core Survey
Agency IC Tracking Number:
0920-1061-18AXT
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
Even-Numbered Year BRFSS Core Questionnaire
Attachment 3a Even- Numbered Year Core Questionnaire (2).docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1061
Odd-Numbered Year BRFSS Core Questionnaire
Attachment 3b Odd-Numbered Year Core Questionnaire.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
none
BRFSS Core Survey
Attachment 5a 2021 BRFSS Questionnaire 10-21 cp.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
480,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
480,000
0
0
0
0
480,000
Annual IC Time Burden (Hours)
120,000
0
0
0
0
120,000
Annual IC Cost Burden (Dollars)
0
0
0
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.