[NCEH] Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)

ICR 202306-0920-014

OMB: 0920-1204

Federal Form Document

Forms and Documents

Document Name	Status
ACBS Consent and Survey - Child Form and Instruction	Modified
ACBS Consent and Survey - Adult Form and Instruction	Modified
Cellphone Screener - Child Form	Modified
Landline Screener - Child Form	Modified
Cell Phone Screener - Adult Form	Modified
Landline Screener - Adult Form	Modified
Att14 Design Oprtn NAS.pdf Supplementary Document	2023-07-05
Att13 ACBS Smmry Data Quality Rpr.docx Supplementary Document	2023-07-05
Att12 ACBS Resp Rate Formulae.docx Supplementary Document	2023-07-05
Att11 ACBS 2020 Response Rates.docx Supplementary Document	2023-07-05
Att10 ACBS Dspstn Codes Call-back Rules.docx Supplementary Document	2023-07-05
Att9 ACBS Dt Cllctn Prcss.docx Supplementary Document	2023-07-05
Att8b BRFSS IRB statement.docx Supplementary Document	2023-07-05
Att8a NCEH-ATSDR Research Determination Form.pdf Supplementary Document	2023-07-05
Att7a BRFSS 2021 Data Com.pdf Supplementary Document	2023-07-05
Att7 BRFSS Data Collection protocol 2023 Rev.docx Supplementary Document	2023-07-05
Att6d BRFSS OMB SSB 2023 Rev.docx Supplementary Document	2023-07-05
Att6c BRFSS OMB SSA 2023 Rev.docx Supplementary Document	2023-07-05
Att6a BRFSS Privacy Cnfdlty Protctn 2023 Rev.docx Supplementary Document	2023-07-05
Att6 2023 BRFSS Questionnaire 2023 Rev.docx Supplementary Document	2023-07-05
Att4 ACBS Dt Cllctn Gdlns 2023 Rev.docx Supplementary Document	2023-07-05
Att3 ListACBSAwrdeeStates 2023.docx Supplementary Document	2023-07-05
Att2 ACBS 2023 60D Publication.pdf Supplementary Document	2023-07-05
Att1 ACBS Authorizing Legislation 2023 Rev.pdf Supplementary Document	2023-07-05
1 - ACBS ListAttchmnts 2023 Rev.docx Supplementary Document	2023-07-05
1 - SSB ACBS OMB 2023 Rev.docx Supporting Statement B	2023-07-05
1 - SSA ACBS OMB 2023 Rev_06272023.docx Supporting Statement A	2023-07-05

IC Document Collections

IC ID	Document Title	Status
243153	ACBS Data Submission Layout - Child Other-Data Submission Layout - Child	Modified
224745	ACBS Data Submission Layout - Adult Other-Data Submission Layout - Adult	Modified
224744	ACBS Consent and Survey - Child Form and Instruction	Modified
224743	ACBS Consent and Survey - Adult Form and Instruction	Modified
224742	Cellphone Screener - Child Form	Modified
224741	Landline Screener - Child Form	Modified
224740	Cell Phone Screener - Adult Form	Modified
224739	Landline Screener - Adult Form	Modified