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PRAMS Field Test
[NCCDPHP] Pregnancy Risk Assessment Monitoring System (PRAMS)
OMB: 0920-1273
IC ID: 236590
OMB.report
HHS/CDC
OMB 0920-1273
ICR 202305-0920-012
IC 236590
( )
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
View Information Collection (IC)
IC Title:
PRAMS Field Test
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Federal Enterprise Architecture Business Reference Module
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 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
150
0
0
0
0
150
Annual IC Time Burden (Hours)
100
0
0
0
0
100
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.