Behavioral Risk Factor Surveillance System (BRFSS) - Emergency Request

Forms and Documents

Document Name	Status
BRFSS - Optional Modules Form and Instruction	New
BRFSS - Core Survey Form and Instruction	New
BRFSS - Screen Form and Instruction	New
BRFSS 2018 Justification Part B emergency 12 20 2018.docx Supporting Statement B	2017-12-21
BRFSS 2018 Justification Part A emergency 12 20 2017.docx Supporting Statement A	2017-12-21
BFRSS emergency request memo.pdf Supplementary Document	2017-12-20
IRB exempt 2016-2019 2988 Continuation.docx Supplementary Document	2017-12-19
Attachment 12 BRFSS Questionnaire Development Process.docx Supplementary Document	2017-12-19
Attachment 11 2015 BRFSS Summary Data Quality Report.pdf Supplementary Document	2017-12-19
Attachment 10 Data Collectors Protocol.docx Supplementary Document	2017-12-19
Attachment 9 Optional Modules and Split Samples by State.docx Supplementary Document	2017-12-19
Attachment 7d BRFSS 2015 Overview.pdf Supplementary Document	2017-12-19
Attachment 7c BRFSS Weighting Documentation.pdf Supplementary Document	2017-12-19
Attachment 7b Sampling Geostrata by State.docx Supplementary Document	2017-12-19
Attachment 7a Adult Population and BRFSS Sample Size by State.docx Supplementary Document	2017-12-19
Attachment 2- List of BRFSS Awardees.docx Supplementary Document	2017-12-19
2017-22317.pdf Supplementary Document	2017-12-19
Attachment 1 Authorizing Legislation [Section 301 of the Public Health Service Act (42 USC 241)].pdf Supplementary Document	2017-12-19

IC Document Collections

IC ID	Document Title	Status
229529	BRFSS - Optional Modules Form and Instruction	New
229525	BRFSS - Core Survey Form and Instruction	New
229524	BRFSS - Screen Form and Instruction	New

ICR Details

OMB Control No: 0920-1213	ICR Reference No: 201712-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18
Title: Behavioral Risk Factor Surveillance System (BRFSS) - Emergency Request
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/29/2017
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/22/2017
	Date Received in OIRA: 12/22/2017
Terms of Clearance: OMB Emergency Clearance is approved consistent with the understanding that significant delays in the internal Departmental clearance process would have prevented the Agency from implementing the collection in a timely manner. As these Departmental clearance processes and timing considerations are no longer unanticipated factors in CDC’s preparation and submission of ICRs to OMB for review, it is understood that emergency approvals will not be granted for future ICRs experiencing similar delays as a result of internal Agency or Departmental clearance processes.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	2 Months From Approved
Responses	264,613	0	0
Time Burden (Hours)	40,188	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The BRFSS is a coordinated system of customized surveys conducted by U.S. states, territories, and the District of Columbia. Respondents are adults 18 years of age and older. The surveys produce state- or jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. Information collection needs and priorities for 2018 were discussed by CDC and the states at the annual BRFSS partners meeting held March 26-29, 2017. At that time states voted on the items to be adopted in 2018. The New Emergency Request is being submitted to cover the gap between the end of Calendar Year 2017 and the time when a pending Revision of Behavioral Risk Factor Surveillance System (BRFSS, OMB Control No. 0920-1061) can reach OMB and be approved.

Emergency Justfication: CDC requests OMB approval for a New Emergency ICR to allow States to begin collecting BRFSS data for the calendar year 2018 on time, and thus not disrupt the temporal comparability of the dataset. CDC requests 8 weeks’ emergency approval to begin fieldwork as of January 1, 2018. This is a short-term request as a Standard Revision request for the BRFSS information collection for years 2018-2020 under OMB approval number 0920-1061 is in progress and is expected to reach OMB within the next few weeks. Due in part to new administrative processes put in place at HHS during 2017, which were circumstances beyond the CDC program’s control, CDC was unable to submit the revision request in time for routine OMB approval before January 1, 2018.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: U.S. 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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
BRFSS - Core Survey	NA	BRFSS - Even-Numbered Year Core Questionnaire
BRFSS - Optional Modules	NA	BRFSS - 2018 Optional Questionnaire Modules
BRFSS - Screen	NA	BRFSS Landline and Cell Phone Screening Script

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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	264,613	0	0	264,613	0	0
Annual Time Burden (Hours)	40,188	0	0	40,188	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: Submission is a New Emergency ICR to allow States to begin collecting BRFSS data for the calendar year 2018. This is a short-term request for collection of data for two months of information prior to approval of the Revision 0920-1061.

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Annual Cost to Federal Government: $2,916,666

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: 12/22/2017

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