OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201612-0920-004 · OMB 0920-1204 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
ACBS Consent and Survey - child Form New Repair queued
ACBS Consent and Survey - adult Form New Available
Cellphone Screener - Child Form New Repair queued
Landline Screener - Child Form New Repair queued
Cell Phone Screener - Adult Form New Available
Landline Screener - Adult Form New Available
Att18 ACBS Nonresponse Plan.docx Supplementary Document Uploaded 2017-10-31 Available
Att17b Sources for the ACBS Child Questions.docx Supplementary Document Uploaded 2017-10-31 Available
Att17a Sources for the ACBS Adult Questions.docx Supplementary Document Uploaded 2017-10-31 Repair queued
Att16 Design and Operation of the National Asthma Survey.pdf Supplementary Document Uploaded 2017-10-31 Available
Att15 History and analysis report ACBS.docx Supplementary Document Uploaded 2017-10-31 Available
Att14 SDQReportACBS.docx Supplementary Document Uploaded 2017-10-31 Repair queued
Att12 ACBS Response Rate Formulae.docx Supplementary Document Uploaded 2017-10-31 Available
Att13 ACBS TOC Usr Mnl Dt Anlyss Wkgrps.docx Supplementary Document Uploaded 2016-12-07 Available
Att12 ACBS Response Rate Formulae.docx Supplementary Document Uploaded 2017-10-31 Available
Att11 ACBS 2013 Rspn Rts by State SID.docx Supplementary Document Uploaded 2016-12-07 Available
Att10 ACBS Dspstn Codes Rules .docx Supplementary Document Uploaded 2016-12-07 Available
Att9 ACBS Qustnnre Chngs edits.docx Supplementary Document Uploaded 2016-12-07 Available
Att8b BRFSS IRB Exempt Approval.docx Supplementary Document Uploaded 2016-12-07 Available
Att8a ACBS NCEH-ATSDR Research Determination Form-OSSigned.pdf Supplementary Document Uploaded 2016-12-07 Repair queued
Att7 ACBS Dt Cllctn Prcss Flwchrt .docx Supplementary Document Uploaded 2016-12-07 Available
Att6 BRFSS-Questionnaire 2015 .docx Supplementary Document Uploaded 2016-12-07 Available
Att4 ACBS Dt Cllctn Gdlns .docx Supplementary Document Uploaded 2016-12-07 Available
Att3 ACBS 2013 Awrde Stts.docx Supplementary Document Uploaded 2016-12-07 Available
Att2 ACBS 60-day.pdf Supplementary Document Uploaded 2016-12-07 Available
Att1 ACBS Authorizing Legislation.pdf Supplementary Document Uploaded 2016-12-07 Repair queued
SSB ACBS OMB clean.docx Supporting Statement B Uploaded 2017-10-31 Available
SSA ACBS.docx Supporting Statement A Uploaded 2017-10-31 Available
IC Document Collections
IC IDCollectionTypeStatusForm
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
0920-1204 201612-0920-004
Historical Active
HHS/CDC 16AWJ
Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)
Existing collection in use without an OMB Control Number   No
Regular
Approved with change 11/06/2017
Retrieve Notice of Action (NOA) 12/12/2016
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
11/30/2020 36 Months From Approved
61,204 0 0
6,029 0 0
0 0 0
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.
US Code: 42 USC 247 Name of Law: PHSA
  
None
Not associated with rulemaking
  81 FR 52874 08/10/2016
81 FR 89467 12/12/2016
No
  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
Yes
Miscellaneous Actions
No
This is an existing collection without an OMB number.
$1,702,413
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/12/2016