View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Feasibility Testing for Collection of Behavioral Risk Factor Surveillance System (BRFSS)-Like Data from U.S. Sub-Populations Using an Internet Panel
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1291 Survey Questionnaire Attachment 1 questionnaire draft April 18 NEW.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

12,600 0
   
Individuals or Households
 
   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 12,600 0 12,600 0 0 0
Annual IC Time Burden (Hours) 3,150 0 3,150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC Request Template 1291 GenIC for 3 panels April 20 2022 NEW.docx 04/21/2022
Core Profile Data Items Attachment 2 core questions.docx 03/21/2022
Consent Form Attachment 3 consent.docx 03/21/2022
Panel Recruitment and Survey Methodology Attachment 4 YouGov panel recruitment and survey methodology-combined.pdf 03/21/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.