Adult Risk Behavior Survey

Surveys must be completed with valid answers to receive the reward. YOU MUST ENTER A VALID EMAIL ADDRESS TO BE NOTIFIED AND RECEIVE YOUR REWARD. 
The first 1,250 people to complete this survey will receive a $20 gift card of their choice. After that, completed surveys will still be eligible to win prizes, but through randomized drawings. 

Survey  completion is  limited to one time per person .

This survey is about health behavior. It has been developed so you can tell us what you do that may affect your health. The information you give will be used to improve health.


The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really do.

Completing the survey is voluntary. If you are not comfortable answering a question, just leave it blank or select "refuse to answer."

The questions that ask about your background will be used only to describe the types of people completing this survey. The information will not be used to find out your name. No names will ever be reported.

Make sure to read every question. 

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid 0MB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:PRA (0920-0493)

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Thank you very much for your help.
If you have questions, please contact Kelley Hochstetler 765.660.7204

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