PRAMS Field Test

Pregnancy Risk Assessment Monitoring System (PRAMS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1273 can be found here:

Documents and Forms

Document Name Document Type
PRAMS Field Test Form and Instruction
PRAMS Field Testing Questionnaire (English and Spanish) Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx Form and Instruction
PRAMS Field Testing Questionnaire (English and Spanish) Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx Form and Instruction
Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx PRAMS Field Testing Questionnaire Informed Consent (English) IC Document
Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx PRAMS Field Testing Questionnaire Informed Consent (English) IC Document
Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx PRAMS Field Testing Questionnaire Informed Consent (Spanish) IC Document
Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx PRAMS Field Testing Questionnaire Informed Consent (Spanish) IC Document

Information Collection (IC) Details

IC Title:	PRAMS Field Test	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	None	PRAMS Field Testing Questionnaire (English and Spanish)	Att 15b - PRAMS Field Testing Questionnaire English and Spanish.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies	FR Citation: 51 FR 42484

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	0	150
Annual IC Time Burden (Hours)	100	50	50
Annual IC Cost Burden (Dollars)	0	-1,227	1,227

Documents for IC

Title	Document	Date Uploaded
PRAMS Field Testing Questionnaire Informed Consent (English)	Att 15c - PRAMS Field Testing Questionnaire Informed Consent_ENGLISH.docx	11/29/2022
PRAMS Field Testing Questionnaire Informed Consent (Spanish)	Att 15d - PRAMS Field Testing Questionnaire Informed Consent_SPANISH.docx	11/29/2022

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