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

Forms and Documents

Document Name	Status
ACBS Consent and Survey - child Form	New
ACBS Consent and Survey - adult Form	New
Cellphone Screener - Child Form	New
Landline Screener - Child Form	New
Cell Phone Screener - Adult Form	New
Landline Screener - Adult Form	New
Att18 ACBS Nonresponse Plan.docx Supplementary Document	2017-10-31
Att17b Sources for the ACBS Child Questions.docx Supplementary Document	2017-10-31
Att17a Sources for the ACBS Adult Questions.docx Supplementary Document	2017-10-31
Att16 Design and Operation of the National Asthma Survey.pdf Supplementary Document	2017-10-31
Att15 History and analysis report ACBS.docx Supplementary Document	2017-10-31
Att14 SDQReportACBS.docx Supplementary Document	2017-10-31
Att12 ACBS Response Rate Formulae.docx Supplementary Document	2017-10-31
Att13 ACBS TOC Usr Mnl Dt Anlyss Wkgrps.docx Supplementary Document	2016-12-07
Att12 ACBS Response Rate Formulae.docx Supplementary Document	2017-10-31
Att11 ACBS 2013 Rspn Rts by State SID.docx Supplementary Document	2016-12-07
Att10 ACBS Dspstn Codes Rules .docx Supplementary Document	2016-12-07
Att9 ACBS Qustnnre Chngs edits.docx Supplementary Document	2016-12-07
Att8b BRFSS IRB Exempt Approval.docx Supplementary Document	2016-12-07
Att8a ACBS NCEH-ATSDR Research Determination Form-OSSigned.pdf Supplementary Document	2016-12-07
Att7 ACBS Dt Cllctn Prcss Flwchrt .docx Supplementary Document	2016-12-07
Att6 BRFSS-Questionnaire 2015 .docx Supplementary Document	2016-12-07
Att4 ACBS Dt Cllctn Gdlns .docx Supplementary Document	2016-12-07
Att3 ACBS 2013 Awrde Stts.docx Supplementary Document	2016-12-07
Att2 ACBS 60-day.pdf Supplementary Document	2016-12-07
Att1 ACBS Authorizing Legislation.pdf Supplementary Document	2016-12-07
SSB ACBS OMB clean.docx Supporting Statement B	2017-10-31
SSA ACBS.docx Supporting Statement A	2017-10-31

IC Document Collections

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

ICR Details

OMB Control No: 0920-1204	ICR Reference No: 201612-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16AWJ
Title: Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/06/2017
	Date Received in OIRA: 12/12/2016
Terms of Clearance: Approved consistent with ACBS staff commitment to collaborate with BRFSS staff to more transparently present a) joint response rates from BRFSS and ACBS and b) potential non-response bias. Tables of prevalence estimates and risk factors disseminated by CDC (either through its web page or publications) should more clearly communicate the caveats of state-to-state comparisons. Over the next three years, ACBS staff should work to streamline the instrument to reduce unnecessary burden and ensure that the question wording is synchronized with more recent studies.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved
Responses	61,204	0	0
Time Burden (Hours)	6,029	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 42 USC 247 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:
	81 FR 52874	08/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 89467	12/12/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Cell Phone Screener - Adult	none	Cellphone screener - adult
Cellphone Screener - Child	none	Cellphone screener - child
Landline Screener - Child	none	Landline screener - child
Landline Screener - Adult	none	Landline screener - adult
ACBS Consent and Survey - child	none	ACBS Consent and Survey - child
ACBS Data Submission Layout
ACBS Consent and Survey - adult	none	ACBS Consent and Survey - adult

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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	61,204	0	0	61,204	0	0
Annual Time Burden (Hours)	6,029	0	0	6,029	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is an existing collection without an OMB number.

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Annual Cost to Federal Government: $1,702,413

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: 12/12/2016

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