View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[NCCDPHP] Cognitive Testing and RDD Push-to-Web Pilot Testing for BRFSS	Agency IC Tracking Number:	0920-1291-24HU

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Web and CATI Survey BRFSS Pilot	1291 Att 3 Web and CATI Survey BRFSS Pilot.docx		Yes	Yes	Fillable Fileable
Form	n/a	Cognitive Testing Questions	Cognitive Testing Questions.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,940	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	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	5,940	0	5,940	0	0	0
Annual IC Time Burden (Hours)	880	0	880	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Pilot - Integrating Web to BRFSS Data Collection	1291 Att 1 Pilot_Integrating Web to BRFSS Data Collection.docx	08/05/2024
Contact Materials	1291 Att 2 Contact_Materials.docx	08/05/2024
Cognitive Testing Consent	1291 Att 4 Cognitive Testing Consent.docx	08/12/2024
Pilot Testing Example	1291 Att 5 Pilot Testing.docx	08/12/2024
GenIC Request Template	1291 GenIC_Cognitive and Pilot Testing_final.docx	08/14/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.