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2024 Field Test - Screener
[NCCDPHP] Behavioral Risk Factor Surveillance System (BRFSS)
OMB: 0920-1061
IC ID: 229652
OMB.report
HHS/CDC
OMB 0920-1061
ICR 202312-0920-004
IC 229652
( )
Documents and Forms
Document Name
Document Type
Form 0920-1061-24BN
2024 Field Test - Screener
Form and Instruction
0920-1061-24BN 2024 BRFSS Questionnaire (Field Test)
5a - 2024 BRFSS Questionnaire.docx
Form and Instruction
0920-1061-24BN 2024 BRFSS Questionnaire (Field Test)
5a - 2024 BRFSS Questionnaire.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
2024 Field Test - Screener
Agency IC Tracking Number:
0920-1061-24BN
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
0920-1061-24BN
2024 BRFSS Questionnaire (Field Test)
5a - 2024 BRFSS Questionnaire.docx
Yes
Yes
Fillable Fileable
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:
900
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
900
0
660
0
0
240
Annual IC Time Burden (Hours)
15
0
11
0
0
4
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.