2021 Field Test Behavioral Risk Factor Surveillance System (BRFSS)

Forms and Documents

Document Name	Status
Form 0920-1061 BRFSS Optional Modules by Online Survey Form and Instruction	New
Form 0920-1061 BRFSS Core Survey by Online Survey Form and Instruction	New
Form 0920-1061 2021 Field Test - Survey Form and Instruction	Modified
Form 0920-1061 Field Test - Screener Form and Instruction	Modified
Form 0920-1061 BRFSS Optional Modules Form and Instruction	Modified
Form 0920-1061 BRFSS Core Survey Form and Instruction	Modified
Form 0920-1061 Cell Phone Screener Form and Instruction	Modified
Form 0920-1061 Landline Screener Form and Instruction	Modified
2021BRFSS Att 16 Rpt on the BRFSS Core Questionnaire Redesign.docx Supplementary Document	2021-10-06
2021BRFSS Att 15 BRFSS Modules by State & Split Samples.docx Supplementary Document	2021-10-06
2021BRFSS Att 14 BRFSS Crisis Protocol for Sensitive Questions.docx Supplementary Document	2021-10-06
2021BRFSS Att 11 Methods for BFRSS Question Adoption and Mod.docx Supplementary Document	2021-10-06
2021BRFSS Att 10 2021 BRFSS Data Coll protocol.docx Supplementary Document	2021-10-06
2021BRFSS Att 9 BRFSS 2019 Summ Data Qual Rpt w Response Rates.pdf Supplementary Document	2021-10-06
2021BRFSS Att 8 State Adult Pop & BRFSS Sample Size 2019.docx Supplementary Document	2021-10-06
2021BRFSS Att 7 BRFSS 2019 Weighting and Comparability Tech Doc.docx Supplementary Document	2021-10-06
2021BRFSS Att 5 Screening Scripts and Subject Recruitment.docx Supplementary Document	2021-10-06
2021BRFSS Att 3 Core Questionnaire Sections by Year.docx Supplementary Document	2021-10-06
2021BRFSS Att 1 Auth Legis.pdf Supplementary Document	2021-10-06
2021BRFSS Att 2 BRFSS Awardees Lis.docx Supplementary Document	2021-10-06
Attachment 13d List of Changes in 2021 Field Test Questionnaire.docx Supplementary Document	2021-06-21
Attachment 13c Screener for the 2021 Field Test.docx Supplementary Document	2021-06-21
Attachment 13 2021 BRFSS Field test questionniare.docx Supplementary Document	2021-06-21
2021 field test change request.docx Justification for No Material/Nonsubstantive Change	2021-06-21
Attachment 10a 2021 BRFSS Data Collection Protocol.docx Supplementary Document	2020-11-02
2021 BRFSS Change Request rev 10-21 cp.docx Justification for No Material/Nonsubstantive Change	2020-11-02
Attachment 10a 2020 BRFSS Data Collection Protocol and Dispositions.docx Supplementary Document	2019-08-05
2020 change request July 31 2019.docx Justification for No Material/Nonsubstantive Change	2019-08-05
2019 field test change request final.docx Justification for No Material/Nonsubstantive Change	2019-05-09
2019 Change request revised per OMB.docx Justification for No Material/Nonsubstantive Change	2018-08-27
2018 Field test change request 10MAY2018.docx Justification for No Material/Nonsubstantive Change	2018-05-10
2021BRFSS SSA (003).docx Supporting Statement A	2021-10-07
2021BRFSS SSB.docx Supporting Statement B	2021-10-06
Change Request for 2017 Field test_04112017.docx Justification for No Material/Nonsubstantive Change	2017-04-14

IC Document Collections

IC ID	Document Title	Status
249661	BRFSS Optional Modules by Online Survey Form and Instruction	New
249660	BRFSS Core Survey by Online Survey Form and Instruction	New
229653	2021 Field Test - Survey Form and Instruction	Modified
229652	Field Test - Screener Form and Instruction	Modified
214640	BRFSS Optional Modules Form and Instruction	Modified
214638	BRFSS Core Survey Form and Instruction	Modified
214637	Cell Phone Screener Form and Instruction	Modified
214636	Landline Screener Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1061	ICR Reference No: 202110-0920-003
Status: Received in OIRA	Previous ICR Reference No: 202106-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1061
Title: 2021 Field Test Behavioral Risk Factor Surveillance System (BRFSS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/07/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2022
Responses	1,968,400	1,589,082
Time Burden (Hours)	287,798	241,519
Cost Burden (Dollars)	0	0

---

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. Behavioral Risk Factor Surveillance System (BRFSS) surveys are conducted in collaboration with U.S. states, territories, and the District of Columbia. The surveys will produce state- or sub-state jurisdiction-level data about health-related risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. CDC also creates a national level dataset that is used by HHS to evaluate its progress toward Healthy People 2020 goals and other policy needs. 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. This Change Request is for edits to the core questionnaire approval to divide one module into three, and minor changes to the protocol with no change in burden.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 14115	03/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 48148	08/27/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
2021 Field Test - Survey	0920-1061	2021 BRFFS Questionnaire
BRFSS Core Survey	0920-1061	2021BRFSS Att 3 Core Questionnaire Sections by Year
BRFSS Core Survey by Online Survey	0920-1061	BRFFS Core Online Survey
BRFSS Optional Modules	0920-1061	Attachment 4 Optional Modules by Topic 6-30
BRFSS Optional Modules by Online Survey	0920-1061	BRFSS Optional Modules by Online Survey
Cell Phone Screener	0920-1061	Phone Screening Scripts and Subject Recruitment
Field Test - Screener	0920-1061	Field Test Screener
Landline Screener	0920-1061	BRFSS Landline Screen Script

---

ICR Summary of Burden

	Total Request	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	1,968,400	1,589,082	0	379,318	0	0
Annual Time Burden (Hours)	287,798	241,519	0	46,279	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a proposed revision to the current BRFFS screening. The request is for approval of 287,798 burden hours.

---

Annual Cost to Federal Government: $24,967,312

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? No

---

Common Form ICR:  No

---

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: 10/07/2021

---