Attachment 6 - BRFSS Self-Certification Form.pdf

New Jersey 2026 Annual Self-Certification

The following checklist is provided to assist you and your colleagues in your state in conducting BRFSE according to protocol and recommended practice. This checklist is intended to be completed in the month of December to assist you in preparing for 2026 data collection year. Procedures that you are n< personally involved with should be verified, not just assumed to be in effect. States that have a contractor should consult with their contractors to complete the form. References in parentheses at tht end of each item refer to the current BRFSS Data Collection Protocol. Answer each item with "Yes"or "No". If you answer "No" provide an explanation (except for items 1.2, 4.1, and 4.6)

Please submit by 12/31/2512:00:00 AM

If you have any questions about any of these items, please contact your Project Officer.

1 Before the survey:

(1) We obtain our BRFSS telephone sample through Population Health Surveillance Branch (PHSB) an use it only for official BRFSS data collection (BRFSS Data Collection Protocol)

• Yes

(2) We have and use systematic, unobtrusive electronic interviewer monitoring, and we document the results for interviewer performance review and survey operations research.

• Yes

(3) We use the introductory script provided by the Population Health Surveillance Branch at the beginning of the questionnaire, or we have received written approval from Population Health Surveillance Branch to use an alternative script.

• Yes

(4) We use the core questionnaire as provided by the CDC or we have received written approval from Population Health Surveillance Branch for modifications.

• Yes

(5) We will consult our state laws concerning the requirement to notify survey respondents of the possibility of monitoring. If required, respondents are notified in our introductory script.

• Yes

2 Data collection staff have been directed:

(1) To abide by confidentiality standards.

• Yes

(2) To apply the BRFSS definition of an eligible household.

• Yes

(3) To apply the BRFSS definition of eligible household members.

• Yes

(4) To conduct surveys only with respondents randomly selected by the CATI system, and not to conduct proxy interviews.

• Yes

(5) To ask all questions completely and as written, without any modification.

(6) To use the prescribed probes and questionnaire instructions found in the margins of the questionnaire when indicated without alteration.

• Yes

(7) To make follow-up attempts to complete terminated interviews and adhere to the definition of a completed interview when the interview ends before the last question.

• Yes

(8) That eligible households that initially refuse to participate are to be contacted at least one addition< time to select a respondent, except when the person contacted has absolutely refused or has used abusive language.

• Yes

(9) That a supervisor or a different interviewer make the second (and succeeding) call attempt(s) to eligible households to select a respondent at a time of day different from the initial refusal after waitin!

as many days as possible (up to two weeks).

• Yes

(10) That selected respondents who initially refused to be interviewed are contacted at least one additional time, except when the person contacted has absolutely refused or has used abusive languagE

• Yes

(11) That a supervisor or a different interviewer make the second (and succeeding) call attempt(s) to interview a selected respondent at a time of day different from the initial refusal after waiting as many days as possible (up to two weeks).

• Yes

(12) To call alllandline sample remaining after prescreening until either (1) fully resolved with final disposition codes assigned or (2) sample are called up to minimum number of times as specified in the current BRFSS Data Collection Protocol.

• Yes

(13) To complete required call attempts on all sample pieces during the calendar month of sample selection unless due to unforeseen circumstances there are unresolved sample pieces without the required call-backs at the end of the month .

• Yes

(14) That final disposition codes are assigned in accordance with the current BRFSS Data Collection Protocol.

• Yes

(15) To complete the cell phone data collection in accordance with the current BRFSS Data Collection Protocol.

• Yes

3 After each month's survey:

(1) We reformat, edit, and make necessary corrections to the monthly data, and submit to Population Health Surveillance Branch within 30 days an error-free file that includes every sample record used to conduct the BRFSS.

• Yes

(2) We correct and resubmit within 2 weeks those data that have been edited by Population Health Surveillance Branch and returned to us for correction.

(3) We ensure that no identifying information is included in the state added question portion of the dai record section.

• Yes

4 Other practices:

(1) We conduct interview verification of 5% of the monthly completes that are randomly selected for quality assurance purposes. Note: This is recommended, but it is not required if conducting monthly unobtrusive electronic monitoring.

• No

(2) We will submit all of the 2026 data, edited and corrected, to Population Health Surveillance Brand on or before 01/25/27 12:00:00 AM.

• Yes

(3) We will provide a paper copy (or an electronic file) of the states final 2026 BRFSS questionnaire to Population Health Surveillance Branch on or before 01/25/2612:00:00 AM. Note: Any changes durin the year to this questionnaire need to be reported to PHSB.

• Yes

(4) We plan to collect data for 12 full months this year.

• Yes

(5) We review the Year to Date Quality Control Report each time we submit data and take appropriate action when possible problems are identified.

• Yes

(6) We will exercise our option to leave messages on answering machines.

• Yes

(7) We will exercise our option to send advanced letters for the 2026 data collection.

• No