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

OMB 0920-1204

The goal is to add depth to the existing body of asthma data and address questions surrounding the health and experiences of persons with asthma. Data are collected through a follow-up survey approximately two weeks after the BRFSS survey. Information is used by asthma control programs in state health departments and at the federal level.

The latest form for [NCEH] Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS) expires 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

202306-0920-014 Approved without change	Revision of a currently approved collection	2023-07-07
202008-0920-004 Approved without change	Revision of a currently approved collection	2020-08-24
201612-0920-004 Approved with change	Existing collection in use without an OMB Control Number	2016-12-12

OMB Details

Landline Screener - Adult

Federal Enterprise Architecture: Health - Public Health Monitoring

Form none

Landline screener - adult

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.